Self-harm: the questions we need to ask
Medical, social, educational and public health services need to understand and address self-harm.
Since the early 1990s national UK surveys have sensitively collected information about experiences of non-suicidal self-harm, suicidal thoughts, and suicide attempts. What can we learn from these existing data sources?
This week sees the publication of a report on suicide and self-harm in Britain, funded by the NIHR Policy Research Programme and drawing on the voices of more than 230,000 people. We analysed data from interviews with men and women, across age and income groups, conducted over two decades in more than twenty different surveys. People answered questions about their health, work, and communities; their experiences of loss, worry, and loneliness; and they disclosed whether they thought about suicide or had self-harmed.
What factors are associated suicidal thoughts and self-harm?
Findings revealed that many different aspects of people’s health, social and economic lives were linked with whether they had suicidal thoughts or self-harmed. We found dose-response relationships: where the more of any one risk someone was exposed to, the more likely it was they were to self-harm. We also found evidence of ‘cumulative’ risk, with greater burden associated with the combination of multiple different stresses.
As expected, mental health was a pervasive theme, with both symptoms of depression and symptoms of anxiety playing independent roles. Relationships emerged as crucial, in terms of the number of people someone felt close to as well as the quality of those relationships. Stressful or traumatic events across the life course - like abuse, divorce, or discrimination - and economic insecurity, through chronic precarity as well as sudden financial shocks, were key contextual risk factors. Physical health conditions were also linked with higher levels of risk, especially when they limited how able people felt to work or socialise, or when they meant someone experienced pain. Those with problematic patterns of drinking and smoking were also identified as higher risk groups.
There are few surprises here. Many of these themes have emerged in other studies, in Britain and elsewhere. What is so powerful however, is this very consistency across so many periods and populations. The surveys we analysed covered adults living in their own homes, as well as looked after children, those who were homeless, and people in prisons. While rates of suicidal thoughts and attempts varied greatly between these groups, these same key themes - of health, social and economic context - mattered across the board.
What are the characteristics of people who take their own lives?
By linking survey data to mortality outcomes we were also able to look at the characteristics of people who at some later point - even many years later - went on to take their own life. Consistent with suicide registration data they were more likely to be men, and they tended to be under fifty when interviewed. The most pervasive risk these people shared was the presence of a diagnosed mental disorder. But beyond that, relatively little set them apart. While they tended to have fewer qualifications and be unemployed at the time of the interview, some had degrees or were in work when interviewed. They were more likely to smoke, although that is something many people do.
We know that many aspects of our lives are associated with self-harm and suicide. We can use these broad patterns, alongside other more focused research, to inform and target suicide reduction activities. But knowing these patterns does not mean we can always identify the individuals who will go on to take their own life. By responding to the needs of all at risk, we hope those at greatest risk are reached too.
How can we use data better to understand suicide and self-harm?
On 25 February, 2019, we are running an event to bring together people working with all kinds of data to understand suicide and self-harm better. Speakers from different disciplines and sectors will ask: how do we ensure we have the right data to address the new questions in suicide and self-harm reduction?
This includes ensuring surveys (like those analysed for this study) yield data that are:
- accessible and timely
- both comparable with the past and meaningful in the present, and
- address the gaps in what we know, such as around intentionality and social media.
It also means looking to data from many other sources – including health and financial services – to ensure our understanding is current, builds insight on causality, and better captures regional variation and nuance. This event forms part of NatCen’s 50th anniversary series.
By bringing together data commissioners, producers, analysts and users, we hope that this event can help facilitate collaborations and useful research.
In the UK, Samaritans can be contacted on 116 123 or email email@example.com
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.