Psychological Correlates of Self-Harm Ideation Among Depressive Outpatients: The Roles of Rumination and Depressive Symptom Severity

Self-harm is a prevalent and clinically significant concern among individuals experiencing depressive symptoms. However, differences in psychological profiles between depressive outpatients with and without self-harm ideation remain poorly understood. To address this gap, the present study examined emotional and cognitive factors associated with self-harm ideation among depressive outpatients. A total of 164 depressive outpatients with a current or past major depressive episode were recruited from public hospitals in Hong Kong. Participants completed standardized self-report measures assessing self-harm ideation, depressive and anxiety symptoms, and rumination. Compared with those without self-harm ideation, individuals reporting self-harm ideation exhibited significantly greater symptom severity, higher rumination, and more pronounced negative affect. Rumination was positively associated with self-harm ideation, whereas the association with reflective thinking was not statistically significant. Depressive symptom severity moderated the relationship between rumination and self-harm ideation, such that the association was stronger at lower levels of depressive symptoms. These findings suggest that distinct emotional and cognitive profiles characterize depressive outpatients who report current self-harm ideation and that the association between rumination and self-harm ideation may vary according to depressive symptom severity.