Epidemiology: Open Access

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Non-suicidal Self-injury in the Over 40s: Results from a Large National Epidemiological Survey

Graham Martin* and Sarah Swannell

Using data drawn from a national community study of Non-suicidal Self-injury (NSSI) in 12,006 Australians aged 10-100 years, we focused on 78 subjects aged ≥ 40 years (53 females, 25 males) reporting NSSI in the previous 12 months. Mean onset was 25.4 years (SD 14.66, range 5-60, mode 15 years), 60.3% beginning before 25 years. Seventeen people began self-injury after 40 (13 females (9.9%); 4 males (6%)). For the month prior, 19 older females claimed 1-50 episodes (mean 10.5), 9 males 1-28 episodes (mean 7.4). Compared to younger self-injurers, older self-injurers more likely had a psychiatric diagnosis (OR21.22, 95% CI [3.90, 115.52]), higher psychological distress (OR9.41, CI [1.73, 51.24]), and lifetime suicide attempts (38.2% to 28.0%, NS). However, younger self-injurers were more likely to report feeling suicidal in the previous four weeks (OR3.16, 95% CI [1.18,8.45]) with 80.0% (versus 55.8% of ≥ 40 years) scoring high on a brief suicidal ideation scale. Most common motivation for NSSI was ‘emotion regulation’, with self-injurers ≥ 40 years (68.6%) more likely to endorse this than <25 years (54.5%) (NS). Compared to those ceased for over two years, current older self-injurers reported higher psychological distress (OR2.39, 95% CI [1.06, 5.40]) and self-blame (OR3.79, CI [1.75, 8.21]). Respondents ≥ 40 years with no NSSI for two years (n=239) reported they had ‘grown up’ or ‘gotten over it’ (33.9%), ‘talked to a mental health professional’ (26.8%), ‘learned better ways to cope with stress’ (25.5%) and ‘received support from other people’ (25.1%). Only 25.7% asked for professional help. Barriers to help-seeking were ‘feeling as if their NSSI problem was not severe enough’ (29.7%), ‘feeling ashamed or embarrassed’ (24.3%), ‘feeling no-one would be able to help’ (21.6%) and ‘not wanting or needing help’ (21.6%). It appears NSSI in the over 40s reflects a hidden and very troubled group. The potential seriousness of self-injury in this group has implications for families, general practitioners, mental health clinicians, emergency departments, and community services.