Understanding pathways to self-harm and suicide ideation in high risk young people: an unmissable opportunity for suicide prevention.

Mental Health Research UK PhD Scholarship 2020 - University of Nottingham 

Supervisors: Professor Ellen Townsend and Professor Jon Arcelus

Lay Summary:

Understanding and responding effectively to self-harm is a vital element of suicide prevention since self-harm is the strongest predictor we have of death by suicide and is related premature death by other causes. Self-harm is complex and changes over time so we have developed the Card Sort Task for Self-Harm (CaTS) to examine how thoughts, feelings, behaviours and events lead to self-harm in high risk adolescents (those with eating disorders and transgender youth). Using novel statistical techniques, we can uncover the significant patterns amongst key factors (e.g. feeling depressed, behaving impulsively) in the months, weeks, days, hours and minutes leading up to self-harm, and what happens after. Three online studies will investigate (i) which key patterns act as warning signals that self-harm is imminent (ii) why some adolescents have thoughts of self-harm but do not act on them and (iii) why another behaviour is carried out sometimes rather than self-harm. Findings will have significant implications for models of, and treatments for, self-harm and suicidality.

Research Student: Katherine Bird, BSc, MSc

I obtained my BSc in Psychology and MSc in Psychological Wellbeing and Mental Health from Nottingham Trent University. I recently began my Mental Health Research UK PhD Scholarship investigating and understanding pathways to self-harm and suicide at the University of Nottingham. My research interests include suicide- and self-harm-related stigma, toxic masculinity and its impact on male help-seeking behaviours, and the development of effective suicide prevention interventions. Additionally, I am interested in social constructs regarding suicide and Mental Health conditions and how they promote or discourage help-seeking behaviours and interaction with Mental Health Services in different populations. In my spare time I love reading, hiking, cooking, and baking. 



Create a new online CaTS-E to examine the key patterns of thoughts, feelings, events and behaviours leading to enaction of self-harm in high risk young people (transgender young people and young people with disordered eating) compared to other young people who self-harm. 

Investigate the key transitions where thoughts do not proceed to action (ideation) (CaTS-I). 

Investigate the key transitions that lead to alternative behaviours which could be positive (e.g. yoga) or negative (e.g. bingeing or purging) using the CaTS-AB.

Katherine Bird photo.jpg

Progress Report Year 1, 2021

This past year was the first of my PhD so was a training year.  Therefore, I undertook several modules which would help me develop the skills necessary to complete my PhD.  These were: Systematic Reviews; Individual and Group Differences; Advanced Methods in Psychology; and Professional Skills in Behavioural Science.  These spanned the whole year and involved weekly lectures and at least one assignment.  These assignments varied including academic essays, research articles, and short presentations of my work to a non-academic audience.  They all required me to think about research from multiple perspectives and write accordingly.  I achieved high academic grades in all modules so feel confident I have learnt and further-developed skills that will aide my research during and beyond my PhD. 


The two high-risk youth groups which are the focus of my PhD are transgender youth and young people with disordered eating.  Understanding factors associated with each groups self-harm and suicidal behaviour is essential to understanding each groups pathway.  Therefore, I began a systematic review during which I will review existing evidence of risk and protective factors for self-harm and suicidal behaviour in transgender youth.  I have a similar review planned for later in my PhD for young people with disordered eating. 


The next step of my PhD is to begin developing an online version of an existing card sort tasks for self-harm (CaTS; see Figure 1 for example).  This task was developed previously and allows young people to describe their individual pathway to self-harm using 117-cards with concepts associated with self-harm.  During my PhD I will use my newly-developed online version of CaTS to investigate factors present in the pathway to self-harm and suicide ideation in each high-risk youth group.  The aim is to identify group-specific targets which can be addressed during intervention.  I have begun investigating the suitability of different software and have recently been advised of a team within the University of Nottingham which can support me in developing the online CaTS.


Figure 1. An example of the Card Sort Task for Self-Harm (CaTS)


This year I presented my research at several conferences, including MHRUK’s Scholar’s Day.  These were great opportunities to create presentations aimed at either academic or non-academic audiences and present them accordingly.  I also attended several online conferences.  They were great because I heard from researchers with similar research interests.  This inspires me to consider how other techniques or methods may be suited to my research.  Finally, despite being online, these conferences were great networking opportunities and I have begun building relationships with people with similar research interests who I can collaborate with in future.