Understanding self-harm in older people: a systematic review of qualitative studies

Rates of suicide in older adults are generally higher than other age groups. Although risk factors for suicide attempts, and self-harm more generally, in this population are well-characterised, many of these vulnerabilities are common to older people and individual motivations are less well understood. Qualitative research may reveal more about the underlying thought processes, meaning and experiences of older people who self-harm.

A systematic review of qualitative studies examining the reasons why older people have self-harmed was undertaken by searching databases and screening the reference lists of articles. The quality of studies was critically appraised. A content analysis was performed to identify themes.

The search yielded eight studies of variable quality which met the inclusion criteria; three pertained to indirect self-harm (refusal to eat or take medications and self-neglect) and five related to suicidal behaviour. Themes emerging from the analysis of studies of people who had self-neglected included control, impaired decision-making and coping skills and threats to self-identity and continuity. In those who had suicidal behaviour, themes related to loss of and regaining control; alienation, disconnectedness and invisibility; meaningless and raison d'etre; and accumulated suffering and a 'painful life'.

There is scant literature evaluating self-harm in older people using qualitative methods. Nonetheless, this review suggests that active and passive self-harm should be considered as distinct entities as the underlying motivations and intents differ. Understanding individual perceptions and experiences which lead to self-harm may guide clinicians in delivering more sensitive, holistic interventions and counter ageism.