title: Distinguishing adolescents who think about self-harm from those who engage in self-harm.
abstract: BACKGROUND
  Adolescent self-harm is a major public health concern, yet little is known about the factors that distinguish adolescents who think about self-harm but do not act on these thoughts from those who act on such thoughts.
  
  
  OBJECTIVE
  Within a new theoretical model, the integrated motivational-volitional model, we investigated factors associated with adolescents having thoughts of self-harm (ideators) v. those associated with self-harm enaction (enactors).
  
  
  METHODS
  Observational study of school pupils employing an anonymous self-report survey to compare three groups of adolescents: self-harm enactors (n = 628) v. self-harm ideators (n = 675) v. those without any self-harm history (n = 4219).
  
  
  RESULTS
  Enactors differed from ideators on all of the volitional factors. Relative to ideators, enactors were more likely to have a family member/close friend who had self-harmed, more likely to think that their peers engaged in self-harm and they were more impulsive than the ideators. Enactors also reported more life stress than ideators. Conversely, the two self-harm groups did not differ on any of the variables associated with the development of self-harm thoughts.
  
  
  CONCLUSIONS
  As more adolescents think about self-harm than engage in it, a better understanding of the factors that govern behavioural enaction is crucial in the effective assessment of the risk of self-harm.
authors.affiliation: Suicidal Behaviour Research Group, School of Natural Sciences, University of Stirling, Stirling FK9 4LA. ro2@stir.ac.uk
authors.forename: Rory C
authors.initials: RC
authors.lastname: O'Connor
authors.forename: Susan
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D057566:Self Report; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology*