On Wednesday 27th March at 12pm (GMT) we held our monthly online journal club session to discuss a recent systematic review, which focused on “Self-harm in older adults: systematic review” led by our netECR member, M. Isabela Troya and colleagues .
Here are some notes from thoughts shared in our discussion, kindly summarised by Donna Littlewood.
Overview of paper
This systematic review of 40 qualitative and quantitative papers indicated that self-harm in older adults (aged 60 years+) has distinct characteristics when comparing the literature to younger populations. Typically, this population can have frequent contact with health care services in relation to their physical and mental comorbid conditions. Thus, this represents a clear opportunity for detection and prevention of self-harm and suicide within this population.
Methodological points discussed by the group:
1. Involvement of a Patient and Public Involvement and Engagement (PPIE) group.
How were the group involved in relation to the systematic review?
There were a series of workshops with 3 core PPIE members, in which the following was covered:
- Reviewed the SR protocol, and specifically the definitions used for ‘self-harm’ and ‘older adults’.
- Presented 5 articles from the search to the group for their comments. They felt that ‘NSSI’ and ‘attempted suicide’ are different, with different motivations, and hence could be something which is examined via subgroup analyses within the review
- Presented the identified studies, and descriptive findings for group discussion, to understand how they interpreted the findings. The research team then co-developed a model with the group, to illustrate the review findings.
- The group were also consulted on the thematic analysis presented in the review, and a dissemination leaflet which aimed to summarise the results from the review. The group made a series of suggestions, which led to revisions of the leaflet to include a more lay appropriate definition of self-harm, and additional support service contact details.
Isabela’s tips for PPIE
- Refer to the NIHR’s commissioning group for Patient and Public Involvement and Engagement, Involve, to see the available resources on how to involve PPIE in a systematic review
- Ensure group members have access to appropriate support should they become distressed or upset through their involvement in the PPIE group. Moreover, it is important to ensure wellbeing of both PPIE members and researchers involved. For this project, a clinician was involved in the group meetings.
You will be able to hear more from Isabela about PPIE as she is currently preparing a manuscript which documents the involvement of the PPIE group in support of her PhD work.
2. Inclusion of quantitative AND qualitative studies, with quality assessment of reported studies
Collectively the group complimented Isabela on the review, in which she provided a detailed, rich overview of both quantitative and qualitative studies. The review was nice to read, and neatly used the quality assessment to summarise the strength of the evidence for each of the identified risk factors which were implicated in self-harm repetition.
Findings from the review discussed by the group:
- Motivations of self-harm in older adults- this was addressed in the three qualitative studies included in the review, which all classified self-harm as attempted suicide. This was something the PPIE group commented on, the absence of literature on other studies with no connotation of self-harm as linked to suicide.
- Prevalence of self-harm in older adults- The PPIE group believed the rates to be an underestimation of prevalence, and indicated that future research should be conducted with those that don’t present to hospital. In Isabela’s wider PhD research, participants from the qualitative study reported that they do not always present to hospitals when engaging in self-harm behaviour. Negative staff attitudes to people who self-harm is one of the barriers to accessing care, which has also been noted in different populations. Older adults also reported prioritising their chronic physical comorbidities over their mental health. They believe that the GP wouldn’t have the expertise to deal with their self-harm, so would prioritise the conditions that they would be able to help with. The compounding impact of multiple stigmas amongst the group was also discussed. Further information on the findings from Isabela’s PhD exploring self-harm in older adults can be found in Isabela’s upcoming publications which are currently in process of being reviewed for publication.