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

Clements, C.; Hawton, K.; Geulayov, G.; Waters, K.; Ness, J.; Rehman, M.; Townsend, E.; Appleby, L.; Kapur, N.


C. Clements

K. Hawton

G. Geulayov

K. Waters

J. Ness

M. Rehman

L. Appleby

N. Kapur


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 [less than] 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. Twelvemonth 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.


Clements, C., Hawton, K., Geulayov, G., Waters, K., Ness, J., Rehman, M., …Kapur, N. (2019). Self-harm in midlife: an analysis using data from the Multicentre Study of Self-harm in England. British Journal of Psychiatry, 215(4), 600-607.

Journal Article Type Article
Acceptance Date Mar 12, 2019
Online Publication Date May 30, 2019
Publication Date 2019-10
Deposit Date Mar 18, 2019
Publicly Available Date May 30, 2019
Journal British Journal of Psychiatry
Print ISSN 0007-1250
Electronic ISSN 1472-1465
Publisher Cambridge University Press (CUP)
Peer Reviewed Peer Reviewed
Volume 215
Issue 4
Pages 600-607
Public URL
Publisher URL


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