title: Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort.
abstract: BACKGROUND
  There is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories.
  
  
  METHODS
  Participants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent.
  
  
  RESULTS
  Many risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm.
  
  
  CONCLUSIONS
  i) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent.
  
  
  CONCLUSIONS
  Self-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm.
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom. Electronic address: becky.mars@bristol.ac.uk.
authors.forename: Becky
authors.initials: B
authors.lastname: Mars
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Heron
authors.affiliation: Department of Psychiatry, University of Oxford, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Crane
authors.affiliation: Department of Psychiatry, University of Oxford, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Judi
authors.initials: J
authors.lastname: Kidger
authors.affiliation: Mental Health Sciences Unit, University College London, United Kingdom.
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Macleod
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Tilling
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D004522:Educational Status; D005260:Female; D006801:Humans; D033182:Intention; D008137:Longitudinal Studies; D008297:Male; D010290:Parents; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: ALSPAC; Adolescent; Longitudinal; Self-harm; Suicide attempt
references.citation: J Child Psychol Psychiatry. 2000 Jul;41(5):645-55
references.pmid: 10946756
references.citation: Am J Psychiatry. 2003 Apr;160(4):765-72
references.pmid: 12668367
references.citation: J Child Psychol Psychiatry. 2008 Jun;49(6):667-77
references.pmid: 18341543
references.citation: Annu Rev Clin Psychol. 2010;6:339-63
references.pmid: 20192787
references.citation: J Am Acad Child Adolesc Psychiatry. 2014 May;53(5):509-17.e2
references.pmid: 24745951
references.citation: Br J Psychiatry. 2013 May;202(5):326-8
references.pmid: 23637107
references.citation: BMJ. 2009 Jun 29;338:b2393
references.pmid: 19564179
references.citation: J Abnorm Psychol. 2006 Aug;115(3):616-23
references.pmid: 16866602
references.citation: J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1424-32
references.pmid: 18978636
references.citation: Psychopharmacology (Berl). 2012 Jan;219(2):501-10
references.pmid: 21735071
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2014 Feb;49(2):193-203
references.pmid: 23744444
references.citation: Suicide Life Threat Behav. 2009 Oct;39(5):518-37
references.pmid: 19929152
references.citation: J Abnorm Psychol. 2013 Feb;122(1):231-237
references.pmid: 23067259
references.citation: Personal Disord. 2010 Jan;1(1):67-75
references.pmid: 22448604
references.citation: Clin Psychol Rev. 2012 Aug;32(6):482-95
references.pmid: 22717336
references.citation: J Youth Adolesc. 2013 Aug;42(8):1257-72
references.pmid: 23212349
references.citation: BMC Psychiatry. 2012 Jun 27;12:69
references.pmid: 22737989
references.citation: Arch Suicide Res. 2009;13(2):105-22
references.pmid: 19363748
references.citation: Clin Psychol Rev. 2004 Dec;24(8):957-79
references.pmid: 15533280
references.citation: J Clin Child Adolesc Psychol. 2008 Apr;37(2):363-75
references.pmid: 18470773
references.citation: Psychol Med. 2000 Jan;30(1):23-39
references.pmid: 10722173
references.citation: Br J Psychiatry. 2003 Jun;182:537-42
references.pmid: 12777346
references.citation: J Youth Adolesc. 2010 Mar;39(3):233-42
references.pmid: 19941045
references.citation: Suicide Life Threat Behav. 2007 Aug;37(4):453-66
references.pmid: 17896885
references.citation: J Psychiatr Res. 2011 Feb;45(2):143-9
references.pmid: 20630542
references.citation: Am J Psychiatry. 2011 May;168(5):495-501
references.pmid: 21285141
references.citation: Drug Alcohol Depend. 2008 Dec 1;98(3):169-78
references.pmid: 18676099
references.citation: Int J Epidemiol. 2013 Feb;42(1):111-27
references.pmid: 22507743
references.citation: J Affect Disord. 2014 Jan;152-154:175-82
references.pmid: 24080206
references.citation: J Exp Psychol Hum Percept Perform. 1984 Apr;10(2):276-91
references.pmid: 6232345
references.citation: J Youth Adolesc. 2010 Mar;39(3):259-69
references.pmid: 19856090
references.citation: BMJ. 2002 Nov 23;325(7374):1207-11
references.pmid: 12446536
references.citation: Suicide Life Threat Behav. 2008 Apr;38(2):152-65
references.pmid: 18444774
references.citation: J Abnorm Child Psychol. 2005 Jun;33(3):375-85
references.pmid: 15957564
references.citation: Arch Suicide Res. 2007;11(1):69-82
references.pmid: 17178643
references.citation: J Adolesc Health. 2009 Dec;45(6):609-17
references.pmid: 19931834
references.citation: Eur Child Adolesc Psychiatry. 2010 Jun;19(6):513-23
references.pmid: 19784715
references.citation: Eur Child Adolesc Psychiatry. 2000 Dec;9(4):244-54
references.pmid: 11202099
references.citation: Suicide Life Threat Behav. 2005 Jun;35(3):239-50
references.pmid: 16156486