The welcoming changes in self-harm research and next steps

By Katerina Kavalidou.

The linguistic and attitudinal changes within self-harm research have been very welcoming in the last years, with studies highlighting that through the last two decades suicide-specific journals, such as Crisis, Archives of Suicide Research, and Suicide and Life-Threatening Behavior have managed to reduce the use of stigmatising language for those with lived experience [1]. This change has been quite challenging, especially to those working early in the field, as few expressions used in their older studies to describe one’s suicide death or attempt were viewed as harmless, in contrast to now.

Significant changes have been also happening in the way we talk about prevention, as the medical model viewing self-harm as the only observable point of further suicide interventions has been transformed into a more holistic one, making suicidal ideation an additional and essential intervention target aiming to reduce any suicide-related pain and loss [2]. Although the calls to make suicidal thoughts an intervention point are more recent, the importance of it has been already seen through the analysis of self-harm surveillance systems, known to be the most effective source in establishing prevention strategies and highlighting risk groups [3].

Given the humanistic and psychosocial lens used in suicide-related research the past years, sociodemographic characteristics, such as ethnicity [4] and deprivation [5], much neglected previously, are now vital information when interpreting suicide/self-harm data and implementing suicide interventions. With further characteristics pinpointed as vital in researching high risk groups, such as being from the LGBTI community [6], living in a developing country with a low socioeconomic level [7] or being from an indigenous group/culture [8], self-harm research had made huge steps in leaving behind the medicalised way of viewing suicide-related pain, where only an illness/disorder played the sole role.

When examining the past attitudes of ‘we-the experts’ and ‘they-the participants/sample’, a major change has also been seen as a number of suicide-related researchers have employed a panel of people with lived experience providing valuable feedback on the way research should be conducted [often called a patient or service user, public involvement and engagement panel; 9]. This latter improvement along with the voices of researchers talking/blogging about their personal self-harm history, are probably the most needed ones in breaking the stigma and stereotypes around self-harm held, unfortunately, among a number of suicide researchers.

Despite all these developments that the suicide prevention community has managed to make all these last years, we still however have a long way in making our working environment ‘safer’ for our mental health wellbeing. Someone would think that the emotional impact of working with suicide-related issues, even when not directly felt, would have been structurally addressed either when someone starts researching or studying the prevention of suicidality.  Similar to the emotional effect that a patient suicide has to a mental health professional, where structured debriefings and meetings help with the grieving process of the practitioner [10], suicide researchers still lack this formal supportive component within their working environment or study curriculum. Although researchers need to work on suicide-related outcomes given to them only for analysis/interpretation, the emotional impact of working with information related to people who have experienced suicidal pain still needs to be addressed structurally within academic departments.

Today’s self-harm research field is probably the most evident example that research is a living organism, where its own study outcomes and needs of improvement are fed back to the researcher and transform how suicide research progresses. With a number of studies conducted from non-suicide focused research departments, where all the internal self-harm changes are being followed and acknowledged, our area of work seems to be important not only in preventing suicide but in helping other colleagues to properly approach the topic of suicide. However, given that the debriefing of the emotional impact of suicide-related information in research is currently dependant on the empathetic feature of the person leading a research team, more efforts should be given in establishing an academic protocol on this and appropriately support early career researchers in the field.

References

1. Nielsen, E., Padmanathan, P., Knipe, D. (2016). Commit* to change? A call to end the publication of the phrase ‘commit* suicide’. Wellcome open research, 1(21), https://doi.org/10.12688/wellcomeopenres.10333.1
2. Jobes, D. A., & Joiner, T. E. (2019). Reflections on Suicidal Ideation. Crisis, 40(4), 227–230. https://doi.org/10.1027/0227-5910/a000615
3. Griffin, E., Kavalidou, K., Bonner, B., O’Hagan, D., & Corcoran, P. (2020). Risk of repetition and subsequent self-harm following presentation to hospital with suicidal ideation: A longitudinal registry study. EClinicalMedicine, 23, 100378. https://doi.org/10.1016/j.eclinm.2020.100378
4. Cha, C. B., Tezanos, K. M., Peros, O. M., Ng, M. Y., Ribeiro, J. D., Nock, M. K., & Franklin, J. C. (2018). Accounting for Diversity in Suicide Research: Sampling and Sample Reporting Practices in the United States. Suicide & life-threatening behavior, 48(2), 131–139. https://doi.org/10.1111/sltb.12344
5. Windsor-Shellard, B. (2020, September 10). How does living in a more deprived area influence rates of suicide? Retrieved from https://blog.ons.gov.uk/2020/09/10/how-does-living-in-a-more-deprived-area-influence-rates-of-suicide/
6. Williams, A.J., Arcelus, J., Townsend, E., Michail, M. (2019). Examining risk factors for self-harm and suicide in LGBTQ+ young people: a systematic review protocol. BMJ Open, 9:e031541. doi: 10.1136/bmjopen-2019-031541
7. Knipe, D. W., Carroll, R., Thomas, K. H., Pease, A., Gunnell, D., & Metcalfe, C. (2015). Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia – a systematic review. BMC public health, 15 (1055). https://doi.org/10.1186/s12889-015-2301-5
8. Pollock, N.J., Naicker, K., Loro, A. Mulay, S., Colman, I. (2018). Global incidence of suicide among Indigenous peoples: a systematic review. BMC Med 16 (145). https://doi.org/10.1186/s12916-018-1115-6
9. Troya, M. I., Chew-Graham, C. A., Babatunde, O., Bartlam, B., Higginbottom, A., & Dikomitis, L. (2019). Patient and Public Involvement and Engagement in a doctoral research project exploring self-harm in older adults. Health expectations : an international journal of public participation in health care and health policy, 22(4), 617–631. https://doi.org/10.1111/hex.12917
10. Sandford, D. M., Kirtley, O. J., Thwaites, R., & O’Connor, R. C. (2021). The impact on mental health practitioners of the death of a patient by suicide: A systematic review. Clinical psychology & psychotherapy, 28(2), 261–294. https://doi.org/10.1002/cpp.2515

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