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Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England

  • Caroline Clements (a1), Keith Hawton (a2), Galit Geulayov (a3), Keith Waters (a4), Jennifer Ness (a5), Muzamal Rehman (a6), Ellen Townsend (a7), Louis Appleby (a8) and Nav Kapur (a9)...



In England suicide rates are highest in midlife (defined as age 40–59). Despite a strong link with suicide there has been little focus on self-harm in this age group.


To describe characteristics and treatment needs of people in midlife who present to hospital following self-harm.


Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000–2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models.


A quarter of self-harm presentations were made by people in midlife (n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02–1.12, P < 0.01), and were positively correlated with national suicide incidence rates (r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00–1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide.


Self-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide.

Declaration of interest

K.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.


Corresponding author

Correspondence: Caroline Clements, Centre for Mental Health and Safety, Division of Psychology and Mental Health, The University of Manchester, Room 2.308, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. Email:


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Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England

  • Caroline Clements (a1), Keith Hawton (a2), Galit Geulayov (a3), Keith Waters (a4), Jennifer Ness (a5), Muzamal Rehman (a6), Ellen Townsend (a7), Louis Appleby (a8) and Nav Kapur (a9)...
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