Prevalence and correlates of lifetime deliberate self-harm and suicidal ideation in naturalistic outpatients: the Leiden Routine Outcome Monitoring study

J Affect Disord. 2011 Sep;133(1-2):257-64. doi: 10.1016/j.jad.2011.03.021. Epub 2011 Apr 3.


Background: Deliberate self-harm and suicidal ideation (DSHI) are common phenomena in general and mental health populations. Identifying factors associated with DSHI may contribute to the early identification, prevention and treatment of DSHI. Aims of the study are to determine the prevalence and correlates of lifetime DSHI in a naturalistic sample of psychiatric outpatients with mood, anxiety or somatoform (MAS) disorders.

Methods: Of 3798 consecutive patients from January 2004 to December 2006, 2844 (74.9%) patients were analyzed (mean age=37.5, SD=12.0; age range: 18-65; 62.7% women). Lifetime DSHI was assessed with routine outcome monitoring (ROM), including demographic parameters, DSM-IV diagnosis, depressive symptoms, symptoms of anxiety, general psychopathology and personality traits.

Results: Of the 2844 subjects, 55% reported lifetime DSHI. In multivariable logistic regression analysis, the most important factors associated with lifetime DSHI were being unmarried, low education, high number of psychiatric diagnoses, lower anxiety scores, higher depression scores and the personality trait of emotional dysregulation.

Limitations: Deliberate self-harm may have been under-reported in self-report questionnaires; The assessment of personality traits may have been influenced by state psychopathology; traumatic events were not assessed.

Conclusions: The findings suggest that DSHI is common among psychiatric outpatients with MAS disorders and that current symptoms and underlying personality vulnerabilities were independently involved in DSHI. Whether symptoms of somatic anxiety are protective should be confirmed in subsequent studies. These findings may help clinicians in identifying patients at risk for deliberate self-harm and suicide.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology
  • Depression / epidemiology
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Emotions
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Middle Aged
  • Netherlands / epidemiology
  • Outcome Assessment, Health Care
  • Outpatients / psychology
  • Prevalence
  • Risk Factors
  • Self-Injurious Behavior / diagnosis
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / psychology
  • Suicidal Ideation*
  • Suicide / psychology
  • Suicide / statistics & numerical data*
  • Suicide Prevention
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data*
  • Surveys and Questionnaires