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Affiliation
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Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; Dementia Centre for Research Collaboration and Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia. |
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Abstract
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OBJECTIVES: To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care.
DESIGN: A qualitative study using in-depth interviews. SETTING: Participants were recruited from two teaching hospitals and associated community services. PARTICIPANTS: People aged 80 years or older who had self-harmed within the previous month.
METHODS: Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO.
RESULTS: Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment".
CONCLUSIONS: Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated.
Copyright © 2018 American Association for Geriatric Psychiatry. All rights reserved.
Language: en |