Abstract
Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm. A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition. Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94-9.94, P = 0.00). Three themes emerged when exploring participants' CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm. CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.
Highlights
Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited
CSA was positively associated with self-harm repetition
CSA was frequently reported among people who frequently selfharm, and associated with self-harm repetition
Summary
A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition This is a mixed-methods study with convergent parallel design in which quantitative and qualitative data were collected and analysed simultaneously.[16] The study was conducted in three emergency departments in the south (Cork) and west (Limerick) of Ireland, where consecutive self-harm presentations were identified for the Downloaded from https://www.cambridge.org/core. Self-harm was defined as ‘an act with non-fatal outcome where an individual deliberately initiates a non-habitual behaviour that without intervention from others will cause self-harm’.17 This included both acts with and without the intention to die. High risk self-harm was defined as in previous studies.[18,19] Participants were recruited regardless of whether they had already a previous presentation
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