The association between COVID-19-related fear and reported self-harm in a national survey of people with a lifetime history of self-harm

Background
Relatively little is known about the characteristics of people living in the community who have previously self-harmed and may benefit from interventions during and after COVID-19. We therefore aimed to: (a) examine the relationship between reported self-harm and COVID-19-related fear, and (b) describe the characteristics of a community sample of people who reported a lifetime history of self-harm.

Methods
A cross-sectional national online survey of UK adults who reported a lifetime history of self-harm (n = 1029) was conducted. Data were collected May – June 2020. Main outcomes were self-reported COVID-19-related fear (based on the Fear of COVID-19 scale [FCV-19S]), lifetime history of COVID-19, and lifetime history of self-harm. Data were analysed using descriptive statistics and binary logistic regression. Chi-square was used to compare characteristics of our sample with available national data.

Results
Overall, 75.1, 40.2 and 74.3% of the total sample reported lifetime suicidal ideation, suicidal attempts and non-suicidal self-harm respectively. When adjusting for age, sex, ethnicity, social grade, and exposure to death and suicide, binary logistic regression showed higher levels of perceived symptomatic (or physiological) reactions to COVID-19 were associated with suicidal ideation (OR = 1.22, 95%CI 1.07, 1.39) and suicidal attempts (OR = 3.91, 95%CI 1.18, 12.96) in the past week.

Conclusions
Results suggest an urgent need to consider the impact of COVID-19 on people with a lifetime history of self-harm when designing interventions to help support people in reducing suicidal ideation and suicidal attempts. Experiencing symptomatic reactions of fear in particular is associated with self-harm. Helping to support people to develop coping plans in response to threat-related fear is likely to help people at risk of repeat self-harm during public health emergencies.