title: The exacerbating influence of hopelessness on other known risk factors for repeat self-harm and suicide.
abstract: BACKGROUND
  Hopelessness is frequently observed in people who harm themselves and is an established risk factor for nonfatal self-harm repetition and suicide. Little is known about how the presence of hopelessness in addition to other risk factors affects subsequent risk.
  
  
  METHODS
  Prospective cohort of 19,479 individuals presenting with self-harm to one of three English Emergency Departments between 1st January 2000 and 31st December 2010. Repeat self-harm and suicide deaths within twelve months of the first assessed episode were identified. Cox Proportional Hazards models were used to estimate Hazard Ratios (HRs) for risk factors with and without hopelessness.
  
  
  RESULTS
  A clinical impression of hopelessness was associated with increased risk of further self-harm (HR 1.35, 95% CI 1.16-1.58) and suicide (HR 2.56, CI 1.10-5.96) in the year following an index episode. For individuals who were living alone or homeless, unemployed, reported problems with housing, had received psychiatric treatment in the past, were currently receiving treatment or used alcohol during the self-harm episode, an exacerbation of an already elevated risk of repetition was observed amongst those who were assessed as hopeless. Where individuals presented with forensic problems, physical health problems or bereavement, an increase in risk was only observed for those who were also assessed as hopeless.
  
  
  CONCLUSIONS
  A clinical impression of hopelessness was assigned using a binary "yes"/"no" classification rather than a validated scale.
  
  
  CONCLUSIONS
  Hopelessness intensifies the impact of several known risk factors for adverse outcomes following self-harm. These findings highlight the importance of identifying and therapeutically addressing this dynamic but potentially modifiable clinical risk factor during the psychosocial assessment and in subsequent care.
authors.affiliation: Centre for Suicide Prevention, University of Manchester, United Kingdom. Electronic address: sarah.steeg@manchester.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steeg
authors.affiliation: Department of Psychology, Northumbria University Newcastle, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Haigh
authors.affiliation: Centre for Suicide Prevention, University of Manchester, United Kingdom.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Webb
authors.affiliation: Centre for Suicide Prevention, University of Manchester, United Kingdom.
authors.forename: Nav
authors.initials: N
authors.lastname: Kapur
authors.affiliation: School of Psychological Sciences, University of Manchester, United Kingdom.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Awenat
authors.affiliation: School of Psychological Sciences, University of Manchester, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Gooding
authors.affiliation: School of Psychological Sciences, University of Manchester, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pratt
authors.affiliation: Centre for Suicide Prevention, University of Manchester, United Kingdom.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D055815:Young Adult
keywords: Epidemiology; Hopelessness; Psychosocial assessment; Self-harm; Suicide