General practitioner management of self-harm in young people in England: a qualitative study
Self-harm in young people is a national public health priority, and self-harm is the strongest risk factor for suicide. Rates of self-harm in young people presenting in primary care are increasing, and GPs have an important role in the management of young people who have harmed themselves. Young people have described varied experiences of GP care for self-harm, however, the clinical approaches of GPs to young people with self-harm behaviour, and the impact of COVID-19, has not previously been explored. This study aimed to seek the perspectives of GPs on presentation and management of self-harm in young people and how COVID-19 has impacted this.
Semi-structured remote interviews were conducted with GPs around England. Purposive sampling aimed for a maximum variation sample in participant age, gender, years in practice, employment role, and practice list size. Recruitment has been facilitated through four NIHR Local Clinical Research Networks. Interviews were audio-recorded and transcribed verbatim. Transcripts formed the data and inductive thematic analysis with principles of constant comparison is ongoing. A patient and public involvement group informed this study’s conception, have advised on recruitment techniques and the interview topic guide, and will contribute to interpretation of data and dissemination.
Nine interviews have so far been conducted. Preliminary findings suggest that GPs use a variety of strategies for managing young people who self-harm in the consultation including treating underlying mental illness and signposting. GPs have found that COVID-19 and remote consulting reduces the opportunity to identify non-verbal cues which can be critical in young people who self-harm.
The understanding of how GPs conceptualise and manage self-harm in young people and how COVID-19 has influenced this will inform clinical practice recommendations on the primary care management of young people with self-harm behaviour.