Elsevier

Journal of Affective Disorders

Volume 294, 1 November 2021, Pages 857-863
Journal of Affective Disorders

Does neighbourhood identification buffer against the effects of socioeconomic disadvantage on self-harm?

https://doi.org/10.1016/j.jad.2021.07.103Get rights and content

Highlights

  • Socioeconomic disadvantage is associated with greater risk of self-harm

  • Identification with one's neighbourhood is associated with lower risk of self-harm

  • Neighbourhood identification did not buffer the effects of disadvantage

  • Social and systemic risk factors for self-harm require greater consideration

Abstract

Background: Socioeconomic disadvantage and lack of group belonging (i.e., social identity) have been linked to poor mental health. However, no research has investigated the relationship between neighbourhood identity and self-harm, nor whether identifying with one's neighbourhood can mitigate the effects of economic stress on self-harm.

Methods: Pre-registered secondary data analysis of a large (N = 3412) community health survey conducted in disadvantaged areas of North West England.

Results: Despite the sample having a relatively high and therefore restricted level of disadvantage, individual and geographic indicators of disadvantage, as well as neighbourhood identification, were unique and strong predictors of self-harm thoughts and behaviours across several analyses. Specifically, experiencing disadvantage and disidentification predicted significantly higher odds of self-harm and self-harm thoughts. No consistent interactive effects emerged.

Limitations: The cross-sectional design limits firm conclusions regarding causal effects of neighbourhood identity and disadvantage on self-harm. However, causal direction is supported by past research and theory. The data is self-report, which is subject to response bias. The sample was also recruited from a region of the UK with low numbers of residents from ethnic minority backgrounds.

Conclusions: The results are consistent with past research indicating an association between social identity and better mental health, but for the first time extend these effects to self-harm. The findings demonstrate the importance of considering social and economic factors when attempting to prevent suicide and understand and treat self-harm thoughts.

Section snippets

Participants

A total of 3,412 participants completed the survey; 1,490 identified as male and 1,922 identified as female. Ten per cent of the sample were from Black and Minority Ethnic (BME) backgrounds and the remaining 90% were from White ethnic backgrounds. The mean age of the sample was 49.37 years (SD = 18.91). Participants were compensated with a £10 voucher for their participation.

Design and sampling

The study is a secondary analysis of the NIHR ARC North West Coast Household Health Survey. This is a two-wave survey, although only the second wave of data (2018) is included in the present study because self-harm and neighbourhood identity were not measured in wave 1 (2015). In-person surveys were conducted with members of the public living in 19 disadvantaged neighbourhoods of North West England between August and December 2018. Neighbourhoods map approximately onto electoral ward boundaries

Patient and public involvement

A public advisory panel was involved in the development of the survey design and materials. Public advisors with lived experience of mental distress also sat on the Household Health Survey Implementation Group, which oversaw the survey administration and consulted on survey modifications between waves 1 and 2. A public advisor with experience of self-harm contributed to the present research questions and preparation of the manuscript and is therefore named as a co-author.

Neighbourhood identification

Neighbourhood identification was measured with the Four Item Social Identity Scale (FISIS; Postmes et al., 2013). The scale taps key components of social identity such as commitment (“I feel committed to my local neighbourhood”) and centrality (“Being part of my local neighbourhood is an important part of how I see myself”). The scale has good reliability and correlates highly with more comprehensive measures of social identification (Postmes, Haslam, & Jans, 2013). Response options range from

Socioeconomic disadvantage

Socioeconomic disadvantage was measured at the individual level and neighbourhood level. Subjective person-level disadvantage was based on a single-item inquiring about people's current financial situation, which they could describe as "doing well", "getting by", or "struggling". For the purposes of the present study, and to aid in the interpretation of the predicted interactive effects, this variable was dichotomised by collapsing the "getting by" and "struggling" categories (1 = struggling or

Self-harm behaviours and thoughts

For self-harm behaviour, participants indicated if they had “deliberately hurt yourself in the past 12 months” (0 = no, 1 = yes). Self-harm thoughts were assessed with item nine of the Patient Health Questionnaire (PHQ9; Kroenke et al., 2001). Participants indicated the extent to which they had been bothered by “Thoughts that you would be better off dead, or of hurting yourself in some way” over the past two weeks. Due to the extremely high level of skewness (S-W = .92, p < .00001) and to

Demographics

Age was recorded in years, ethnicity was coded as 0 = White background, 1 = BME background, and gender was coded as 1 = male, 2 = female.

Analysis plan

The study hypotheses and analysis plan were pre-registered prior to being undertaken (https://osf.io/amkuv). Analyses were undertaken using STATA version 12 (StataCorp, 2011). Unadjusted bivariate relationships were examined with point-biserial correlations. Logistic regression was used to estimate the relationship between self-harm behaviours and thoughts (in both cases, 1 = present, 0 = absent) and the variables of interest with strengths of association reported as odds ratios. Clustering by

Missing data analysis

Missing data analysis indicated very low levels of missing data at the variable and participant level. For the multi-item scale (neighbourhood identity), missing values analysis indicated that eleven participants (< .01%) had missing data for more than 20% of the items. As such, these participants were excluded from subsequent analyses in-line with the pre-registration plan. This resulted in a final sample size of N = 3401. Following this step, we conducted variable level missing values

Preliminary analyses and descriptive statistics

Four hundred and ninety-one participants (14.7%) reported thoughts of self-harm in the previous two weeks and 91 participants (2.8%) reported self-harm behaviours. Mean levels of neighbourhood identification were above the mid-point of the five-point scale (M = 3.60, SD = .94) and 719 participants (21.2%) indicated that they were “doing well” financially, relative to “struggling” or “getting by”. Eighty-one per cent of participants were in the most disadvantaged quintile based on IMD scores (M

Logistic regression analyses

A series of weight- and cluster-adjusted logistic regressions were conducted to examine the predictors of self-harm thoughts and behaviours. All coefficients and confidence intervals are reported in Tables 1, 2, 3, 4, 5 to 6. Predictors were entered in separate steps for every model, with socioeconomic status (SES) entered at Step 1 (Model A), neighbourhood identity at Step 2 (Model B) the interaction between neighbourhood identity and SES at Step 3 (Model C), and the demographic covariates

Self-harm thoughts (Tables 1 to 3)

Model 1, which assessed neighbourhood identity and IMD as predictors, found that at Step 1, IMD was a significant predictor of self-harm thoughts. Specifically, each one-point increase in IMD was associated with 2% higher odds of reporting self-harm thoughts. At Step 2, neighbourhood identity was also a significant predictor of self-harm thoughts. Each one-point increase in neighbourhood identity was associated with 24% lower odds of reporting self-harm thoughts. The interaction term did not

Self-harm behaviours (Tables 4 to 6)

In Model 4, IMD was a significant predictor of self-harm behaviours at Step 1. Each one-point increase in IMD was associated with 3% higher odds of self-harming. Neighbourhood identity was also a significant predictor of self-harm behaviours at Step 2. Each one-point increase in identification was associated with 41% lower odds of reporting self-harm behaviours. The interaction term was not significant at Step 3, but was significant at Step 4 when adjusting for demographic covariates. The

Discussion

The aim of this study was to investigate the association between neighbourhood identification, socioeconomic disadvantage and self-harm thoughts and behaviour. The study benefits from a large, locally representative sample, and pre-registered hypotheses and analysis plan. Lower neighbourhood identification and greater socioeconomic disadvantage were associated with self-harm across the analyses. The hypothesised interaction between identity and disadvantage was not evident in any analyses.

The

Declaration of competing interests

None

The role of funding source

This research is part funded by the National Institute for Health Research Applied Research Collaboration North West Coast (ARC NWC). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. The funding body had no role in any aspect of this study, including the design, data collection, analysis, interpretation, and write up.

Acknowledgement

Nothing to report

Ethical Statement

Ethical approval: Ethical approval was obtained from the University of Liverpool (Ref: RETH000836). Participants provided written informed consent prior to taking part in the study.

Availability of data and materials Users can obtain access to the ARC NWC HHS data files after submitting a brief proposal (including agreement to HHS’ conditions of use) at [[email protected]]. Users will also be required to outline which version of the survey dataset they wish to access, data security arrangements in

References (61)

  • K. Visser et al.

    Neighbourhood deprivation effects on young people's mental health and well-being: a systematic review of the literature

    Soc. Sci. Med.

    (2021)
  • K.L. Batejan et al.

    Sexual orientation and non-suicidal self-injury: a meta-analytic review

    Arch. Suicide Res.

    (2015)
  • N.R. Branscombe et al.

    Perceiving pervasive discrimination among African Americans: implications for group identification and well-being

    J. Pers. Soc. Psychol.

    (1999)
  • B. Bromage et al.

    Project connect: a community intervention for individuals with mental illness

    Am. J. Psychiatric Rehabilit.

    (2017)
  • M.J. Carr et al.

    The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001–2013

    BMC Psychiatry

    (2016)
  • C. Chu et al.

    The interpersonal theory of suicide: a systematic review and meta-analysis of a decade of cross-national research

    Psychol. Bull.

    (2017)
  • T. Cruwys et al.

    Depression and social identity: an integrative review

    Pers. Soc. Psychol. Rev.

    (2014)
  • D. Daukantaitė et al.

    What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up

    Eur. Child Adolesc. Psychiatry

    (2020)
  • Department for Communities and Local Government, 2015. The English Index of Multiple Deprivation (IMD) 2015 –...
  • A. Elahi et al.

    Home is where you hang your hat: host town identity, but no hometown identity, protects against mental health symptoms associated with financial stress

    J. Soc. Clin. Psychol.

    (2018)
  • C. Giebel et al.

    The longitudinal NIHR ARC North West Coast Household Health Survey: exploring health inequalities in disadvantaged communities

    BMC Public Health

    (2020)
  • S.J. Goldman-Mellor et al.

    Suicide attempt in young people: a signal for long-term health care and social needs

    JAMA Psychiatry

    (2014)
  • E. Griffin et al.

    The association between self-harm and area-level charatceristics in Northern Ireland: an ecological study

    Eur. J. Public Health

    (2019)
  • D.J. Gunnell et al.

    Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation

    BMJ

    (1995)
  • P. Hasking et al.

    A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure

    Cognit. Emot.

    (2017)
  • C. Haslam et al.

    Groups 4 Health reduces loneliness and social anxiety in adults with psychological distress: findings from a randomized controlled trial

    J. Consult. Clin. Psychol.

    (2019)
  • K. Hawton et al.

    The influence of the economic and social environment on deliberate self-harm and suicide: an ecological and person-based study

    Psychol. Med.

    (2001)
  • R.M. Hill et al.

    Evaluating the interpersonal needs questionnaire: comparison of the reliability, factor structure, and predictive validity across five versions

    Suicide Life Threat. Behav.

    (2015)
  • J.M. Hooley et al.

    Why do people hurt themselves? A new conceptual model of nonsuicidal self-injury

    Clinical Psychological Science

    (2017)
  • M.A. Hughes et al.

    This corrosion: a systematic review of the association between alternative subcultures and the risk of self-harm and suicide

    Br. J. Clin. Psychol.

    (2018)
  • Cited by (5)

    View full text