Sarah Butter, a final year PhD Researcher in the School of Psychology, along with her supervisors, Professor Jamie Murphy and Professor Mark Shevlin, recently had their paper “Negative self-evaluation and the genesis of internal threat: Beyond a continuum of suicidal thought and behaviour” published in Psychological Medicine.
The study, conducted as part of Sarah’s doctoral research, explored whether concepts such as low self-esteem, self-criticism, feelings of inadequacy and submissive behaviour, collectively termed ‘negative self-evaluation’ (NSE) could be incorporated into an existing Suicidality Continuum (comprising of self-injurious thoughts and behaviours only) that has been under investigation for some time. Additionally, the researchers were interested in identifying what the risks and outcomes were of occupying different points along this proposed continuum. Identification of a continuum inclusive of both NSE concepts and suicidal thoughts and self-harming behaviours potentially affords greater and more valuable opportunities for clinicians to identify suicide risk and intervene at the earliest possible time.
Using a series of robust analytic techniques to investigate the viability of this extended continuum in a general population sample (N = 8580), the study demonstrated that 7 groups of individuals with graded severity of NSE, suicidal ideation and self-harming behaviour emerged from the data. The composition of these groups captured variation from less severe NSE experiences to the most severe suicidality-related thoughts and behaviours. Of note, only one group emerged which was characterised by self-harm; this was the smallest group but had the highest probabilities for endorsing items related to low self-worth, subordination, depression and suicidal thoughts.
A series of sociodemographic, substance use, adversity and diagnostic variables were used to predict class membership. Of the adversity variables, sexual abuse and bullying were particularly relevant to class membership, corroborating previous research linking these traumas to suicidal ideation and self-harm. Furthermore, the study highlighted that membership of groups characterised by the more severe thoughts and behaviours (suicidal ideation and self-harm) were at an extremely elevated risk of having a number of psychiatric diagnoses including generalised anxiety disorder, panic disorder, psychosis and social phobia. This elevated risk status also extended to suicide attempts. Notably however, groups characterised by less severe experiences (i.e. low self-worth, subordination and depression only) were also at greater risk of having some of these disorders compared to individuals without these experiences.
The study was supportive of an extended suicidality continuum, inclusive of NSE. The findings support the literature that negative self-concepts are present across the spectrum of psychopathology and are seen in a range of mental health problems. NSE, therefore, is unlikely to be diagnostic specific but may instead be transdiagnostic, a relevant construct for psychopathology more generally. The study concludes that challenging NSE may be a fruitful avenue for therapeutic interventions that aim to reduce psychological distress, limit suicidal ideation and prevent self-harming behaviour and death by suicide.