Understanding self-harm in older adults: A qualitative study

Abstract

Background Self-harm is the leading risk factor for suicide, with elevated rates reported amongst older populations. This study explores how older adults experience self-harm, identifying factors leading to self-harm. Methods Semi-structured interviews with older adults (≥ 60 years) engaging in self-harm and support workers from third sector services in England. Older adults were invited to participate in a follow-up interview. Interviews were recorded, transcribed verbatim and data analysed thematically. Ethical approval obtained from Keele University's Ethics Review Panel. A Patient Involvement group contributed to study design, data analysis and interpretation. Outcomes Between September 2017 to September 2018, 24 interviews were conducted involving 16 participants: nine older adults and seven support workers. Eight older adults consented to follow-up interviews. All older adults reported diagnoses of mental illness in addition to physical illness. Participants identified diverse stressors accumulating over the life-course leaving older adults particularly vulnerable to self-harm. Such stressors included adverse events, loss, interpersonal and health problems. A sense of shame and stigma amongst older people using self-harm to manage distress was also reported. Interpretation Self-harm is often concealed due to stigma and shame, being further accentuated amongst older adults, which may result in low levels of medical help-seeking behaviour for self-harm. Self-harm occurred along a spectrum of no-suicidal intent to high-levels of intent, suggesting self-harm holds different functions to older adults. Clinicians should be aware of the existence of self-harm in this age-group, and the heightened risk amongst those with comorbidities so adequate assessment, support and/or referral is provided.

Role of primary care in supporting older adults who self-harm: a qualitative study in England

“…3,4 Furthermore, increased treatment costs exist when treating older adults who selfharm owing to complications caused by comorbidities. 5 The authors' previous work 6 suggests self-harm holds several functions for older adults and suicidal intent is not the only reason they engage in such behaviour, as traditionally reported. 4 Accounts of older adults using self-harm as a coping mechanism throughout the life course suggest the need for a more nuanced approach to intervening and providing support than one principally focused on suicide prevention.…”

The Violence of the Cut: Gendering Self-Harm

“…In terms of age, rates do seem higher among younger groups, and some studies suggest that most people who self-harm as teenagers stop by the time they are in their 30s [ 5 ]. However, studies also show that self-harm can begin in later life, or continue across the life course, and may be significantly under-reported among older groups [ 6 , 7 ]. Where studies engage with race (and often they do not), findings are varied—some studies in UK contexts find no evidence of patterns by ethnic group [ 3 ]; however, one study based in the Southern US found that the highest reported rates were among black males [ 8 ].…”

Child Sexual Abuse Victimization: Focus on Self-Compassion

“…In Liu et al's ( 45 ) review, a medium effect size was found for the relationship of CSA to non-suicidal self-injury. CSA was associated with an over 6-fold increase in repeated self-harm, with CSA being linked with loss and shame ( 46 ). Violent victimization is predictive of Indigenous boys' and girls' suicidal ideation and attempts ( 47 ), although CSA was not uniquely measured.…”