Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-21T11:27:12.494Z Has data issue: false hasContentIssue false
  • English
  • Français

Prediction and network modelling of self-harm through daily self-report and history of self-injury

Published online by Cambridge University Press:  08 April 2020

Michael J. Kyron Open the ORCID record for Michael J. Kyron [Opens in a new window] ,
Geoff R. Hooke  and
Andrew C. Page
Michael J. Kyron*
Affiliation:
School of Psychological Science, University of Western Australia, Crawley, WA, Australia
Geoff R. Hooke
Affiliation:
School of Psychological Science, University of Western Australia, Crawley, WA, Australia Perth Clinic, West Perth, WA, Australia
Andrew C. Page
Affiliation:
School of Psychological Science, University of Western Australia, Crawley, WA, Australia
*
Author for correspondence: Michael J. Kyron, E-mail: michael.kyron@uwa.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Self-harm is a significant public health issue, and both our understanding and ability to predict adverse outcomes are currently inadequate. The current study explores how preventative efforts could be aided through short-term prediction and modelling of risk factors for self-harm.

Methods

Patients (72% female, Mage = 40.3 years) within an inpatient psychiatric facility self-reported their psychological distress, interpersonal circumstances, and wish to live and die on a daily basis during 3690 unique admissions. Hierarchical logistic regressions assessed whether daily changes in self-report and history of self-harm could predict self-harm, with machine learning used to train and test the model. To assess interrelationships between predictors, network and cross-lagged panel models were performed.

Results

Increases in a wish to die (β = 1.34) and psychological distress (β = 1.07) on a daily basis were associated with increased rates of self-harm, while a wish to die on the day prior [odds ratio (OR) 3.02] and a history of self-harm (OR 3.02) was also associated with self-harm. The model detected 77.7% of self-harm incidents (positive predictive value = 26.6%, specificity = 79.1%). Psychological distress, wish to live and die, and interpersonal factors were reciprocally related over the prior day.

Conclusions

Short-term fluctuations in self-reported mental health may provide an indication of when an individual is at-risk of self-harm. Routine monitoring may provide useful feedback to clinical staff to reduce risk of self-harm. Modifiable risk factors identified in the current study may be targeted during interventions to minimise risk of self-harm.

Keywords

Non-suicidal self-injuryperceived burdensomenesspsychological distresssuicidewish to die
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 12 , September 2021 , pp. 1992 - 2002
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anestis, M. D., Pennings, S. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2013). Low distress tolerance as an indirect risk factor for suicidal behavior: Considering the explanatory role of non-suicidal self-injury. Comprehensive Psychiatry, 54(7), 996–1002.10.1016/j.comppsych.2013.04.005CrossRefGoogle ScholarPubMed
Anestis, M. D., Soberay, K. A., Gutierrez, P. M., Hernández, T. D., & Joiner, T. E. (2014). Reconsidering the link between impulsivity and suicidal behavior. Personality and Social Psychology Review, 18(4), 366–386. https://doi.org/https://doi.org/10.1016/j.comppsych.2014.07.007CrossRefGoogle ScholarPubMed
Armey, M. F., Crowther, J. H., & Miller, I. W. (2011). Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury. Behaviour Therapy, 42(4), 579–588. https://doi.org/10.1016/j.beth.2011.01.002CrossRefGoogle ScholarPubMed
Australian Bureau of Statistics. (2018). Causes of death, Australia, 2018. Retrieved July 17, 2019.Google Scholar
Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97(1), 90.CrossRefGoogle Scholar
Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The scale for suicide ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–352. https://doi.org/10.1037//0022-006x.47.2.343CrossRefGoogle ScholarPubMed
Belsher, B. E., Smolenski, D. J., Pruitt, L. D., Bush, N. E., Beech, E. H., Workman, D. E., … Skopp, N. A. (2019). Prediction models for suicide attempts and deaths: A systematic review and simulation. JAMA Psychiatry, 76(6), 642–651. https://doi.org/10.1001/jamapsychiatry.2019.0174CrossRefGoogle ScholarPubMed
Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6–19. https://doi.org/10.1080/10503307.2013.817696CrossRefGoogle ScholarPubMed
Bresin, K., Carter, D. L., & Gordon, K. H. (2013). The relationship between trait impulsivity, negative affective states, and urge for nonsuicidal self-injury: A daily diary study. Psychiatry Research, 205(3), 227–231. https://doi.org/https://doi.org/10.1016/j.psychres.2012.09.033CrossRefGoogle ScholarPubMed
Bryan, C. J., & Rudd, M. D. (2016). The importance of temporal dynamics in the transition from suicidal thought to behavior. Clinical Psychology: Science and Practice, 23(1), 21–25. https://doi.org/https://doi.org/10.1111/cpsp.12135Google Scholar
Bryan, C. J., Rudd, M. D., Peterson, A. L., Young-McCaughan, S., & Wertenberger, E. G. (2016). The ebb and flow of the wish to live and the wish to die among suicidal military personnel. Journal of Affective Disorders, 202, 58–66. https://doi.org/https://doi.org/10.1016/j.jad.2016.05.049CrossRefGoogle ScholarPubMed
Czyz, E., King, C., & Nahum-Shani, I. (2018). Ecological assessment of daily suicidal thoughts and attempts among suicidal teens after psychiatric hospitalization: Lessons about feasibility and acceptability. Psychiatry Research, 267, 566–574. https://doi.org/https://doi.org/10.1016/j.psychres.2018.06.031CrossRefGoogle ScholarPubMed
Dyer, K., Hooke, G., & Page, A. C. (2014). Development and psychometrics of the five item daily index in a psychiatric sample. Journal of Affective Disorders, 152-154, 409–415. https://doi.org/10.1016/j.jad.2013.10.003CrossRefGoogle Scholar
Epskamp, S., Borsboom, D., & Fried, E. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195–212. https://doi.org/https://doi.org/10.3758/s13428-017-0862-1CrossRefGoogle ScholarPubMed
Fliege, H., Lee, J. R., Grimm, A., & Klapp, B. F. (2009). Risk factors and correlates of deliberate self-harm behavior: A systematic review. Journal of Psychosomatic Research, 66(6), 477–493. https://doi.org/10.1016/j.jpsychores.2008.10.013CrossRefGoogle ScholarPubMed
Gunnell, D., Metcalfe, C., While, D., Hawton, K., Ho, D., Appleby, L., & Kapur, N. (2012). Impact of national policy initiatives on fatal and non-fatal self-harm after psychiatric hospital discharge: Time series analysis. British Journal of Psychiatry, 201(3), 233–238. https://doi.org/10.1192/bjp.bp.111.104422CrossRefGoogle ScholarPubMed
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis: Global edition. Upper Saddle River, NJ: Pearson Higher Education.Google Scholar
Hamaker, E. L., Kuiper, R. M., & Grasman, R. P. (2015). A critique of the cross-lagged panel model. Psychological Methods, 20(1), 102–116. https://doi.org/10.1037/a0038889CrossRefGoogle ScholarPubMed
Haslbeck, J., & Waldorp, L. J. (2015). Structure estimation for mixed graphical models in high-dimensional data. Retrieved from https://arxiv.org/abs/1510.06871 (2020).Google Scholar
Haw, C., Hawton, K., Houston, K., & Townsend, E. (2001). Psychiatric and personality disorders in deliberate self-harm patients. British Journal of Psychiatry, 178(1), 48–54. https://doi.org/10.1192/bjp.178.1.48CrossRefGoogle ScholarPubMed
Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182(6), 537–542. https://doi.org/10.1192/bjp.182.6.537CrossRefGoogle ScholarPubMed
James, K., Stewart, D., & Bowers, L. (2012). Self-harm and attempted suicide within inpatient psychiatric services: A review of the literature. International Journal of Mental Health Nursing, 21(4), 301–309. https://doi.org/https://doi.org/10.1111/j.1447-0349.2011.00794.xCrossRefGoogle ScholarPubMed
Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.Google Scholar
Joiner, T. E., & Van Orden, K. A. (2008). The interpersonal–psychological theory of suicidal behavior indicates specific and crucial psychotherapeutic targets. International Journal of Cognitive Therapy, 1(1), 80–89. https://doi.org/https://doi.org/10.1521/ijct.2008.1.1.80CrossRefGoogle Scholar
Joiner, T. E., Van Orden, K. A., Witte, T. K., & Rudd, M. D. (2009). The interpersonal theory of suicide: Guidance for working with suicidal clients. Washington, DC: American Psychological Association. https://doi.org/http://dx.doi.org/10.1037/11869-000.CrossRefGoogle Scholar
Kashyap, S., Hooke, G. R., & Page, A. C. (2015). Identifying risk of deliberate self-harm through longitudinal monitoring of psychological distress in an inpatient psychiatric population. BMC Psychiatry, 15(1), 81. https://doi.org/10.1186/s12888-015-0464-3CrossRefGoogle Scholar
Kessler, R. C. (2019). Clinical epidemiological research on suicide-related behaviors – Where we are and where we need to go. JAMA Psychiatry, 76(8), 777–778. https://doi.org/doi:10.1001/jamapsychiatry.2019.1238CrossRefGoogle Scholar
Kinchin, I., Doran, C. M., Hall, W. D., & Meurk, C. (2017). Understanding the true economic impact of self-harming behaviour. The Lancet. Psychiatry, 4(12), 900–901. https://doi.org/10.1016/S2215-0366(17)30411-XCrossRefGoogle ScholarPubMed
Kleiman, E. M., Turner, B. J., Fedor, S., Beale, E. E., Huffman, J. C., & Nock, M. K. (2017). Examination of real-time fluctuations in suicidal ideation and its risk factors: Results from two ecological momentary assessment studies. Journal of Abnormal Psychology, 126(6), 726–738. https://doi.org/10.1037/abn0000273CrossRefGoogle ScholarPubMed
Kuhn, M., & Johnson, K. (2013). Applied predictive modeling (Vol. 26). New York: Springer.CrossRefGoogle Scholar
Kyron, M. J., Hooke, G. R., & Page, A. C. (2018). Daily assessment of interpersonal factors to predict suicidal ideation and non-suicidal self-injury in psychiatric inpatients. Journal of Consulting and Clinical Psychology, 86(6), 556–567. https://doi.org/10.1037/ccp0000305CrossRefGoogle ScholarPubMed
Kyron, M. J., Hooke, G. R., & Page, A. C. (2019). Assessing interpersonal and mood factors to predict trajectories of suicidal ideation within an inpatient setting. Journal of Affective Disorders, 252, 315–324. https://doi.org/https://doi.org/10.1016/j.jad.2019.04.029CrossRefGoogle ScholarPubMed
Large, M., Myles, N., Myles, H., Corderoy, A., Weiser, M., Davidson, M., & Ryan, C. J. (2018). Suicide risk assessment among psychiatric inpatients: a systematic review and meta-analysis of high-risk categories. Psychological Medicine, 48(7), 1119–1127.CrossRefGoogle ScholarPubMed
Large, M., Ryan, C., & Nielssen, O. (2011). The validity and utility of risk assessment for inpatient suicide. Australasian Psychiatry, 19(6), 507–512. https://doi.org/10.3109/10398562.2011.610505CrossRefGoogle ScholarPubMed
Lilley, R., Owens, D., Horrocks, J., House, A., Noble, R., Bergen, H., … Kapur, N. (2008). Hospital care and repetition following self-harm: Multicentre comparison of self-poisoning and self-injury. British Journal of Psychiatry, 192(6), 440–445. https://doi.org/10.1192/bjp.bp.107.043380CrossRefGoogle ScholarPubMed
Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202.CrossRefGoogle Scholar
Muehlenkamp, J. J., Engel, S. G., Wadeson, A., Crosby, R. D., Wonderlich, S. A., Simonich, H., & Mitchell, J. E. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behaviour Research and Therapy, 47(1), 83–87. https://doi.org/10.1016/j.brat.2008.10.011CrossRefGoogle ScholarPubMed
Muehlenkamp, J. J., & Gutierrez, P. M. (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research, 11(1), 69–82. https://doi.org/https://doi.org/10.1080/13811110600992902CrossRefGoogle ScholarPubMed
Muehlenkamp, J. J., & Kerr, P. L. (2010). Untangling a complex web: How non-suicidal self-injury and suicide attempts differ. The Prevention Researcher, 17(1), 8–11.Google Scholar
National Center for Health Statistics. (2018). Suicide Mortality in the United States, 1999–2017. Retrieved July 17, 2019, from https://www.cdc.gov/nchs/products/databriefs/db330.htm.Google Scholar
Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18(2), 78–83. https://doi.org/https://doi.org/10.1111/j.1467-8721.2009.01613.xCrossRefGoogle ScholarPubMed
Nock, M. K., Joiner, T. E. Jr., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72.10.1016/j.psychres.2006.05.010CrossRefGoogle ScholarPubMed
O'Connor, S. S., Jobes, D. A., Yeargin, M., FitzGerald, M. E., Rodríguez, V. M., Conrad, A. K., & Lineberry, T. W. (2012). A cross-sectional investigation of the suicidal spectrum: Typologies of suicidality based on ambivalence about living and dying. Comprehensive Psychiatry, 53(5), 461–467.CrossRefGoogle Scholar
Plener, P. L., Schumacher, T. S., Munz, L. M., & Groschwitz, R. C. (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: A systematic review of the literature. Borderline Personality Disorder and Emotion Dysregulation, 2(1), 2. https://doi.org/10.1186/s40479-014-0024-3CrossRefGoogle ScholarPubMed
Podlogar, M. C., & Joiner, T. E. (2019). Allowing for nondisclosure in high suicide risk groups. Assessment, 27(3), 547–559. https://doi.org/10.1177/1073191119845495CrossRefGoogle ScholarPubMed
Ribeiro, J., Franklin, J., Fox, K. R., Bentley, K., Kleiman, E. M., Chang, B., & Nock, M. K. (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225–236. https://doi.org/https://doi.org/10.1017/S0033291715001804CrossRefGoogle ScholarPubMed
Roaldset, J. O., Linaker, O. M., & Bjørkly, S. (2012). Predictive validity of the MINI suicidal scale for self-harm in acute psychiatry: A prospective study of the first year after discharge. Archives of Suicide Research, 16(4), 287–302.10.1080/13811118.2013.722052CrossRefGoogle ScholarPubMed
Rogers, M. L., & Joiner, T. E. (2019). Exploring the temporal dynamics of the interpersonal theory of suicide constructs: A dynamic systems modeling approach. Journal of Consulting and Clinical Psychology, 87(1), 56–66. https://doi.org/10.1037/ccp0000373CrossRefGoogle ScholarPubMed
Royston, P., & Altman, D. G. (2010). Visualizing and assessing discrimination in the logistic regression model. Statistics in Medicine, 29(24), 2508–2520. https://doi.org/10.1002/sim.3994CrossRefGoogle ScholarPubMed
Saunders, K., Brand, F., Lascelles, K., & Hawton, K. (2014). The sad truth about the SADPERSONS Scale: An evaluation of its clinical utility in self-harm patients. Emergency Medicine Journal, 31(10), 796–798.10.1136/emermed-2013-202781CrossRefGoogle ScholarPubMed
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. https://doi.org/10.1016/j.jad.2017.11.073CrossRefGoogle ScholarPubMed
Turner, B. J., Dixon-Gordon, K. L., Austin, S. B., Rodriguez, M. A., Rosenthal, M. Z., & Chapman, A. L. (2015). Non-suicidal self-injury with and without borderline personality disorder: Differences in self-injury and diagnostic comorbidity. Psychiatry Research, 230(1), 28–35.CrossRefGoogle ScholarPubMed
van Buuren, S. (2007). Multiple imputation of discrete and continuous data by fully conditional specification. Statistical Methods in Medical Research, 16(3), 219–242. https://doi.org/10.1177/0962280206074463CrossRefGoogle ScholarPubMed
Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24(1), 197–215. https://doi.org/10.1037/a0025358CrossRefGoogle ScholarPubMed
van Zyl, C. (2018). A network analysis of the General Health Questionnaire. Journal of Health Psychology, 1359105318810113. https://doi.org/10.1177/1359105318810113Google ScholarPubMed
Waern, M., Sjöström, N., Marlow, T., & Hetta, J. (2010). Does the Suicide Assessment Scale predict risk of repetition? A prospective study of suicide attempters at a hospital emergency department. European Psychiatry, 25(7), 421–426.CrossRefGoogle Scholar
Whipple, J. L., Lambert, M. J., Vermeersch, D. A., Smart, D. W., Nielsen, S. L., & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50(1), 59.CrossRefGoogle Scholar
Woodford, R., Spittal, M. J., Milner, A., McGill, K., Kapur, N., Pirkis, J., … Carter, G. (2019). Accuracy of clinician predictions of future self-harm: A systematic review and meta-analysis of predictive studies. Suicide and Life-Threatening Behavior, 49(1), 23–40. https://doi.org/10.1111/sltb.12395CrossRefGoogle ScholarPubMed
Supplementary material: File

Kyron et al. supplementary material

Kyron et al. supplementary material 1

Download Kyron et al. supplementary material(File)
File 377.4 KB
Supplementary material: File

Kyron et al. supplementary material

Kyron et al. supplementary material 2

Download Kyron et al. supplementary material(File)
File 25.2 KB