General Practitioners' Accounts of Patients Who Have Self-Harmed: A Qualitative, Observational Study

Abstract

Background: The relationship between self-harm and suicide is contested. Self-harm is simultaneously understood to be largely nonsuicidal but to increase risk of future suicide. Little is known about how self-harm is conceptualized by general practitioners (GPs) and particularly how they assess the suicide risk of patients who have self-harmed.

Aims: The study aimed to explore how GPs respond to patients who had self-harmed. In this paper we analyze GPs' accounts of the relationship between self-harm, suicide, and suicide risk assessment.

Method: Thirty semi-structured interviews were held with GPs working in different areas of Scotland. Verbatim transcripts were analyzed thematically.

Results: GPs provided diverse accounts of the relationship between self-harm and suicide. Some maintained that self-harm and suicide were distinct and that risk assessment was a matter of asking the right questions. Others suggested a complex inter-relationship between self-harm and suicide; for these GPs, assessment was seen as more subjective. In part, these differences appeared to reflect the socioeconomic contexts in which the GPs worked.

Conclusion: There are different conceptualizations of the relationship between self-harm, suicide, and the assessment of suicide risk among GPs. These need to be taken into account when planning training and service development.

Keywords: general practice; risk assessment; self-harm; suicide.