Elaborating the Cry of Pain model of suicidality: testing a psychological model in a sample of first-time and repeat self-harm patients

Abstract

Objectives. Few studies have specifically tested the Cry of Pain model (Williams, 2001). This model conceptualises suicidal behaviour as a behavioural response to a stressful situation which has three components: defeat, no escape potential, and no rescue. In addition, the model specifies a mediating role for entrapment on the defeat-suicidal ideation relationship, and a moderating role for rescue factors on the entrapment-suicidal ideation relationship. This is the first study to investigate the utility of this psychological model in a sample of first-time and repeat self-harm (SH) patients. Method. One hundred and thirteen patients who had been admitted to hospital following an episode of SH (36 first-time, 67 repeat) and 37 hospital controls completed measures of defeat, entrapment/escape potential, rescue (social support and positive future thinking), as well as depression, anxiety and suicidal ideation. Results. Analyses highlighted differences between the three participant groups on all of the Cry of Pain variables. Hierarchical regression analysis confirmed that total entrapment and internal entrapment mediated the relationship between defeat and suicidal ideation, whilst impaired ability to think positively about the future (but not social support) moderated the relationship between total and internal entrapment and suicidal ideation. Conclusions. The findings provide further empirical support for the Cry of Pain model. The findings are discussed in relation to theory and practice and we recommend that the findings are replicated within a prospective design.