in more negative ways, which may have introduced bias in the association seen between depressed mood and self-harm, particularly self-harm with intent to die. A third problem, relating to the face validity of the questionnaire, is that approximately 10% of those who had wanted to die during the most recent episode of self-harm had never had thoughts of killing themselves. This indicates that for some respondents ticking ‘I wanted to die’ as a reason for their most recent self-harm did not necessarily mean they were trying to kill themselves - it may be that for this group the self-harm was a reaction to the misery they were experiencing, but was not an attempt to fulfil their desire to die. Therefore the distinction made in this paper between those who wanted to die and those who did not during the most recent self-harm act, although a useful indication of the most serious cases of self-harm, is not exactly equivalent to a distinction between suicide attempts and NSSI.
