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AbstractBackgroundSelf-harm is common, debilitating and associated with completed suicide and increased all-cause mortality, but there is uncertainty about its causal risk factors, limiting risk assessment and effective management. Neuroticism is a stable personality trait associated with self-harm and suicidal ideation, and correlated with coping styles, but its value as an independent predictor of these outcomes is disputed.MethodsPrior history of hospital-treated self-harm was obtained by record-linkage to administrative health data in Generation Scotland:Scottish Family Health Study (N = 15,798; self-harm cases = 339) and by a self-report variable in UK Biobank (N = 35,227; self-harm cases = 772). Neuroticism in both cohorts was measured using the Eysenck Personality Questionnaire-Short Form. Associations of neuroticism with self-harm were tested using multivariable regression following adjustment for age, sex, cognitive ability, educational attainment, socioeconomic deprivation, and relationship status. A subset of GS:SFHS was followed-up with suicidal ideation elicited by self-report (n = 3342, suicidal ideation cases = 158) and coping styles measured by the Coping Inventory for Stressful Situations. The relationship of neuroticism to suicidal ideation, and the role of coping style, was then investigated using multivariable logistic regression.ResultsNeuroticism was positively associated with hospital-associated self-harm in GS:SFHS (per EPQ-SF unit odds ratio 1.2 95% credible interval 1.1–1.2,pFDR0.0003) and UKB (per EPQ-SF unit odds ratio 1.1 95% confidence interval 1.1–1.2,pFDR9.8 × 10−17). Neuroticism, and the neuroticism-correlated coping style, emotion-oriented coping (EoC), were also associated with suicidal ideation in multivariable models.ConclusionsNeuroticism is an independent predictor of hospital-treated self-harm risk. Neuroticism and emotion-orientated coping styles are also predictive of suicidal ideation.

This investigation was supported by the Wellcome Trust 104036/Z/14/Z (STRADL, Stratifying Resilience and Depression Longitudinally). Generation Scotland received core funding from the Chief Scientist Office of the Scottish Government Health Directorate CZD/16/6 and the Scottish Funding Council HR03006. We thank all families, practitioners and the Scottish School of Primary Care involved in the recruitment process as well as the entirety of Generation Scotland team; interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, healthcare assistants and nurses. We are grateful towards the Dr Mortimer and Theresa Sackler foundation for the financial support for this work. This research has been conducted using the UK Biobank resource and we would therefore like to thank all participants and coordinators in this cohort. The UK Biobank study was conducted under generic approval from the NHS National Research Ethics Service (approval letter dated 17 June 2011. Ref 11/NW/0362). Samples from the English Longitudinal Study of Ageing DNA Repository (EDNAR), which receives support from the National Institute on Aging (NIA) and the Economic and Social Research Council (ESRC), were used in this study. We thank contributors and the ELSA participants. IJD is supported by MRC and BBSRC funding to the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology (MR/K026992/1). Supplementary Information accompanies the paper on the Translational Psychiatry website (http://www.nature.com/tp) ; Peer reviewed ; Publisher PDF