title: Understanding vulnerability to self-harm in times of economic hardship and austerity: a qualitative study.
abstract: OBJECTIVE
  Self-harm and suicide increase in times of economic recession, but little is known about why people self-harm when in financial difficulty, and in what circumstances self-harm occurs. This study aimed to understand events and experiences leading to the episode of self-harm and to identify opportunities for prevention or mitigation of distress.
  
  
  METHODS
  Participants' homes or university rooms.
  
  
  METHODS
  19 people who had attended hospital following self-harm in two UK cities and who specifically cited job loss, economic hardship or the impact of austerity measures as a causal or contributory factor.
  
  
  METHODS
  Semistructured, in-depth interviews. Interviews were audio recorded, transcribed and analysed cross-sectionally and as case studies.
  
  
  RESULTS
  Study participants described experiences of severe economic hardship; being unable to find employment or losing jobs, debt, housing problems and benefit sanctions. In many cases problems accumulated and felt unresolvable. For others an event, such as a call from a debt collector or benefit change triggered the self-harm. Participants also reported other current or past difficulties, including abuse, neglect, bullying, domestic violence, mental health problems, relationship difficulties, bereavements and low self-esteem. These contributed to their sense of despair and worthlessness and increased their vulnerability to self-harm. Participants struggled to gain the practical help they felt they needed for their economic difficulties or therapeutic support that might have helped with their other co-existing or historically damaging experiences.
  
  
  CONCLUSIONS
  Economic hardships resulting from the recession and austerity measures accumulated or acted as a 'final straw' to trigger self-harm, often in the context of co-existing or historically damaging life-experiences. Interventions to mitigate these effects should include providing practical advice about economic issues before difficulties become insurmountable and providing appropriate psychosocial support for vulnerable individuals.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: M C
authors.initials: MC
authors.lastname: Barnes
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: R
authors.initials: R
authors.lastname: Davies
authors.affiliation: Centre for Suicide Research, University of Oxford, Oxford, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hawton
authors.affiliation: Centre for Suicide Prevention, University of Manchester, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Kapur
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: J
authors.initials: J
authors.lastname: Potokar
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Donovan
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology; D001601:Bereavement; D058445:Bullying; D017579:Domestic Violence / Q000523:psychology; D057172:Economic Recession; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D011203:Poverty / Q000523:psychology*; D036301:Qualitative Research; D016728:Self-Injurious Behavior / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D014478:Unemployment / Q000523:psychology*; D006113:United Kingdom
keywords: QUALITATIVE RESEARCH; SOCIAL MEDICINE