Beurs, D. de, Vancayseele, N., Borkulo, C. van, Portzky, G., Heeringen, K. van
The association between motives, perceived problems and current thoughts of self-harm following an episode of self-harm: A network analysis.
Journal of Affective Disorders, 240 (2018) 11, p. 262-270.
A history of self-harm is a major risk factor for suicide. Some patients are more likely than others to repeat suicidal behaviour after an episode of self-harm. Insight in the relation between current thoughts of self-harm, motives for the self-harm episode and perceived problems may improve prevention strategies. Network analysis allows to investigate the co-occurence of these factors and their association with each other.

Methods
Ising model based networks are estimated on data collected between 2007–2015 within the Multicentre Study of Self-harm in Flanders. Patients were interviewed within 24 hours after hospitalization by a trained professional on their motives for the episode of self-harm and their perceived problems. Additionally, they were asked whether they had current thoughts of self-harm. Network analyses are used to determine which motives and problems are uniquely related to current thoughts of self-harm, and which are most central in the network.

Results
Data were used of 6068 patients (2279 males and 3789 females). Four internal motives (wish to die, lost control, escape from situation, situation was unbearable), one external motive (show somebody how hopeless I was) and four perceived problems (psychiatric, loneliness, trauma, rejection) are directly related to current thoughts of self-harm. Of all motives and problems, the motive a wish to die is most strongly related to current thoughts of self-harm. However, external motives are more central in the network when compared to internal motives and perceived problems.

Limitations
Data most probably refer to a selected group of self-harm patients as many individuals who self-harm do not come to the attention of hospital services. Patients might be reluctant to tell professionals they had current thoughts of self-harm.

Conclusions
Many internal motives and problems are directly related to current thoughts of self-harm, but external motives are more central in the network. The clinically most important motive (wish to die) does not play a central role in the network.