Self-harm in women in midlife: rates, precipitating problems, and outcomes following hospital presentations in the Multicentre Study of Self-harm in England.

C. Clements, H. Bickley, K. Hawton, G. Geulayov, K. Waters, J. Ness, S. Kelly, E. Townsend, L. Appleby, N. Kapur

Research output: Contribution to journalArticlepeer-review

Abstract

Background

Suicide in women in the UK is highest in those in midlife. Characteristics associated with self-harm are also known to differ from men in this age-group. Given the unique changes in biological, social, and economic risk factors typically experienced by women in midlife, more detailed information is needed to inform care.

Aim

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.

Method

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. Data were collected via specialist assessments or directly from 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.

Results

The self-harm rate in midlife women was 435 per 100,000 population and was relatively stable over time (incident rate ratio [IRR] 0.99, p<0.01). Midlife women reported more problems around finances, alcohol use, along with physical and mental health problems. Within-group comparisons showed suicide was more common in older women in midlife (Hazard Ratio [HR] 2.20, p<0.01). Intensity of clinical care, as measured by psychosocial assessment and psychiatric inpatient admission, also increased with age.

Conclusion

Addressing issues relating to finances, mental health and alcohol misuse, alongside the social and biological transitions associated with midlife, may help to reduce self-harm in women during this period. Alcohol misuse was important across all stages of midlife, whereas physical health problems and experiencing bereavement increased with age. Despite receiving more intensive follow-up care, the suicide risk in older midlife women was elevated, perhaps indicating the need for more targeted support. Awareness of these potential vulnerabilities may help inform clinicians’ risk formulation and safety planning.
Original languageEnglish
JournalBritish Journal of Psychiatry
Publication statusAccepted/In press - 25 Sept 2024

Fingerprint

Dive into the research topics of 'Self-harm in women in midlife: rates, precipitating problems, and outcomes following hospital presentations in the Multicentre Study of Self-harm in England.'. Together they form a unique fingerprint.
  • MaSH: Manchester Self-Harm Project

    Clements, C. (Researcher) & Donaldson, I. (Support team)

    1/04/97 → …

    Project: Research

Cite this