Repetition of deliberate self-harm by adolescents: the role of psychological factors.

The aim of this study was to examine the relationship between psychological variables and repetition of deliberate self-harm by adolescents (n=45) aged 13-18 years who had been admitted to a general hospital having taken overdoses. Standardized measures of depression, hopelessness, suicidal intent, impulsivity, trait and state anger, self-esteem and problem-solving (both self-report and observer-rated) were administered to the adolescents while still in the general hospital. Repetition was assessed on the basis of previous overdoses (n=14) and repetition of self-harm (self-poisoning and self-injury) during the subsequent year (n=9). Adolescents with a history of a previous overdose and/or who repeated self-harm during the following year (n=18) differed from non-repeaters in having higher scores for depression, hopelessness and trait anger, and lower scores for self-esteem, self-rated problem-solving and effectiveness of problem-solving rated on the basis of the Means End Problem Solving test, all measured at the initial assessment. These differences largely disappeared when level of depression was controlled for. Similarly, differences found between repeaters and non-repeaters in the year following the index overdoses for problem-solving were much reduced when account was taken of differences in depression scores. Depression is a key factor associated with risk of repetition of adolescent self-harm (and hence of suicide risk). In the management of adolescents who have harmed themselves, careful assessment of depression and appropriate management of those who are depressed is essential.