‘But as I said, you try to hide it’. Self-harm in older adults- a hidden problem. A qualitative study

Problem

Self-harm is a major public health concern worldwide. In older people, the risk of suicide following self-harm is higher when compared to younger populations. Methods and patterns of self-harm in older adults have been shown to vary compared to younger populations. However, there is limited qualitative evidence exploring motivations for self-harm, and access to care and support for self-harm in older people. This study aimed to increase the understanding of self-harm behaviour in older adults (>60 years) by exploring: i) motivations and barriers to self-harm ii) barriers and facilitators to access to care iii) role of different sources of support (including primary care).

Approach

Ethical approval obtained. Semi-structured in-depth interviews were conducted with two participant groups: older adults who self-harm and third sector support workers. Participants were recruited throughout England using local site and social media advertising and contact with national self-harm support groups. Interviews digitally recorded with consent and transcribed verbatim. Data were analysed using a framework analysis approach. A Patient and Public Involvement and Engagement (PPIE) group was involved in developing the research question, the study design, analysis and interpretation of findings.

Findings

Initial results from the on-going analysis suggest five main themes:i) self-harm in older adults as a hidden problem, concealed by the individual, due to stigmaii) psychosocial stressors, such as loss, health problems contribute to self-harm behaviouriii) self-harm as an ‘addictive’ cycle, the behaviour precipitated by distress, then temporarily relieved by the action of self-harmiv) difficulties accessing care, with people reporting repeated attempts to seek help before acceptable support is found v) the complex role of support workers when dealing with people who self-harm.

Consequences

nitial analysis suggests that self-harm in older adults remains a problem largely hidden from statutory services, including primary care. Self-harm behaviour is described as ‘addictive’ and a ‘vicious cycle’ precipitated by a variety of life stressors. Stigma often prevents help-seeking. Persistent and repeated requests seem to be needed before help is found, with people finding it difficult to access support from statutory services such as primary care. Third sector groups offer support to older adults who self-harm but this is often limited: these groups are not available in every locality and may be commissioned on a short-term basis. Third sector workers describe limited resources, limited training, and lack of supervision to work with people who self-harm. Given that self-harm in older people may be comorbid with other mental and physical health conditions, thus there is a potential role for primary care clinicians to identify self-harm, and offer support and management to older people who self-harm, and potentially prevent further deterioration in mental health and possible suicide.