Vulnerabilities and life stressors of people presented to emergency departments with deliberate self-harm; consolidating the experiences to develop a continuum of care using a mixed-method framework

Saju Madavanakadu Devassy; Lorane Scaria; Jaicob Varghese; Anuja Maria Benny; Nicole Hill; Lynette Joubert

doi:10.3389/fpubh.2022.1019131

Vulnerabilities and life stressors of people presented to emergency departments with deliberate self-harm; consolidating the experiences to develop a continuum of care using a mixed-method framework

Front Public Health. 2023 Jan 11:10:1019131. doi: 10.3389/fpubh.2022.1019131. eCollection 2022.

Authors

Saju Madavanakadu Devassy^{1

2

3}, Lorane Scaria^{1

2}, Jaicob Varghese⁴, Anuja Maria Benny², Nicole Hill³, Lynette Joubert³

Affiliations

¹ Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India.
² International Centre for Consortium Research in Social Care (ICRS), Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India.
³ Department of Social Work, Melbourne School of Health Sciences at the University of Melbourne, Parkville, VIC, Australia.
⁴ Department of Critical Care Medicine, Rajagiri Hospital, Kochi, Kerala, India.

Abstract

Objective: Suicide is a crucial public health concern. However, the interactions between bio psychosocial vulnerabilities and stressors leading to deliberate self-harm behavior remain unexplored, especially in the Indian context. This study examined the experiences leading to self-harm behavior among people who presented to emergency departments with suicidal attempts.

Methods: In this mixed-methods study, we enrolled 44 patients who presented with self-harm behavior at three tertiary health care facilities between October and December 2019. To collect quantitative data, we employed standardized tools: General Health Questionnaire (GHQ-28), General Help-Seeking Questionnaire, Mini International Neuropsychiatric Interview, and the Brief Resilience Scale. Further, we conducted semi-structured interviews to qualitatively explore participants' life experiences and other risk factors. Qualitative analyses were performed using thematic analysis and quantitative descriptive and inferential statistics were performed using STATA software.

Results: The mean age of subjects were 29.8 years. The mean suicidality score for the patients was 26 (±8.7). In univariate analysis, depression and anxiety were positively associated with suicidality. While help-seeking behavior and resilience were negatively associated with suicidality. Qualitative results were centered on three major themes; life stressors, family related stressors, and social support-related vulnerabilities. The subjects' lived experiences were introduced in the backdrop of the interplay of vulnerabilities and stressors.

Conclusion: The biopsychosocial vulnerabilities remain dormant until it is activated by life stressors resulting in severe self-harm behaviors. Mental health team-driven assertive engagement, positive coping, and social support interventions would help prevent reattempts in people with self-harm behaviors.

Keywords: India; emergency departments; psychosocial factors; self-harm; trauma care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Continuity of Patient Care
Emergency Service, Hospital
Humans
Self-Injurious Behavior* / psychology
Suicidal Ideation
Suicide* / psychology

Grants and funding

The authors thank Rajagiri College of Social Sciences for all the research support. The project is financially supported by the Rajagiri College of Social Sciences, under seed money for faculty Minor Research. Funders have no role in the design, implementation, and analysis of the study.