Problem-solving ability and repetition of deliberate self-harm: A multicentre study

Carmel McAuliffe, Paul Corcoran, Helen S. Keeley, Ella Arensman, Unni Bille-Brahe, Diego De Leo, Sandor Fekete, Keith Hawton, Heidi Hjelmeland, Margaret Kelleher, Ad J.F.M. Kerkhof, Jouko Lönnqvist, Konrad Michel, Ellinor Salander-Renberg, Armin Schmidtke, Kees Van Heeringen, Danuta Wasserman

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45 Citations (Scopus)


Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. Method. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. Results. Factor analysis identified five dimensions - Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance - characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems - was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. Conclusions. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Original languageEnglish
Pages (from-to)45-55
Number of pages11
JournalPsychological Medicine
Issue number1
Publication statusPublished - Jan 2006

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

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    McAuliffe, C., Corcoran, P., Keeley, H. S., Arensman, E., Bille-Brahe, U., De Leo, D., Fekete, S., Hawton, K., Hjelmeland, H., Kelleher, M., Kerkhof, A. J. F. M., Lönnqvist, J., Michel, K., Salander-Renberg, E., Schmidtke, A., Van Heeringen, K., & Wasserman, D. (2006). Problem-solving ability and repetition of deliberate self-harm: A multicentre study. Psychological Medicine, 36(1), 45-55.