Examining the mechanisms by which adverse life events affect having a history of self-harm, and the protective effect of social support

JOURNAL OF AFFECTIVE DISORDERS

卷:263

Article

Tham, Su-Gwan^1,2  Ibrahim, Saied^1,2  Hunt, Isabelle M.^1,2  Kapur, Nav^1,2,3,4,5  Gooding, Patricia^2,3 

[1] Univ Manchester, Ctr Mental Hlth & Safety, Natl Confidential Inquiry Suicide & Safety Mental, Manchester, Lancs, England

[2] Univ Manchester, Sch Hlth Sci, Div Psychol & Mental Hlth, Manchester, Lancs, England

[3] Univ Manchester, Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England

[4] Greater Manchester Mental Hlth NHS Fdn Trust, Manchester, Lancs, England

[5] NIHR Greater Manchester Patient Safety Translat R, Manchester, Lancs, England

关键词: Suicide;    Life events;    Hopelessness;    Self-harm;    Social support;    Mediation;   

DOI  :  10.1016/j.jad.2019.11.037

来源: Elsevier

【 摘 要 】

Background: Psychological models of suicide emphasize perceptions of negative stressors, hopelessness and self-harm as key antecedents to suicidal thoughts/acts. Such models also emphasize the potential protective role of social support in these pathways. However, such pathways have not been tested using population level data. Hence, this study aimed to redress this gap. Methods: Questionnaire data regarding 24,444 patient suicide deaths were analysed. All individuals died between 1996 and 2015 and were seen by secondary mental health services in England within 12 months before their death. Mediation analyses, using fitted logistic regression models, investigated direct and indirect pathways between negative stressors, hopelessness and a proxy measure of suicide, namely, self-harm history. In addition, the buffering effects of social support were examined in these pathways. Results: There was a direct effect of negative life events on suicidal behaviors. Supporting contemporary psychological models of suicide, a mediated effect via hopelessness and a protective effect of social support were identified. Social support buffered the pathway between stressful life events and hopelessness, with hopelessness decreasing as social support increased. Limitations: Causal inferences are inappropriate as the design was cross-sectional. A proxy measure of suicidality was utilized (history of self-harm) as all individuals had died by suicide. Conclusions: This is the first time that population data has been used to test psychological pathways to suicidal acts involving negative stressors, hopelessness and social support. Psychological interventions should focus on increasing social support following negative life events together with ameliorating perceptions of hopelessness.

【 授权许可】

Free