How do adolescents talk about self-harm: a qualitative study of disclosure in an ethnically diverse urban population in England

Background: Self-harm is prevalent in adolescence. It is often a behaviour without verbal expression, seeking relief from a distressed state of mind. As most adolescents who self-harm do not seek help, the nature of adolescent self-harm and reasons for not disclosing it are a public health concern. This study aims to increase understanding about how adolescents in the community speak about self-harm; exploring their attitudes towards and experiences of disclosure and help-seeking. Methods: This study involved 30 qualitative individual interviews with ethnically diverse adolescents aged 15-16 years (24 females, 6 males), investigating their views on coping with stress, self-harm and help-seeking, within their own social context in multicultural East London. Ten participants had never self-harmed, nine had self-harmed on one occasion and 11 had self-harmed repeatedly. Verbatim accounts were transcribed and subjected to content and thematic analysis using a framework approach. Results: Self-harm was described as a complex and varied behaviour. Most participants who had self-harmed expressed reluctance to talk about it and many had difficulty understanding self-harm in others. Some participants normalised self-harm and did not wish to accept offers of help, particularly if their self-harm had been secretive and 'discovered', leading to their referral to more formal help from others. Disclosure was viewed more positively with hindsight by some participants who had received help. If help was sought, adolescents desired respect, and for their problems, feelings and opinions to be noticed and considered alongside receiving treatment for injuries. Mixed responses to disclosure from peers, family and initial sources of help may influence subsequent behaviour and deter presentation to services. Conclusions: This study provides insight into the subjective experience of self-harm, disclosure and help-seeking from a young, ethnically diverse community sample. Accounts highlighted the value of examining self-harm in the context of each adolescent's day-to-day life. These accounts emphasised the need for support from others and increasing awareness about appropriate responses to adolescent self-harm and accessible sources of help for adolescents.