Meaning in Life, Self-Esteem, and Self-Harm Among Adult Depressive Patients at a Thai University Hospital

Objective: We aimed to study the prevalence of self-harm in the adult population with depressive disorder and its association with risk and protective factors; especially self-esteem and meaning in life. Material and Methods: This cross-sectional study recruited 128 depressive outpatients that visited Siriraj Hospital from July to October 2021 and were willing to participate. Data was collected through self-reports via six online questionnaires; including sociodemographic data, a self-harm behavior questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Screening Instrument for Borderline Personality Disorder (SI-Bord), the Revision of Rosenberg Self-Esteem Scale (Revised RSES) and the Meaning in Life Questionnaire (MLQ). Data was analyzed using bivariate and multivariate logistic regression. Results: The one-year prevalence of self-harm in adult depressive patients was 39.84% (N=51). Significant risk factors for self-harm included: younger age (Mann-Whitney U= 828.0, p-value<0.001), low education (X2=4.337, p-value=0.037), substance use (X2= 9.862, p-value=0.002), more depressive symptoms (X2=9.407, p-value=0.009), suicidal ideation (X2=17.212, p-value<0.001) and borderline personality disorder traits (X2=10.334, p-value=0.001). Protective factors included: high self-esteem (Mann-Whitney U=1315.5%, p-value=0.002) and meaning in life (X2=15.633, p-value=0.001). Conclusion: The high prevalence of self-harm in adults with depressive disorder emphasizes the need for greater awareness. Identifying significant risk factors is crucial for effective intervention. Promoting self-esteem and meaning in life should be considered a key protective strategy to reduce the risk of self-harm and suicide in this population.