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Background: Research has identified functions of non-suicidal self-harm/self-injury (NSSH) but whether functions change over time, from adolescence to early adulthood, or predict the continuation of the behaviour prospectively remains unclear. This study aimed to prospectively explore whether intrapersonal and interpersonal NSSH functions in adolescence predict repetition of self-harm (regardless of suicidal intent) and incident suicide attempts in early adulthood. Methods: Participants were 528 individuals with NSSH at age 16 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the UK. Descriptive statistics were used to explore changes in functions over time from age 16 to 21, and logistic regression used to examine associations between NSSH functions and repeat self-harm and suicide attempts at age 21, 24 and 25 years. Findings: The majority of 16-year-olds with NSSH endorsed intrapersonal (e.g., affect regulatory) functions only (73% at 16 years and 64% at 21 years). Just under half of adolescents (42%) and three quarters of 21 years olds reported more than one function simultaneously. A greater number of intrapersonal functions at 16 years independently predicted future repetition of self-harm at ages 21-25 years, over and above interpersonal functions (OR=1.46, 95% CI 1.06 to 2.01). Interpersonal functions during adolescence did not predict repeat self-harm or suicide attempts in adulthood. Discussion: Our findings suggest that intrapersonal but not interpersonal NSSH functions are a prospective risk factor for future self-harm and might also predict incident suicide attempts. The results highlight the central role of underlying affective difficulties and motivations in self-harm maintenance.

Background: Young adults and especially those with pre-existing mental health conditions, such as disordered eating and self-harm, appear to be at greater risk of developing metal health problems during the COVID-19 pandemic. However, it is unclear whether this increased risk is affected by any changes in lockdown restrictions, and whether any lifestyle changes could moderate this increased risk. Methods: In a longitudinal UK-based birth cohort (The Avon Longitudinal Study of Parents and Children, ALSPAC) we assessed the relationship between pre-pandemic measures of disordered eating and self-harm and mental health during the COVID-19 pandemic in 2657 young adults. Regression models examined the relationship between self-reported disordered eating, self-harm, and both disordered eating and self-harm at age 25 years and depressive symptoms, anxiety symptoms and mental wellbeing during a period of eased restrictions in the COVID-19 pandemic (May–July 2020) when participants were aged 27–29 years. Analyses were adjusted for sex, questionnaire completion date, pre-pandemic socioeconomic disadvantage and pre-pandemic mental health and wellbeing. We also examined whether lifestyle changes (sleep, exercise, alcohol, visiting green space, eating, talking with family/friends, hobbies, relaxation) in the initial UK lockdown (April–May 2020) moderated these associations. Results: Pre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with the reporting of a higher frequency of depressive symptoms and anxiety symptoms, and poorer mental wellbeing during the pandemic compared to individuals without disordered eating and self-harm. Associations remained when adjusting for pre-pandemic mental health measures. There was little evidence that interactions between disordered eating and self-harm exposures and lifestyle change moderators affected pandemic mental health and wellbeing. Conclusions: Young adults with pre-pandemic disorde

Depression is a significant global problem and is among the leading causes of disability worldwide. Depression in children and adolescents is associated with wide-ranging impairments and often marks the beginning of a lifelong, chronic illness. Early treatment and prevention of depression is therefore a major public health concern. Parental depression is one of the most consistently identified risk factors for depression in young people. Although depression is a highly heterogeneous disorder, most studies examining cross-generational depression risk have simply dichotomised parents into ‘depressed’ and ‘non-depressed’ groups and clinical characteristics beyond diagnostic status are rarely presented. In this thesis I examine how differences in clinical features of parental depression including variations in depression course, severity, timing and symptom manifestation differentially relate to offspring depression risk. Data were drawn from the Early Prediction of Adolescent Depression study. A three-wave longitudinal study of the offspring of 337 parents with a history of recurrent unipolar depression. Within this high risk group of offspring, specific clinical features of parental depression were identified that may serve as useful markers of current and/or future offspring depression risk. These included a recent episode of clinical depression, an episode involving severe impairment or hospitalisation and symptoms of appetite or weight loss. In addition, findings from this thesis highlight that there is considerable variability in the course of parent depression over time and suggest that any persistent symptoms of depression in parents, even those at low levels, may be clinically important in indexing offspring risk for depression symptoms. vi Findings highlight the importance of considering clinical characteristics of depression in parents beyond diagnostic status when examining cross-generational depression risk. The identification of subgroups of offspring who

Depression is a significant global problem and is among the leading causes of disability worldwide. Depression in children and adolescents is associated with wide-ranging impairments and often marks the beginning of a lifelong, chronic illness. Early treatment and prevention of depression is therefore a major public health concern. Parental depression is one of the most consistently identified risk factors for depression in young people. Although depression is a highly heterogeneous disorder, most studies examining cross-generational depression risk have simply dichotomised parents into ‘depressed’ and ‘non-depressed’ groups and clinical characteristics beyond diagnostic status are rarely presented. In this thesis I examine how differences in clinical features of parental depression including variations in depression course, severity, timing and symptom manifestation differentially relate to offspring depression risk. Data were drawn from the Early Prediction of Adolescent Depression study. A three-wave longitudinal study of the offspring of 337 parents with a history of recurrent unipolar depression. Within this high risk group of offspring, specific clinical features of parental depression were identified that may serve as useful markers of current and/or future offspring depression risk. These included a recent episode of clinical depression, an episode involving severe impairment or hospitalisation and symptoms of appetite or weight loss. In addition, findings from this thesis highlight that there is considerable variability in the course of parent depression over time and suggest that any persistent symptoms of depression in parents, even those at low levels, may be clinically important in indexing offspring risk for depression symptoms. vi Findings highlight the importance of considering clinical characteristics of depression in parents beyond diagnostic status when examining cross-generational depression risk. The identification of subgroups of offspring who