The interaction between coping styles with relationship breakdowns, loss, and conflict and the frequency of self-harm thoughts and behaviours: a longitudinal analysis of 21,581 UK adults

Background: Relationship breakdowns or conflict are frequent precipitants for self-harm thoughts and behaviours, but the majority who experience these stressful life events do not think about or engage in self-harm. Understanding factors that attenuate or exacerbate this risk is therefore needed. The aim of this paper is to investigate whether relationship breakdowns, loss, and conflict lead to more frequent self-harm thoughts and behaviours. We also examine whether coping styles and neuroticism, posited by diathesis-stress models of suicide risk to interact with these events, attenuate or exacerbate the risk for self-harm thoughts and behaviours from these events. Methods: This study utilised data collected during the COVID-19 pandemic, which acted as a natural experiment by leading to a greater prevalence of relationship breakdowns than usual. Data from 21,581 adults who participated in the UCL COVID-19 Social Study between 28 February 2021 and 4 April 2022 were utilised. Poisson regression models which controlled for socio-demographics and a diagnosed mental health condition were used to examine the impact of four predictor variables (separation or divorce, family problem, an ‘other’ relationship breakdown [e.g., friend or colleague], and the death of a close relative or friend) with the number of times self-harm thoughts and behaviours were reported over the study period. Interactions between these events and coping styles (problem-focused, emotion-focused, socially supported, and avoidant coping) were also examined. Results: Variables representing relationship breakdowns, loss, and conflict were associated with an increased frequency of self-harm thoughts (incidence rate ratio [RRR] range: 1.04 to 1.77) and behaviours (RRR range: 1.48 to 1.96). The use of more avoidant coping strategies (e.g., substance use, denial) increased the risk for both outcomes but unexpectedly attenuated associations between predictor variables and self-harm thoughts. Socially supported coping increased the likelihood of both outcomes, but not in sensitivity analyses which excluding ‘venting’ from the scale. Problem-focused coping strategies (e.g., active planning) attenuated the impact of separation or divorce and having had a family problem on the frequency of self-harm behaviours. Conclusions: Findings underscore the importance of interpersonal loss and conflict for the frequency of thinking about and engaging in self-harm and suggest that the magnitude of these associations may depend on different coping styles.