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Could a brief assessment of negative emotions and self-esteem identify adolescents at current and future risk of self-harm in the community? A prospective cohort analysis

Rhiannon Phillips16*, Melissa R Spears2, Alan A Montgomery3, Abigail Millings4, Kapil Sayal5 and Paul Stallard1

Author Affiliations

1 Department for Health, University of Bath, 22-23 Eastwood, Claverton Down, Bath BA2 7AY, UK

2 School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK

3 Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, Queen’s Medical Centre, South Block, Nottingham NG7 2UH, UK

4 Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TP, UK

5 Division of Psychiatry and Institute of Mental Health, University of Nottingham, Nottingham NG7 2UH, UK

6 Institute of Primary Care & Public Health, Cardiff University, School of Medicine, Heath Park, Neuadd Meirionnydd, Cardiff CF14 4YS, UK

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BMC Public Health 2013, 13:604  doi:10.1186/1471-2458-13-604

Published: 22 June 2013



Self-harm is common in adolescents, but it is often unreported and undetected. Available screening tools typically ask directly about self-harm and suicidal ideation. Although in an ideal world, direct enquiry and open discussion around self-harm would be advocated, non-psychiatric professionals in community settings are often reluctant to ask about this directly and disclosure can be met with feeling of intense anxiety. Training non-specialist staff to directly ask about self-harm has limited effects suggesting that alternative approaches are required. This study investigated whether a targeted analysis of negative emotions and self-esteem could identify young adolescents at risk of self-harm in community settings.


Data were collected as part of a clinical trial from young people in school years 8–11 (aged 12–16) at eight UK secondary schools (N = 4503 at baseline, N = 3263 in prospective analysis). The Short Mood and Feelings Questionnaire, Revised Child Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, personal failure (Children’s Automatic Thoughts Scale), and two items on self-harm were completed at baseline, 6 and 12 months.


Following a process of Principal Components Analysis, item reduction, and logistic regression analysis, three internally reliable factors were identified from the original measures that were independently associated with current and future self-harm; personal failure (3 items), physical symptoms of depression/anxiety (6 items), positive self-esteem (5 items). The summed score of these 14 items had good accuracy in identifying current self-harm (AUC 0.87 girls, 0.81 boys) and at six months for girls (0.81), and fair accuracy at six months for boys (AUC 0.74) and 12 months for girls (AUC 0.77).


A brief and targeted assessment of negative emotions and self-esteem, focusing on factors that are strongly associated with current and future self-harm, could potentially be used to help identify adolescents who are at risk in community settings. Further research should assess the psychometric properties of the items identified and test this approach in more diverse community contexts.

Self-harm; Screening; Adolescents; Negative emotions; Self-esteem