Self-harm in midlife: an analysis using data from the Multicentre Study of Self-harm in England

Background: Suicide rates in England are highest in men and women in midlife (defined here as people aged 40-59 years). Despite the link between self-harm and suicide there has been little focus on self-harm in this age-group. Method: Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data on self-harm presentations 2000-2013 were collected via specialist assessments or hospital records. Trends were assessed using negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition of self-harm and suicide mortality were assessed using Cox proportional hazards models. Results: A quarter of self-harm presentations were made by people in midlife (n=24,599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio (IRR) 1.07; 95%CI 1.02-1.12; p<0.01) and were positively correlated with national suicide incidence rates (r=0.52, p=0.05). Rates in women remained relatively stable (IRR 1.00; 95%CI 1.00-1.02; p=0.39) and not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men, while indicators of poor mental health were more common in women. Twelve-month repetition was 25% in men and women, and during follow-up 2.8% of men and 1.2% of women died by suicide. Conclusion: People in midlife who self-harm represent a key target for intervention. Addressing underlying mental health issues, alcohol use, and economic factors—potentially working with organisations offering advice on employment, housing and debt—may help prevent further self-harm and suicide.