Self-harm in women in midlife: rates, precipitating problems and outcomes following hospital presentations in the multicentre study of self-harm in England

Clements, Caroline; Bickley, Harriet; Hawton, Keith; Geulayov, Galit; Waters, Keith; Ness, Jennifer; Kelly, Samantha; Townsend, Ellen; Appleby, Louis; Kapur, Nav

Abstract

Background
Suicide in women in the UK is highest among those in midlife. Given the unique changes in biological, social and economic risk factors experienced by women in midlife, more 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, collected via specialist assessments and/or 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 relatively stable over time (incident rate ratio (IRR) 0.99, p < 0.01). Midlife women reported more problems with finances, alcohol and physical and mental health. Suicide was more common in the oldest midlife women (hazard ratio 2.20, p < 0.01), while psychosocial assessment and psychiatric inpatient admission also increased with age.

Conclusion
Addressing issues relating to finances, mental health and alcohol misuse, alongside known social and biological transitions, may help reduce self-harm in women in midlife. Alcohol use was important across midlife while physical health problems and bereavement increased with age. Despite receiving more intensive follow-up care, suicide risk in the oldest women was elevated. Awareness of these vulnerabilities may help inform clinicians’ risk formulation and safety planning.

Citation

Clements, C., Bickley, H., Hawton, K., Geulayov, G., Waters, K., Ness, J., Kelly, S., Townsend, E., Appleby, L., & Kapur, N. (2025). Self-harm in women in midlife: rates, precipitating problems and outcomes following hospital presentations in the multicentre study of self-harm in England. British Journal of Psychiatry, https://doi.org/10.1192/bjp.2024.215

• Journal Article Type: Article
• Acceptance Date: Sep 25, 2024
• Online Publication Date: Jan 15, 2025
• Publication Date: Jan 15, 2025
• Deposit Date: Oct 4, 2024
• Publicly Available Date: Jul 16, 2025
• Journal: British Journal of Psychiatry
• Print ISSN: 0007-1250
• Electronic ISSN: 1472-1465
• Publisher: Cambridge University Press
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1192/bjp.2024.215
• Public URL: https://nottingham-repository.worktribe.com/output/40289411
• Publisher URL: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/selfharm-in-women-in-midlife-rates-precipitating-problems-and-outcomes-following-hospital-presentations-in-the-multicentre-study-of-selfharm-in-england/D75F0892CEEAF8E82A0E2
• Additional Information: Copyright © The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists; License: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.; Free to read: This content has been made available to all.