Factors associated with non-suicidal self-injury (NSSI): An exploration of rumination and biphobia

Abstract

The aim of this thesis was to explore associations between rumination and biphobia with non-suicidal self-injury (NSSI). The thesis consists of three papers: 1) a systematic review and meta-analysis, 2) an empirical study, and 3) a critical appraisal of the research process. The review paper (Paper 1) is a meta-analysis and narrative synthesis of the association between rumination and NSSI. Thirty-nine studies were included, with meta-analyses grouped by rumination type (depressive, transdiagnostic, anger, brooding, catastrophising, overall) and NSSI type (history and frequency). Narrative syntheses of adjusted associations and longitudinal studies were also conducted, to allow for a comprehensive review of the literature. Rumination was found to have a small to moderate positive association with NSSI and the narrative syntheses yielded mixed findings. In light of these results, it is suggested that therapies including strategies to manage rumination may be beneficial for NSSI, but other risk factors may be more important. It has been suggested that state rumination may be more associated with NSSI than trait rumination. As the studies included in the review measured trait rumination, more research focused on state rumination is needed. The empirical paper (Paper 2) is focused on young bisexual people, who are a high risk group for NSSI. The paper uses a micro-longitudinal design to explore the associations between rumination and biphobia with NSSI urges over a six week period. This allowed for associations to be explored at the same time point and with the predictors lagged by one week. A total of 207 participants were recruited to the study. Results suggest that both rumination and biphobia are associated with NSSI urges in young bisexual people, although only rumination remained significant when covariates were included in the lagged model. This suggests that rumination-focused therapies for NSSI may be beneficial for young bisexual people. In addition, it is important for biphobic discrimination to be targeted and for professionals to have an awareness of the unique difficulties faced by bisexual people. Future research including a non-bisexual comparison group is needed to investigate any differences between groups. Furthermore, research should focus on testing a rumination-focused therapy for this population. Finally, Paper 3 is a critical reflection of the research process. The paper provides further detail on how the studies were developed and designed. In addition, the challenges that were faced and the decision making processes that took place are discussed. Strengths and limitations of the research and personal reflections are included throughout.

Date of Award	31 Dec 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Peter Taylor (Supervisor)