Coping Style as a Mediator of the Relationship Between Depressive Symptoms and Deliberate Self-Harm
Abstract
Background: Deliberate self-harm (DSH) occurs with high frequency among clinical and nonclinical youth populations. Although depression has been consistently linked with the behavior, not all depressed individuals engage in DSH. Aims: The current study examined maladaptive coping strategies (i.e., self-blame, distancing, and self-isolation) as mediators between depression and DSH among undergraduate students. Methods: 202 students from undergraduate psychology courses at a private university in Southern California (77.7% women) completed anonymous self-report measures. Results: A hierarchical regression model found no differences in DSH history across demographic variables. Among coping variables, self-isolation alone was significantly related to DSH. A full meditational model was supported: Depressive symptoms were significantly related to DSH, but adding self-isolation to the model rendered the relationship nonsignificant. Limitations: The cross-sectional study design prevents determination of whether a casual relation exists between self-isolation and DSH, and obscures the direction of that relationship. Conclusions: Results suggest targeting self-isolation as a means of DSH prevention and intervention among nonclinical, youth populations.
References
(1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 54, 1173–1182.
(2002). General practice based intervention to prevent repeat episodes of deliberate self harm. British Medical Journal, 324, 1254.
(1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68, 609–620.
(2007). Stopping self-harm once and for all: Relapse prevention in Dialectical Behavior Therapy. In , Therapist’s guide to evidence-based relapse prevention. London: Academic Press.
(2007). Past and recent deliberate self-harm: Emotion and coping strategy differences. Journal of Clinical Psychology, 63, 791–803.
(2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behavior Research and Therapy, 44, 371–394.
(2005). Factors associated with suicide attempts in female inmates: The hegemony of hopelessness. Suicide and Life Threatening Behavior, 35, 558–569.
(2002). Self-harm in adults: A randomized controlled trial of nurse-led case management versus routine care only. Journal of Mental Health, 11, 167–176.
(2007). A study of self-harm in older people: Mental disorder, social factors, and motives. Aging and Mental Health, 11, 520–525.
(1991). Prevalence and correlates of cutting behavior: Risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 735–739.
(2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77, 534–542.
(2005). In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? Journal of Adolescence, 28, 573–587.
(1992). Repetitive self-mutilation. Psychiatric Annals, 22, 60–63.
(2006). Three assessment tools for deliberate self-harm and suicide behavior: Evaluation and psychopathological correlates. Journal of Psychosomatic Research, 61(1), 113–121.
(1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992–1003.
(1993). Loneliness, depression, stress, and social supports in neglectful families. American Journal of Orthopsychiatry, 63, 597–605.
(2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253–264.
(2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192–204.
(2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry, 76, 238–250.
(2003). Coping and problem solving of self-mutilators. Journal of Clinical Psychology, 59, 1097–1106.
(1999). Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: A longitudinal comparative study. Journal of Pain and Symptom Management, 17, 311–319.
(2007). Life problems and deliberate self-harm: Associations with gender, age, suicidal intent and psychiatric and personality disorder. Journal of Affective Disorders, 109, 139–148.
(2005). A comparative study of young and adult deliberate self-harm patients. Crisis, 26, 64–72.
(1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples form the child-clinical and pediatric psychological literatures. Journal of Consulting and Clinical Psychology, 65, 599–610.
(2005). Coping with their lives – women, learning disabilities, self-harm and the secure unit: A Q-methodological study. British Journal of Learning Disabilities, 33, 120–127.
(2006). Genetic, developmental and personality correlates of self-mutilation in depressed patients. Australian and New Zealand Journal of Psychiatry, 40, 225–229.
(2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617–27.
(1998). Applied regression analysis and other multivariable methods (3rd ed.). Pacific Grove, CA: Brooks/Cole.
(2004). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34, 447–457.
(1997, April). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. Paper presented at the Annual Meeting of the Society for Behavioral Medicine, New Orleans, Louisiana.
(2007). Deliberate self-harm in 15-year-old adolescents: A pilot study with a modified version of the Deliberate Self-Harm Inventory. Scandinavian Journal of Psychology, 48(1), 33–41.
(2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890.
(2006). Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India. Suicide and Life-Threatening Behavior, 36, 223–238.
(2005). Self-harming in depressed patients: Pattern analysis. Australian and New Zealand Journal of Psychiatry, 39, 899–906.
(2007). Adolescent alienation: Examining the relevance of contextual domains and psychological components. Dissertation Abstracts International: Section B: The Sciences and Engineering, 67(7-B), 4113.
(1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867–872.
(2007). Cognitive therapy in relapse prevention in depression. International Journal of Neuropsychopharmacology, 10(1), 131–136.
(1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 6(1), 385–401.
(2004). Reasons for deliberate self-harm: Comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 80–87.
(2005). Self-harm. Lancet, 366, 1471–1483.
(2008). Cognitive-behavioral intervention for self-harm: Randomized controlled trial. British Journal of Psychiatry, 192, 202–211.
(2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259.
(2003). Randomized controlled trial of brief cognitive behavior therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychological Medicine, 33, 969–976.
