Understanding self-harm amongst people with PTSD: Clinical and psychological predictors and outcomes

Self-harm poses a significant global health and societal challenge. The lifetime prevalence of self-harm has increased by 4% in a fourteen year period (2000-2014) in England. There is a plethora of research that has established the relationship between self-harm behaviours and post-traumatic stress disorder (PTSD) symptoms.

Yet, limited evidence exists regarding the psychological and clinical predictors and outcomes in people who self-harm with PTSD, and the role of PTSD-related phenomena in maintaining self-harm over time.

This proposed project will address these evidence gaps through a series of work packages. The aim is to enhance the understanding of self-harm among people with PTSD including their needs and factors linked with self-harm behaviours. The objectives of this project are three-fold and will be addressed by each work package.

The first objective and work package will examine the needs, risk factors and prognosis between people who engage in self-harm behaviours with PTSD and those without. A matched case control study will be conducted using patient clinical records. People presenting with self-harm behaviours with PTSD will be compared to those without, matched on age and gender. A series of variables among the two groups will be compared.

The second objective and work package will identify the psychological predictors that contribute to self-harm in people with PTSD. An experience sampling method will be conducted to capture real-time triggers and processes such as symptoms that contribute to self-harm behaviours, ideation and methods.

The third objective and work package will identify the effectiveness of PTSD-related psychological interventions in reducing self-harm in those with PTSD. A systematic review and meta-analysis will be carried out and reported following established methods (e.g., Cochrane and PRISMA).

Embedded throughout the project will be a patient and public engagement group, established to contribute their expertise regarding the safety and methodological aspects of the work packages at various stages such as data collection processes, the sensitivity of language, and eligibility criteria.

The results of this project will improve characterisation of self-harm in people with PTSD, increase understanding of self-harm-related cognitions and momentary triggers, and potentially inform the development or refinement of more targeted trauma focused approaches for this population.

The results of this project will contribute to understanding the complex interplay between PTSD and self-harm and uncover the effectiveness of current trauma-focused clinical interventions for this population.