Clements Caroline, Bickley Harriet, Hawton Keith, Geulayov Galit, Waters Keith, Ness Jennifer, Kelly Samantha, Townsend Ellen, Appleby Louis, Kapur Nav
Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Br J Psychiatry. 2025 Jul;227(1):456-462. doi: 10.1192/bjp.2024.215.
Suicide in women in the UK is highest among those in midlife. Given the unique changes in biological, social and economic risk factors experienced by women in midlife, more information is needed to inform care.
To investigate rates, characteristics and outcomes of self-harm in women in midlife compared to younger women and identify differences within the midlife age-group.
Data on women aged 40-59 years from the Multicentre Study of Self-harm in England from 2003 to 2016 were used, including mortality follow-up to 2019, collected via specialist assessments and/or emergency department records. Trends were assessed using negative binomial regression models. Comparative analysis used chi-square tests of association. Self-harm repetition and suicide mortality analyses used Cox proportional hazards models.
The self-harm rate in midlife women was 435 per 100 000 population and relatively stable over time (incident rate ratio (IRR) 0.99, < 0.01). Midlife women reported more problems with finances, alcohol and physical and mental health. Suicide was more common in the oldest midlife women (hazard ratio 2.20, < 0.01), while psychosocial assessment and psychiatric inpatient admission also increased with age.
Addressing issues relating to finances, mental health and alcohol misuse, alongside known social and biological transitions, may help reduce self-harm in women in midlife. Alcohol use was important across midlife while physical health problems and bereavement increased with age. Despite receiving more intensive follow-up care, suicide risk in the oldest women was elevated. Awareness of these vulnerabilities may help inform clinicians' risk formulation and safety planning.
在英国，中年女性的自杀率在各年龄段女性中是最高的。鉴于中年女性在生物、社会和经济风险因素方面经历的独特变化，需要更多信息来为护理工作提供依据。
调查中年女性与年轻女性相比的自我伤害发生率、特征及后果，并确定中年年龄组内的差异。
使用了2003年至2016年英格兰自我伤害多中心研究中40至59岁女性的数据，包括截至2019年的死亡率随访数据，这些数据通过专业评估和/或急诊科记录收集。使用负二项回归模型评估趋势。比较分析采用卡方关联检验。自我伤害重复率和自杀死亡率分析采用Cox比例风险模型。
中年女性的自我伤害率为每10万人435例，且随时间相对稳定（发病率比（IRR）为0.99，<0.01）。中年女性在财务、酒精以及身心健康方面报告了更多问题。自杀在年龄最大的中年女性中更为常见（风险比为2.20，<0.01），同时社会心理评估和精神科住院治疗也随年龄增加。
解决与财务、心理健康和酒精滥用相关的问题，以及已知的社会和生物转变问题，可能有助于减少中年女性自我伤害的发生。饮酒问题在整个中年阶段都很重要，而身体健康问题和丧亲之痛则随年龄增加。尽管年龄最大的女性接受了更密集的随访护理，但其自杀风险仍然较高。了解这些脆弱性可能有助于临床医生进行风险评估和制定安全计划。
