Non-suicidal Self-injury in the Over 40s: Results from a Large National Epidemiological Survey Graham Martin 1* and Sarah Swannell 2 1 Department of Psychiatry, Child and Adolescent Psychiatry, The University of Queensland, Brisbane, Australia 2 Department of Psychiatry, The University of Queensland, Brisbane, Australia * Corresponding author: Graham Martin, Professor Mental Health Centre, Royal Brisbane and Women’s Hospital, Herston, Brisbane, Queensland, 4006, Australia, Tel: +61 400080489; E-mail: g.martin@uq.edu.au Received date: August 16, 2016; Accepted date: September 20, 2016; Published date: September 27, 2016 Copyright: © 2016 Martin G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract 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. Keywords: Non-suicidal self-injury; Self-harm; Older adults; Demographics; Epidemiology Introduction Non-suicidal self-injury (NSSI) is reported by patients in mental health units [1,2] and people in the community [3,4]. Media reports ofen suggest an ‘epidemic’ with ever increasing numbers [5,6]. However, recent meta-analyses [7,8] have shown this to be unfounded, apparent increases resulting from increasing construct specifcity in research reports, and more comprehensive, focused questionnaires. A large Australian epidemiological study [9] found overall lifetime community prevalence across all ages of 8.1%, with 1.1% claiming deliberate self-injury without suicidal intent in the month prior to survey. NSSI was carefully defned based on international best practice [10,11]. A large proportion of self-injurers also reported episodes of suicidality (thoughts and suicide attempts) confrming overlap between NSSI and ‘deliberate self-harm’, a term referring to self-harm irrespective of suicidal intent [12]. Te implication NSSI may be a marker or risk factor for later suicide is of major public health concern given increasing international focus on prevention [13]. NSSI predominantly has an onset in early adolescence [14,15], peaks in young adulthood [4,9] and thereafer declines. International researchers have focused on adolescents in school-based studies [16-19] and young adults attending college or university [20-22]. In an extensive search, we could fnd little research into NSSI focused specifcally on older people. Yet this group raises important questions. Does NSSI ever begin in adulthood rather than in adolescence or young adulthood? If so, what factors precipitate this behavior, and are underlying dynamics the same as for younger initiators? Does NSSI in adults who continue to self-injure from adolescence into adulthood, serve the same purposes as in younger people? Can we discern what factors perpetuate the problem and, conversely, what factors might assist adults to cease NSSI? Finally, are older self-injurers diferent to younger self-injurers on psychiatric history, suicidality, treatment seeking or help-seeking? Tree research studies on NSSI reference older people. In an ofen cited epidemiological paper, Briere et al. (1998) [23] reported three studies of self-injurers (a national community study, a clinical sample, and a specifc sample of self-injurers). Te community study, a US survey of the Trauma Symptom Inventory (TSI), included responses to a single question specifc to NSSI ‘over the last six months’, with three Epidemiology: Open Access Martin and Swannell, Epidemiology (Sunnyvale) 2016, 6:5 DOI: 10.4172/2161-1165.1000266 Research Article OMICS International Epidemiology (Sunnyvale), an open access journal ISSN:2161-1165 Volume 6 • Issue 5 • 1000266 E p i d e m i o l o g y : O p e n A c c e s s ISSN: 2161-1165