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Objectives The central aim of the present study was to investigate the extent to which social cognitive variables could mediate the effects of past self-harm behaviour and clinical variables on intentions to engage in deliberate self-harm (DSH) and suicidality in the next three months. In addition, we aimed to extend the application of the theory of planned behaviour (TPB) beyond distal health outcomes to a behaviour that is proximal and extreme.

Design and method A prospective study design was employed. Ninety parasuicide patients admitted via accident and emergency to a general hospital completed measures of hopelessness, depression, anxiety, past self-harm behaviour, standard TPB and group identity measures within days of an overdose. Three months later, participants were asked to complete a measure of suicidal thinking and behaviour.

Results There was clear evidence that the social cognitive variables were significant predictors of intention to engage in DSH and suicidality three months later. Depression was the only clinical variable which remained significant when all variables were entered into the final model to predict intentions. Attitudes, self-efficacy and intention mediated the clinical variables-suicidality relationship.

Conclusions The TPB is a useful framework for understanding suicidal behaviour. The results extend the application of the TPB beyond distal health outcomes to a behaviour that is both proximal and extreme. Future research should explore the implications for screening assessment and suicide prevention.