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“There is so much more for us to lose if we were to kill ourselves”: understanding paradoxically low rates of self-harm in deprived urban communities in the UK.

Research output: Contribution to journalArticle

Original languageEnglish
JournalQualitative Health Research
Publication statusSubmitted - 5 Mar 2020

King's Authors


Epidemiological studies show rates of suicidal behaviours, including self-harm through injury or poisoning, vary substantially between different social contexts. Socio-economic deprivation predicts risk at individual and community level. However, despite high poverty rates, London has low rates of self-harm overall and contains highly deprived areas with paradoxically low rates. This study uses qualitative data from interviews and focus groups with 26 individuals living and working in one such area in South London, UK, between October 2018 and June 2019. We explore why a community exposed to multiple, chronic stressors, might nonetheless appear to have low rates of self-harm. We use the stress process model to understand how local social context influences the stressors people experience, resources available to buffer them and the way they respond to distress, including through self-harm.

Participants described people in the community as exposed to multiple, chronic stressors related to their social position and the social environment of the area, which have significant impacts on their mental health. These were to some extent buffered by social resources related to community solidarity and an understanding of stressors as communal challenges, as well as a culture of self-reliance amongst individuals. However, identifying oneself as mentally ill, especially through being known to have intentionally harmed oneself or attempted suicide, was seen as highly risky. Doing so would diminish a person’s social status in this context, exposing them to additional stressors during their interactions within their community and with services. Consequently, people within the community tended to hide mental distress and respond with behaviours less obviously linked to mental illness than self-harm, lowering rates of both self-harm and help-seeking following it. These findings highlight the importance of using approaches that acknowledge social context when conceptualising and measuring mental health need in a population to avoid reinforcing existing health inequalities.

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