Clinical and Psychosocial Stress Correlates of Self-Harm in Women: A Retrospective Cohort Study in the Forensic Mental Health Setting.

Para-suicidal behaviours and self-harm are commonly observed in mental health institutions, with women inpatients being particularly at risk. Little research has looked at characteristics of women engaging in self-harmful conduct beyond diagnostic and socio-demographic information. The current study investigated occurrences of self-harm over time in a large sample of women housed in forensic mental health units in the province of Ontario, Canada. Background and clinical information was obtained from staff ratings on the Resident Assessment Instrument-Mental Health at admission and every 3 months afterwards for an approximately 2-year time period. Latent class mixed models identified two distinct profiles, the first one (77.4% of sample) characterised by a low or intermittent use of self-harm, the second (22.6% of sample) showing a stable elevated risk profile. Women in the at-risk group tended to be younger, showed increased signs of subjective distress and greater occurrence of adverse life events in their history. Psychiatric diagnosis in itself was not a valid predictor of the stability of self-harm for this sample. These findings highlight the importance of addressing both clinical and stress-related distal vulnerability factors in the background of institutionalised women who engage in self-harm on a stable basis.