Research: Self-Harm Treatments Less Effective for Men

Men are more likely to die by suicide globally.

One of the strongest predictors of death by suicide is self-harm . This is when a person physically hurts themselves as a way of dealing with very difficult feelings , painful memories or overwhelming situations and experiences.

Preventing self-harm could potentially reduce deaths by suicide . But our recent study showed that talking therapies designed to reduce self-harm are less effective in men .

We reviewed the evidence from 46 studies focusing on the effectiveness of talking therapies, clinical contact (such as letters, postcards, phone calls or contact with a GP or support worker) and two digital apps in reducing self-harm.

Talking therapies use conversation to help people understand patterns in their thinking, emotions and behaviour, and to help them build healthier ways of dealing with challenges. Many forms of therapy or contact also provide information about self-harm, risk factors, understanding stressors and looking out for warning signs of self-harm.

But our review found that after completing some type of talking therapy or series of clinical contacts, only women saw a decrease in rates of self-harm. For men, there was no change in rates of self-harm. This meant that men were 20% more likely than women to self-harm again after attending any form of therapy.

We found this was only the case for adults. There was no difference between male and female adolescents - though there were fewer studies involving adolescents. Most studies were done in western countries.

Around two-thirds of the information in our review came from women. Most of the studies identified people presenting with self-harm in hospital or mental health settings. As men are less likely to seek help for self-harm, this reduces the pool of men who can be approached for self-harm studies. Yet despite the fact that there were fewer men than women in the studies, there was still a sufficient number of men to detect sex differences in our review.

Reducing self-harm

If talking therapies are less effective for preventing self-harm in men compared to women, this may be one of many contributing factors to higher suicide rates in men.

This could suggest that talking therapies don't address the underlying issues that are causing men to harm themselves. For instance, socioeconomic adversity - such as problems with housing, finances or employment - are particularly important risk factors for poor mental health and suicide in men.

Men are also half as likely to be in contact with psychological services after self-harm compared to women. Traditional views of masculinity and stigma may mean men are less comfortable talking about their emotions and seeking help for psychological distress.

Addressing self-harm and suicide in men needs to involve a whole society approach. This should include early emotional education in homes and schools and de-stigmatising psychological distress and asking for help.

Understanding signs of self-harm and how men present to GPs, emergency departments and other services is also important.

Men may punch objects, abuse alcohol or drugs or engage in risky behaviours which might not be recognised as self-harm . This means that healthcare professionals may not identify self-harm as readily in men and refer them for help.

Community-based approaches such as sports clubs, men's support groups or helplines could be more effective for men in addressing mental health than talking therapies. Instead of a direct focus on talking about feelings, men also find activities such as working on a project together, problem solving, coaching and mentoring helpful.

Many of these approaches also reduce loneliness and social isolation, which are major risk factors for self-harm and suicide. Prioritising these approaches to support men's mental health may help to reduce self-harm and suicide in men.

National Institute for Health and Care Research ARC North Thames

Rose McCabe received funding from the National Institute for Health and Care Research ARC North Thames.