Abstract:BackgroundSelf-harm and suicide are major public health concerns. Self-harm is the strongest risk factor for suicide, with the highest suicide rates reported in older populations. Little is known about how older adults access care following self-harm, but they are in frequent contact with primary care.AimTo identify and explore barriers and facilitators to accessing care within primary care for older adults who self-harm.Design and settingAn exploratory qualitative methods study using semi-structured interview… Show more
“…All transcripts were coded by at least two of the authors and discussed amongst all authors.Fig. 2Summary of Data analysis process (from Troya et al, [21]). …”
Section: Methodsmentioning
confidence: 99%
“…Participants were excluded from taking part in the study if they lacked capacity to consent or could not understand or speak in English. For further information regarding steps followed for participant recruitment, see Troya et al [21]…”
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.
“…All transcripts were coded by at least two of the authors and discussed amongst all authors.Fig. 2Summary of Data analysis process (from Troya et al, [21]). …”
Section: Methodsmentioning
confidence: 99%
“…Participants were excluded from taking part in the study if they lacked capacity to consent or could not understand or speak in English. For further information regarding steps followed for participant recruitment, see Troya et al [21]…”
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.
“…Overwhelmingly there is a reluctance to seek help in people who self-harm across all ages, with stigma primarily affecting help-seeking (Long, 2018;Troya et al, 2019a). Lloyd, Blazely and Phillips (2018) argue that it is perceived stigma that prevents people who engage in self-harm from seeking help.…”
Section: Discussionmentioning
confidence: 99%
“…Yet despite this unitary definition self-harm remains an area where misconceptions and assumptions prevail. One of the most enduring assumptions is that self-harm is primarily undertaken by adolescents (Chandler, Myers & Platt, 2011;Troya et al, 2019a).…”
Section: Introductionmentioning
confidence: 99%
“…Murphy et al (2012) found the risk of suicide was 67 times higher among individuals 60 years and above presenting to hospital with self-harm relative to the general population and the risk of suicide in older adults was almost three times greater than the risk among young people presenting with self-harm. However, the notion that self-harm in older adults is largely associated with suicidal intent is questioned by Troya et al (2019aTroya et al ( , 2019bTroya et al ( , 2019c. Through their qualitative interviews with adults 60 years and above and third sector workers with experience of supporting older adults who self-harm they found older people used self-harm as coping mechanism throughout the life course (Troya et al, 2019a).…”
Purpose
Self-harm can affect people of all ages, yet the high prevalence rate in adolescents and the potential risk factor of suicide in adults 60 years and above has meant research has tended to focus within these areas. Therefore, the purpose of this exploratory study is to examine the experiences of self-harm in people from early adulthood to late middle age to gain greater insight and understanding in this underexplored area.
Design/methodology/approach
An online open-ended survey was used to collect the data from a UK user-led moderated online forum that supports people who self-harm.
Findings
Thematic data analysis indicates that feelings of shame and guilt were intensified, due to the double stigma participants face as adults that self-harm. Although most participants had seen a reduction in the frequency of their self-harm many experienced an increase in the severity of harm. In not fitting the assumed typical profile of someone that self-harm participants often struggled to gain formal support.
Research limitations/implications
This was a small-scale online survey; hence, it is not possible to generalise the findings to all adults who self-harm.
Practical implications
The findings from this research provide evidence that greater recognition needs to be given to the reality that self-harm can affect people of all ages. As a result, access to support needs to be widened as a means of supporting those who do not fit the typical profile of someone who self-harms.
Originality/value
This exploratory online study provides insights around the tensions and challenges facing adults that self-harm, which remains an under-researched and largely ignored area.
ObjectivesTo explore healthcare practitioners' views on management practices of self‐harm in older adults.MethodsSemi‐structured interviews were conducted with healthcare practitioners, including consultant psychiatrists, general practitioners, clinical psychologists, psychotherapists, clinical nurse specialists and social workers. Purposeful sampling was used to recruit participants in the Republic of Ireland ensuring diverse perspectives of healthcare practitioners were included. Healthcare practitioners were recruited advertising via professional and clinical research networks, social media, and snowballing methods. Interviews were audio‐recorded, transcribed verbatim, and analysed using reflexive thematic analysis.ResultsWe conducted interviews with 20 healthcare practitioners from April to July 2023. Three main themes were generated: first, a perceived greater risk of suicide, and increased awareness of complexity in older adults' self‐harm presentations. Second, integrated care as an avenue for improving the management of self‐harm in older adults. Third, the importance of safety planning in risk assessments of older adults.ConclusionsHealthcare practitioners viewed self‐harm in older adults as complex, challenging, and associated with high suicide risk, approaching patients with care and caution. The need for integrated support and improved collaboration between relevant healthcare practitioners was identified. Suggestions were made for primary care having a lead role in identifying and managing older adults after self‐harm. Increased mental health promotion and awareness of mental health and self‐harm in this age group would help address current stigma and shame.
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