Troya M Isabela, Dikomitis Lisa, Babatunde Opeyemi O, Bartlam Bernadette, Chew-Graham Carolyn A
Research Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, Staffordshire ST5 5BG, United Kingdom.
School of Medicine, Keele University, David Weatherall Building, Staffordshire ST5 5BG, United Kingdom.
EClinicalMedicine. 2019 Jun 19;12:52-61. doi: 10.1016/j.eclinm.2019.06.002. eCollection 2019 Jul.
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.
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.
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.
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.
自我伤害是自杀的首要风险因素，据报道老年人群中的发生率有所上升。本研究探讨老年人如何经历自我伤害，确定导致自我伤害的因素。
对英格兰参与自我伤害的老年人（≥60岁）以及第三部门服务机构的支持人员进行半结构化访谈。邀请老年人参加后续访谈。访谈进行录音，逐字转录，并对数据进行主题分析。获得了基尔大学伦理审查小组的伦理批准。一个患者参与小组参与了研究设计、数据分析和解读。
在2017年9月至2018年9月期间，共进行了24次访谈，涉及16名参与者：9名老年人和7名支持人员。8名老年人同意参加后续访谈。所有老年人除身体疾病外还被诊断患有精神疾病。参与者指出，在人生历程中积累的各种压力源使老年人特别容易受到自我伤害。这些压力源包括不良事件、丧失、人际关系和健康问题。还报告了使用自我伤害来应对痛苦的老年人中存在羞耻感和污名化现象。
由于羞耻感和污名化，自我伤害往往被隐瞒，在老年人中这种情况更为突出，这可能导致自我伤害的医疗求助行为水平较低。自我伤害发生在从无自杀意图到高自杀意图的范围内，这表明自我伤害对老年人具有不同的功能。临床医生应意识到该年龄组中存在自我伤害现象，以及合并症患者中风险更高的情况，以便提供充分的评估、支持和/或转诊。
