Becky Mars

This data note describes the linking of records of the Bristol Self Harm Register with the cohort of the index children of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’). These records were obtained from the computerised data base maintained by the Bristol Self Harm Register (BSHR). The BSHR is operated out of the two largest NHS trusts in the ALSPAC study catchment area, North Bristol NHS Trust (NBT) based at Southmead Hospital (SMH) in Bristol and the University Hospitals Bristol and Weston NHS Foundation Trust (UHBWT) based at Bristol Royal Infirmary (BRI), also in Bristol. The BSHR database was designed to be populated by staff after an encounter with a patient attending with an indication of self-harm. Some of the information in the BSHR database was self-reported by the patient and was unable to be independently verified. Software syntax was written using STATA (StataCorp LLC, version 17) to convert the original files into a single consistent format in a data base which was reviewed for its potential use in future research. The cleaned BSHR records provide a contemporaneous record of a subset of the ALSPAC cohort over a period of the ALSPAC study in an easily accessible format, which is valuable when other sources of data may be missing.

Background: Lived experience stories are often used on formal help sites as a support resource for individuals who self-harm. While self-harm–related internet use provides an alternative for individuals who are not yet ready or are unwilling or unable to access support offline, it has also been shown to unintentionally reinforce self-harm behavior. There are several components that might influence whether a lived experience story is perceived as helpful, unhelpful, or potentially harmful, and the evidence supporting that these encourage help-seeking in the reader is limited. Objective: This study is part of a mixed methods project that aimed to investigate how variations in help-seeking messages contained within online lived experience stories are interpreted by and psychologically impact those with a history of self-harm. Methods: Individuals with a recent history of self-harm were recruited via newsletters, social media, and websites run by the university and mental health charities to take part in an online experiment. During the experiment, participants were randomized to read stories that either mentioned (1) self-help strategies, (2) seeking help from informal and formal sources, or (3) did not mention help-seeking. Help-seeking intentions, mood, entrapment, and expectations of future self-harm were measured, and participants provided feedback on the stories. Results: There was limited evidence for an effect of story type on help-seeking intentions (F2, 230=4.2; P=.02; η2=0.25), and clearer evidence for an effect of story type on negative affect (F2, 230=4.02; P=.02; η2=0.10; adjustment for age, gender, and help-seeking history included). Participants in the “self-help” condition (n=83) reported lower negative affect after reading the stories compared to participants in the “no help” condition (n=80; mean difference=–3.97, 95% CI –7.72 to –0.22; P=.04) and the “informal/formal” help condition (n=75; mean difference=–3.70, 95% CI –7.55 to 0.14; P=.06). A key criticism of the stories was that they were unrelatable, but this sentiment was less prevalent among those in the “no help” condition. Key positives were that the stories included a realistic but hopeful outlook of recovery (less prevalent in the “informal/formal help” condition) and were supportive (less prevalent in the “no help” condition). Conclusions: While the inclusion of self-help strategies in a lived experience story reduced its impact on negative affect, the inclusion of self-help strategies or seeking help from others did not encourage help-seeking intentions. Making stories relatable, authentic, and providing multiple strategies for support might be key to encouraging help-seeking, but more research is needed.

Background: A family history of mental illness, particularly parental depression, is a risk factor for mental health difficulties in young people, with this heightened risk extending into adulthood. Evidence suggests low rates of formal mental health support in children/adolescents with depressed parents, but it is unknown whether this pattern persists into adulthood and applies to informal support. Aims: We examined the prevalence of formal and informal mental health support accessed by young adults with recurrently depressed parents. We identified factors associated with access to different support, and report satisfaction with support. Method: The sample included 144 young adults (mean age 23 years, range 18–28 years) who completed psychiatric assessments and reported on their use of mental health support in a cross-sectional analysis of a longitudinal cohort study (wave 4). Regression analyses explored predictors for support. Results: Young adults accessed a range of formal (29%) and informal (56%) support. Among those with a psychiatric disorder, nearly half had not accessed formal support and a fifth had not accessed any support. Predictors of support included psychiatric disorder, severity indicators (e.g. self-harm/suicidal thoughts, impairment) and demographic factors (e.g. education, gender). Predictors varied by type of support. Most participants reported satisfaction with support. Conclusions: Young adults at high risk of mental disorders accessed various mental health support. However, many did not access/receive support when needed. Further work is required to improve access to tailored support.

Adverse childhood experiences (ACEs) elevate the risk of self-harm and depression, which are significant public health concerns. This study examined the association between the longitudinal co-occurrence patterns of ACEs across childhood and adolescence, and self-harm and depression in adolescence and early adulthood. We included 8,859 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined ten ACEs reported prospectively and retrospectively by parents and children throughout childhood and adolescence, and retrospectively by cohort members in adulthood. Self-harm and depression were self-reported in adolescence (age 16 years) and early adulthood (ages 23 and 24 years). Logistic regression models examined associations between previously derived latent classes of co-occurring ACEs over time, and self-harm and depression. A higher risk of adolescent self-harm was found for each of the latent classes when compared to the Low ACEs reference class ( n = 6,380) ( Mid-childhood and adolescence ACEs n = 230; adjusted odds ratio (aOR) 1.76, 95% CI 1.11–2.80; Early childhood abuse and parental mental health problems n = 445; aOR 1.85, 95% CI 1.34–2.56; Persistent parental mental health problems n = 861; aOR 1.44, 95% CI 1.07–1.94; Early and mid-childhood household disharmony n = 943; aOR 1.47, 95% CI 1.10–1.97). The association between Persistent parental mental health problems and self-harm persisted in early adulthood (aOR 1.57, 95% CI 1.16–2.12). For adolescent depression, associations were found with the Early childhood abuse and parental mental health problems (aOR 2.89, 95% CI 2.20–3.79), Persistent parental mental health problems (aOR 1.54, 95% CI 1.18–2.01), and Early and mid-childhood household disharmony (aOR 1.36, 95% CI 1.03–1.81) classes when compared to the Low ACEs class. These associations persisted in early adulthood. Early childhood abuse and parental mental health problems (aOR 2.50, 95% CI 1.68–3.73) and Early and mid-childhood household disharmony (aOR 1.58, 95% CI 1.05–2.37) were associated with a higher likelihood of co-occurring self-harm and depression in adolescence. However by early adulthood, only Persistent parental mental health problems were associated with a higher likelihood of co-occurring self-harm and depression (aOR 2.13, 95% CI 1.47–3.10). ACEs occurring throughout childhood and adolescence are associated with a higher risk of adolescent self-harm and both adolescent and early adulthood depression. In contrast, the class most strongly associated with early adult self-harm was Persistent parental mental health problems . Multicomponent interventions and multi-sectoral preventative efforts are needed to address distinct patterns of co-occurring ACEs during childhood and adolescence, to mitigate their short- and long-term impacts on self-harm and depression.

BACKGROUND Lived experience stories are often used on formal help sites as a support resource for individuals who self-harm. While self-harm–related internet use provides an alternative for individuals who are not yet ready or are unwilling or unable to access support offline, it has also been shown to unintentionally reinforce self-harm behavior. There are several components that might influence whether a lived experience story is perceived as helpful, unhelpful, or potentially harmful, and the evidence supporting that these encourage help-seeking in the reader is limited. OBJECTIVE This study is part of a mixed methods project that aimed to investigate how variations in help-seeking messages contained within online lived experience stories are interpreted by and psychologically impact those with a history of self-harm. METHODS Individuals with a recent history of self-harm were recruited via newsletters, social media, and websites run by the university and mental health charities to take part in an online experiment. During the experiment, participants were randomized to read stories that either mentioned (1) self-help strategies, (2) seeking help from informal and formal sources, or (3) did not mention help-seeking. Help-seeking intentions, mood, entrapment, and expectations of future self-harm were measured, and participants provided feedback on the stories. RESULTS There was limited evidence for an effect of story type on help-seeking intentions (F2, 230=4.2; P=.02; η2=0.25), and clearer evidence for an effect of story type on negative affect (F2, 230=4.02; P=.02; η2=0.10; adjustment for age, gender, and help-seeking history included). Participants in the “self-help” condition (n=83) reported lower negative affect after reading the stories compared to participants in the “no help” condition (n=80; mean difference=–3.97, 95% CI –7.72 to –0.22; P=.04) and the “informal/formal” help condition (n=75; mean difference=–3.70, 95% CI –7.55 to 0.14; P=.06). A key criticism of the stories was that they were unrelatable, but this sentiment was less prevalent among those in the “no help” condition. Key positives were that the stories included a realistic but hopeful outlook of recovery (less prevalent in the “informal/formal help” condition) and were supportive (less prevalent in the “no help” condition). CONCLUSIONS While the inclusion of self-help strategies in a lived experience story reduced its impact on negative affect, the inclusion of self-help strategies or seeking help from others did not encourage help-seeking intentions. Making stories relatable, authentic, and providing multiple strategies for support might be key to encouraging help-seeking, but more research is needed.

Background: A family history of mental illness, particularly parental depression, is a risk factor for mental health difficulties in young people, with this heightened risk extending into adulthood. Evidence suggests low rates of formal mental health support in children/adolescents with depressed parents, but it is unknown whether this pattern persists into adulthood and applies to informal support. Aims: We examined the prevalence of formal and informal mental health support accessed by young adults with recurrently depressed parents. We identified factors associated with access to different support, reported satisfaction with support and identified potential facilitators/barriers to access. Methods: A mixed-method study comprising 144 young adults (mean age=23 years, range=18-28 years) who completed psychiatric assessments and reported on their use of mental health support. Regression analyses explored predictors for support. A focus group examined facilitators and barriers. Results: Young adults accessed a range of formal (29%) and informal (56%) support. Among those with psychiatric disorder, nearly half had not accessed formal support and one-fifth had not accessed any support. Predictors of support included psychiatric disorder, severity indicators (e.g. self-harm/suicidal thoughts, impairment), and demographic factors (e.g. education, gender). Predictors varied by type of support. Most participants reported satisfaction with support. Facilitators included role models, public mental health discussions, and practitioner training. Barriers included identifying difficulties, stigma, service limitations, and family/friends’ experiences. Conclusions: Young adults at high risk of mental disorders accessed various mental health support. However, many did not access/receive support when needed. Further work is required to improve access to tailored support.

Background: The integrated motivational-volitional model (IMV) is one of the leading theoretical models of suicidal thoughts and behavior. There has been a recent proliferation in the assessment of suicidal and nonsuicidal self-harm thoughts and behaviors (SHTBs) in daily life. Objective: This systematic review synthesized evidence from ecological momentary assessment (EMA) studies in the SHTB literature to address the following questions: (1) Which constructs in the IMV model have been assessed using EMA, and how have they been assessed? (2) Do different constructs from the IMV model fluctuate in daily life? (3) What is the relationship between the different IMV constructs and SHTBs in daily life? Methods: Consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted systematic searches of 5 databases—Web of Science, Embase, MEDLINE, PsycINFO, and Europe PMC Preprints—from inception to March 26, 2024. Results: Our searches resulted in the inclusion and narrative synthesis of 53 studies across 58 papers. A total of 15 IMV constructs were measured using EMA across the included papers. The most frequently measured constructs were thwarted belongingness (24/58, 41% of the papers), future thinking (20/58, 34% of the papers), and perceived burdensomeness (16/58, 28% of the papers). The least frequently measured constructs were humiliation, social problem-solving, mental imagery, and perceived capability for suicide. None of the included papers measured memory biases, goals, norms, or resilience using EMA. Comparison of intraclass correlation coefficients (45/58, 78% of the papers) revealed moderate but inconsistent within-person variance across all the examined constructs. We found evidence (39/58, 67% of the papers) of concurrent associations between almost all constructs and SHTBs in daily life, with some evidence that entrapment, shame, rumination, thwarted belongingness, hopelessness, social support, and impulsivity are additionally associated with SHTBs in lagged (ie, longitudinal) relationships. Conclusions: Comparisons were hindered by variation in methodology, including the populations studied, EMA sampling scheme, operationalization of IMV constructs and SHTBs, and statistical approach used. Our findings suggest that EMA studies are a useful methodology for examining risk factors for SHTBs; however, more research is needed for some IMV constructs. Quality assessment suggested several areas for improvement in the reporting of EMA studies in this field. Trial Registration: PROSPERO CRD42022349514; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=349514

BACKGROUND The integrated motivational-volitional model (IMV) is one of the leading theoretical models of suicidal thoughts and behavior. There has been a recent proliferation in the assessment of suicidal and nonsuicidal self-harm thoughts and behaviors (SHTBs) in daily life. OBJECTIVE This systematic review synthesized evidence from ecological momentary assessment (EMA) studies in the SHTB literature to address the following questions: (1) Which constructs in the IMV model have been assessed using EMA, and how have they been assessed? (2) Do different constructs from the IMV model fluctuate in daily life? (3) What is the relationship between the different IMV constructs and SHTBs in daily life? METHODS Consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted systematic searches of 5 databases—Web of Science, Embase, MEDLINE, PsycINFO, and Europe PMC Preprints—from inception to March 26, 2024. RESULTS Our searches resulted in the inclusion and narrative synthesis of 53 studies across 58 papers. A total of 15 IMV constructs were measured using EMA across the included papers. The most frequently measured constructs were thwarted belongingness (24/58, 41% of the papers), future thinking (20/58, 34% of the papers), and perceived burdensomeness (16/58, 28% of the papers). The least frequently measured constructs were humiliation, social problem-solving, mental imagery, and perceived capability for suicide. None of the included papers measured memory biases, goals, norms, or resilience using EMA. Comparison of intraclass correlation coefficients (45/58, 78% of the papers) revealed moderate but inconsistent within-person variance across all the examined constructs. We found evidence (39/58, 67% of the papers) of concurrent associations between almost all constructs and SHTBs in daily life, with some evidence that entrapment, shame, rumination, thwarted belongingness, hopelessness, social support, and impulsivity are additionally associated with SHTBs in lagged (ie, longitudinal) relationships. CONCLUSIONS Comparisons were hindered by variation in methodology, including the populations studied, EMA sampling scheme, operationalization of IMV constructs and SHTBs, and statistical approach used. Our findings suggest that EMA studies are a useful methodology for examining risk factors for SHTBs; however, more research is needed for some IMV constructs. Quality assessment suggested several areas for improvement in the reporting of EMA studies in this field. CLINICALTRIAL PROSPERO CRD42022349514; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=349514

Background: Adverse childhood experiences (ACEs) are well‐established risk factors for self‐harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co‐occurring self‐harm and depression. Methods: Data were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14–18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E‐Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four‐category outcome: no self‐harm or depression, self‐harm alone, depression alone and self‐harm with co‐occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self‐harm and depression in adolescence. Results: The majority of ACEs were associated with co‐occurring self‐harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co‐occurring self‐harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10–1.25) and MCS (1.18, 1.11–1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co‐occurring self‐harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS. Conclusions: Efforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long‐term exposure to ACEs contributing to risk of self‐harm and depression in adolescence.

This data note describes the linking of records of the Bristol Self Harm Register with the cohort of the index children of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’). These records were obtained from the computerised data base maintained by the Bristol Self Harm Register (BSHR). The BSHR is operated out of the two largest NHS trusts in the ALSPAC study catchment area, North Bristol NHS Trust (NBT) based at Southmead Hospital (SMH) in Bristol and the University Hospitals Bristol and Weston NHS Foundation Trust (UHBWT) based at Bristol Royal Infirmary (BRI), also in Bristol. The BSHR database was designed to be populated by staff after an encounter with a patient attending with an indication of self-harm. Some of the information in the BSHR database was self-reported by the patient and was unable to be independently verified. Software syntax was written using STATA (StataCorp LLC, version 17) to convert the original files into a single consistent format in a data base which was reviewed for its potential use in future research. The cleaned BSHR records provide a contemporaneous record of a subset of the ALSPAC cohort over a period of the ALSPAC study in an easily accessible format, which is valuable when other sources of data may be missing.