Lifetime abuse and self-harm in people with severe mental illness: A structural equation model

We tested the hypothesis that lifetime physical and sexual abuse would have direct effects on self-harm (i.e., thoughts of self-harm, self-harming behaviors, and suicide attempts) and indirect effects on self-harm via negative appraisals of trauma and psychiatric symptoms in a sample of 242 clients with severe mental illness (SMI). Structural equation modeling partly confirmed our expectations. Although there was no direct effect between abuse and self-harm, abuse and self-harm appear to be fully mediated by negative appraisal and psychiatric symptoms. Limitations to this study include the cross-sectional nature of the research, which precludes firm causal inferences regarding the relationships among these factors. Longitudinal designs are needed to understand better the direct and indirect effects of abuse on people with SMI.