Abstract
Non-suicidal self-injury and suicidal behavior are prevalent in young adults, and often constitute a continuum of self-destructiveness. Not all those who self-injure, however, engage in suicidal behaviors with intent to die, perhaps due to protective intrapersonal characteristics. We examined the role of one such potential buffer, social problem-solving ability, as a moderator of the association between non-suicidal self-injury and suicidal thoughts and attempts, hypothesizing that individuals with greater social problem-solving ability would report fewer suicidal behaviors in relation to self-harm. An ethnically diverse sample was recruited from a large, Northeastern urban university, and completed self-report questionnaires assessing non-suicidal self-injury, suicidal behaviors, and social problem-solving ability. Multivariate hierarchical regression analyses were conducted. For the entire sample, individuals with higher social problem-solving abilities reported fewer suicidal behaviors associated with non-suicidal self-injury. In ethnically stratified analyses, social problem-solving significantly moderated the relationship between self-injury and suicidal behaviors for Whites and Hispanics only. Promotion of problem-solving skills may weaken the linkage between self-injury and potential for future suicidal behaviors for some individuals; however, culture-specific differences in this effect may exist.
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Baron, R. M., & Kenny, D. A. (1986). The moderator mediator variable distinction is social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.
Becker-Weidman, E., Jacobs, R., Reinecke, M., Silva, S., & March, J. (2010). Social problem-solving among adolescents treated for depression. Behaviour Research and Therapy, 48(1), 11–18. doi:10.1016/j.brat.2009.08.006.
Bernal, G., Cumba-Avilés, E., & Sáez-Santiago, E. (2006). Cultural and relational processes in depressed Latino adolescents. In S. H. Beach, M. Z. Wamboldt, N. J. Kaslow, R. E. Heyman, M. B. First, L. G. Underwood, et al. (Eds.), Relational processes and DSM-V: neuroscience, assessment, prevention, and treatment (pp. 211–224). Washington, DC: American Psychiatric Association.
Bhugra, D., Singh, J., Fellow-Smith, E., & Bayliss, C. (2002). Non-suicidal self-injury in adolescents. A case note study among two ethnic groups. European Journal of Psychiatry, 16(3), 145–151.
Bonner, R. L., & Rich, A. R. (1987). Toward a predictive model of suicidal ideation and behavior: some preliminary data in college students. Suicide and Life-threatening Behavior, 17(1), 50–63.
Cardemil, E. V., Reivich, K. J., & Seligman, M. E. P. (2002). The prevention of depressive symptoms in low-income minority middle school students. Prevention and Treatment, 5(1), 1–31. doi:10.1037/1522-3736.5.1.58a.
Chan, D. (2001). Dimensionality and correlates of problems solving: the use of the Problem Solving Inventory in the Chinese context. Behaviour Research and Therapy, 39(7), 859–875. doi:10.1016/S0005-7967(00)00082-6.
Chang, E. C. (1996). Cultural differences in optimism, pessimism, and coping: predictors of subsequent adjustment in Asian American and Caucasian American college students. Journal of Counseling Psychology, 43, 113–123.
Chang, E. C. (1998). Cultural differences, perfectionism, and suicidal risk in a college population: does social problem solving still matter? Cognitive Therapy and Research, 22(3), 237–254. doi:10.1023/A:1018792709351.
Chang, E. C., & Sanna, L. J. (2006). Optimism, accumulated life stress, and psychological and physical adjustment: is it always adaptive to expect the best. Journal of Social and Clinical Psychology, 22, 97–115.
Chang, E. C., Watkins, A. F., & Banks, K. H. (2004). How adaptive and maladaptive perfectionism relate to positive and negative psychological functioning: testing a stress-mediation model in black and white female college students. Journal of Counseling Psychology, 51, 93–102.
Chapman, A., Gratz, K., & Brown, M. (2006). Solving the puzzle of non-suicidal self-injury: the experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394. doi:10.1016/j.brat.2005.03.005.
Chatters, L. M., Taylor, R. J., Jackson, J. S., & Lincoln, K. D. (2008). Religious coping among African Americans, Caribbean Blacks, and Non-Hispanic Whites. Journal of Community Psychology, 36(3), 371–386.
Clum, G., & Febbraro, G. (1994). Stress, social support, and problem-solving appraisal/skills: prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment, 16(1), 69–83. doi:10.1007/BF02229066.
Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jone, K., et al. (2005). Suicide after non-suicidal self-injury: a 4-year cohort study. American Journal of Psychiatry, 162(2), 297–303. doi:10.1176/appi.ajp.162.2.297.
Cotton, C., Peters, D., & Range, L. (1995). Psychometric properties of the Suicidal Behaviors Questionnaire. Death Studies, 19(4), 391–397.
Croyle, K. (2007). Self-harm experiences among Hispanic and non-Hispanic White young adults. Hispanic Journal of Behavioral Sciences, 29(2), 242–253. doi:10.1177/0739986307299452.
D’Zurilla, T. J., & Chang, E. C. (1995). The relations between social problem solving and coping. Cognitive Therapy and Research, 19(5), 547–562. doi:10.1007/BF02230513.
D’Zurilla, T. J., & Sheedy, C. F. (1991). Relation between social problem-solving ability and subsequent level of psychological stress in college students. Journal of Personality and Social Psychology, 61(5), 841–846. doi:10.1037/0022-3514.61.5.841.
D’Zurilla, T., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social problem solving inventory–revised: technical manual. Multi-Health Systems: North Tonawanda.
Daly, A., Jennings, J., Beckett, J. O., & Leashore, B. R. (1995). Effective coping strategies for African Americans. Social Work, 40(2), 240–248.
Del Pilar, J. A. (2009). Mental health and Latino/a college students: a psychological perspective and new findings. Journal of Hispanic Higher Education, 8(3), 263–281. doi:10.1177/1538192708328891.
Dixon, W. A., Heppner, P. P., & Anderson, W. P. (1991). Problem-solving appraisal, stress, hopelessness, and suicide ideation in a college population. Journal of Counseling Psychology, 38(1), 51–56.
Dreer, L., Berry, J., Little, T., et al. (2009). Efficient assessment of social problem-solving abilities in medical and rehabilitation settings: a Rasch analysis of the Social Problem-Solving Inventory-Revised. Journal of Clinical Psychology, 65(7), 653–669.
D'Zurilla, T. J., & Nezu, A. (1982). Social problem solving in adults. In P. C. Kendall (Ed.), Advances in cognitive-behavioral research and therapy (Vol. 1, pp. 201–274). New York: Academic Press.
Garlow, S. J., Purselle, D., & Heninger, M. (2005). Ethnic differences in patterns of suicide across the life cycle. American Journal of Psychiatry, 162(2), 319–323.
Garlow, S., Rosenberg, J., Nemeroff, C., et al. (2008). Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depression and Anxiety, 25(6), 482–488.
Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M., & Bunney, W. E. (Eds.). (2002). Reducing suicide: a national imperative. Washington (DC): National Academy Press.
Goodman, S. H., Gravitt, G. W., & Kaslow, N. J. (1995). Social problem solving: a moderator of the relation between negative life stress and depression symptoms in children. Journal of Abnormal Child Psychology, 23(4), 473–485.
Gratz, K. (2001). Measurement of non-suicidal self-injury: Preliminary data on the Non-suicidal self-injury Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. doi:10.1023/A:1012779403943.
Grover, K., Green, K., Pettit, J., Monteith, L., Garza, M., & Venta, A. (2009). Problem solving moderates the effects of life event stress and chronic stress on suicidal behaviors in adolescence. Journal of Clinical Psychology, 65(12), 1281–1290. doi:10.1002/jclp.20632.
Gutierrez, P., Osman, A., Kopper, B., Barrios, F., & Bagge, C. (2000). Suicide risk assessment in a college student population. Journal of Counseling Psychology, 47(4), 403–413.
Hawkins, D., Sofronoff, K., & Sheffield, J. (2009). Psychometric properties of the social problem solving inventory-revised short-form: is the short form a valid and reliable measure for young adults? Cognitive Therapy and Research, 33(5), 462–470.
Hawton, K., & Harriss, L. (2007). Non-suicidal self-injury in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. Journal of Clinical Psychiatry, 68(10), 1574–1583.
Hawton, K., & Harriss, L. (2008). How often does non-suicidal self-injury occur relative to each suicide? A study of variations by gender and age. Suicide and Life-threatening Behavior, 38(6), 650–660. doi:10.1521/suli.2008.38.6.650.
Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E., & Bond, A. (2003). Non-suicidal self-injury in Oxford, 1990-2000: a time of change in patient characteristics. Psychological Medicine, 33(6), 987–995. doi:10.1017/S0033291703007943.
Heppner, P. P. (2008). Expanding the conceptualization and measurement of applied problem solving and coping: from stages to dimensions to the almost forgotten cultural context. American Psychologist, 63(8), 805–816. doi:10.1037/0003-066X.63.8.805.
Heron, R. L., Twomey, H. B. J. D. P., & Kaslow, N. J. (1997). Culturally competent interventions for abused and suicidal African American women. Psychotherapy, 34(4), 410–424.
Heron, M., Hoyert, D.L., Murphy, S.L., Xu, J., Kochanek, K.D., & Tejada-Vera, B. (2009). Deaths: final data for 2006, 57(14), 1–52.
Hilt, L., Nock, M., Lloyd-Richardson, E., & Prinstein, M. (2008). Longitudinal study of non-suicidal self-injury among young adolescents: rates, correlates, and preliminary test of an interpersonal model. Journal of Early Adolescence, 28(3), 455–469. doi:10.1177/0272431608316604.
Hirsch, J. K., Duberstein, P., Conner, K. R., Heisel, M. J., Beckman, A., & Conwell, Y. (2006). Future orientation and suicide ideation and attempts in depressed adults ages 50 and over. American Journal of Geriatric Psychiatry, 14, 752–757.
Husain, M., Waheed, W., & Husain, N. (2006). Self-harm in British South Asian women: psychosocial correlates and strategies for prevention. Annals of General Psychiatry, 5, 5–7. doi:10.1186/1744-859X.
Ittenbach, R., & Harrison, P. (1990). Predicting ego-strength from problem-solving ability of college students. Measurement and Evaluation in Counseling and Development, 23(3), 128–136.
Kaslow, N., Thompson, M., Meadows, L., Chance, S., Puett, R., Hollins, L., et al. (2000). Risk factors for suicide attempts among African American women. Depression and Anxiety, 12, 13–20.
Kaslow, N. J., Webb, A. P., Wyckoff, S., Bender, M. G., Sherry, A., Young, S., et al. (2004). Person factors associated with suicidal behavior among African American women and men. Cultural Diversity and Ethnic Minority Psychology, 10(1), 5–22. doi:10.1037/1099-9809.10.1.5.
Konick, L., & Gutierrez, P. (2005). Testing a model of suicide ideation in college students. Suicide and Life-threatening Behavior, 35(2), 181–192.
Latimer, S., Covic, T., Cumming, S., & Tennant, A. (2009). Psychometric analysis of the Self-Harm Inventory using Rasch modelling. BMC Psychiatry, 53, 1–9.
Lent, R. W., Brown, S. D., & Larkin, K. C. (1984). Relation of self-efficacy expectations to academic achievement and persistence. Journal of Counseling Psychology, 31(3), 356–362. doi:10.1037/0022-0167.31.3.356.
Lincoln, K. D., Chatters, L. M., & Taylor, R. J. (2005). Social support, traumatic events, and depressive symptoms among African Americans. Journal of Marriage and Family, 67(3), 754–766.
Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristic and functions on non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192. doi:10.1017/S003329170700027X.
Mahadevan, S., Hawton, K., & Casey, D. (2010). Non-suicidal self-injury in oxford university students, 1993–2005: a descriptive and case–control study. Social Psychiatry and Psychiatric Epidemiology, 45(2), 211–219. doi:10.1007/s00127-009-0057-x.
McAuliffe, C., Corcoran, P., Keeley, H., Arensman, E., Bille-Brahe, U., de Leo, D., et al. (2006). Problem-solving ability and repetition of non-suicidal self-injury: a multicentre study. Psychological Medicine, 36(1), 45–55. doi:10.1017/S0033291705005945.
McLaughlin, J., Miller, P., & Warwick, H. (1996). Non-suicidal self-injury in adolescents: hopelessness, depression, problems and problem-solving. Journal of Adolescence, 19(6), 523–532. doi:10.1006/jado.1996.0051.
Muehlenkamp, J. J., & Gutierrez, P. M. (2004). An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life-threatening Behavior, 34(1), 12–23. doi:10.1521/suli.34.1.12.27769.
NCHS (2004). Deaths: final data for 2002. U.S. Department of Health and Human Services.
Orbach, I., Bar-Joseph, H., & Dror, N. (1990). Styles of problem solving in suicidal individuals. Suicide and Life-threatening Behavior, 20, 56–64.
Osman, A., Bagge, C., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclincal samples. Assessment, 8, 443–454.
Overholser, J. (1995). Cognitive-behavioral treatment of depression, part II: techniques for improving social functioning. Journal of Contemporary Psychotherapy, 25(3), 205–222. doi:10.1007/BF02306629.
Oyserman, D., Coon, H., & Kemmelmeier, M. (2002). Rethinking individualism and collectivism: evaluation of theoretical assumptions and meta-analyses. Psychological Bulletin, 128, 3–72.
Pollock, L., & Williams, J. (2004). Problem-solving in suicide attempters. Psychological Medicine, 34(1), 163–167. doi:10.1117/S0033291703008092.
Printz, B. L., Shermis, M. D., & Webb, P. M. (1999). Stress buffering factors related to adolescent coping: a path analysis. Adolescence, 34, 715–734.
Sadowski, L. S., & Kelley, M. L. (1993). Social problem solving in suicidal adolescents. Journal of Consulting & Clinical Psychology, 61, 121–127.
Sansone, R., Wiederman, M., & Sansone, L. (1998). The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. Journal of Clinical Psychology, 54(7), 973–983. doi:10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H.
Sansone, R. A., Songer, D. A., & Sellbom, M. (2006). The relationship between suicide attempts and low lethal self-harm behavior among psychiatric inpatients. Journal of Psychiatric Practice, 12, 148–152. doi:10.1097/00131746-200605000-00003.
Skowron, E. A. (2004). Differentiation of self, personal adjustment, problem solving, and ethnic group belonging among persons of color. Journal of Counseling and Development, 82, 447–456.
Storch, E. A., Roberti, J. W., & Roth, D. A. (2004). Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depression and Anxiety, 19(3), 187–189. doi:10.1002/da.20002.
Sue, S., & Okazaki, S. (1990). Asian-American educational achievements: a phenomenon in search of an explanation. American Psychologist, 45, 913–920.
Suicide Prevention Resource Center. (2004). Promoting mental health and preventing suicide in college and university settings. Newton: Education Development Center.
Thompson, P. C., Anderson, L. P., & Bakeman, R. A. (2000). Effects of racial socialization and racial identity on acculturative stress in African American college students. Cultural Diversity and Ethnic Minority Psychology, 6(2), 196–210. doi:10.1037/1099-9809.6.2.196.
Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., House, A., & Van Heeringen, K. (2001). The efficacy of problem-solving treatments after non-suicidal self-injury: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine, 31(6), 979–988. doi:10.1017/S0033291701004238.
Triandis, H. C., Marín, G., Lisansky, J., & Betancourt, H. (1984). Simpatía as a cultural script of Hispanics. Journal of Personality and Social Psychology, 47(6), 1363–1375. doi:10.1037/0022-3514.47.6.1363.
US Public Health Service (1999). The Surgeon General’s call to action to prevent suicide. Washington, D.C.
Vanderwerker, L. C., Chen, J. H., Charpentier, P., Paulk, M. E., Michalski, M., & Prigerson, H. G. (2007). Differences in risk factors for suicidality between African American and white patients vulnerable to suicide. Suicide & Life-Threatening Behavior, 37, 1–9.
Wilcox, H., Arria, A., Caldeira, K., Vincent, K., Pinchevsky, G., & O'Grady, K. (2010). Prevalence and predictors of persistent suicide ideation, plans, and attempts during college. Journal of Affective Disorders, 127(1–3), 287–294.
Yang, B., & Clum, G. A. (1994). Life stress, social support, and problem solving skills predictive of depressive symptoms, hopelessness and suicide ideation in an Asian student population: a test of a model. Suicide & Life-Threatening Behavior, 24, 127–139.
Yeh, C. J., Arora, A. K., & Wu, K. A. (2006). A new theoretical model of collectivistic coping. In P. T. P. Wong & L. C. J. Wong (Eds.), Handbook of multicultural perspectives on stress and coping (pp. 55–72). New York: Springer Publishing Company.
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Walker, K.L., Hirsch, J.K., Chang, E.C. et al. Non-Suicidal Self-Injury and Suicidal Behavior in a Diverse Sample: The Moderating Role of Social Problem-Solving Ability. Int J Ment Health Addiction 15, 471–484 (2017). https://doi.org/10.1007/s11469-017-9755-x
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DOI: https://doi.org/10.1007/s11469-017-9755-x