This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Researchers analysed 15 studies on self-harm and suicidal behaviours in South Asian communities in the UK. Reasons for self-harm included:
- low self-esteem, loneliness, and isolation
- abuse, including racism, sexism and domestic violence
- economic and political issues, such as a lack of financial independence and fear of deportation
- the need to protect family honour.
These findings could help policymakers to develop policies that are sensitive to South Asian people in the UK, and clinicians to have more informed conversations with this group.
Information and support for people who self-harm is available on the NHS website.
The issue: research on self-harm in South Asian communities is lacking
There were almost 94,000 emergency hospital admissions for self-harm in England in 2021. People who self-harm often have poor mental health and are at high risk of suicide.
Research findings on self-harm rates in different ethnic groups are mixed. Self-harm is known to be more common among young South Asian women than white women (aged 16–24). It is less common in South Asian men than white men across all age groups . South Asian people aged 50 years and above are at particular risk of suicide and depression.
Reasons for self-harm may vary according to ethnicity. For example, children and adolescents from ethnic minority groups are less likely to present at hospital after self-harming, and less likely to access specialist psychiatric care, than those from white groups.
This study brought together previous research on self-harm and suicidal behaviours in South Asian communities in the UK.
What’s new?
The researchers included 15 studies in their analysis (published 1999 – 2022), of which 5 were doctoral theses. Most studies involved young adults; the age range was 14–55 years. Only 1 study included men.
Reasons for self-harm reported by South Asian people, included:
- low self-esteem and worth, with self-harm seen as a punishment (“I don’t know why I can’t love myself… I see myself as a disappointment, like the family see me as a disappointment”)
- loneliness, isolation, and having no one to share their difficulties with (“I was in a world of my own, suffering the hurt in silence”)
- abuse including racism, sexism and domestic violence (“we’re treated differently by our own because we’re women, we’re treated differently outside because we’re Asian”)
- economic and political issues, such as a fear of deportation
- the need to protect the family’s honour (“protecting the honour of the family is another expectation”).
A former law (that has now been repealed) meant that foreign spouses who ended their marriage within 2 years of coming to the UK were deported. Women in abusive marriages could therefore feel trapped, with limited options for financial support.
People said self-harm could provide emotional release, temporary relief from psychological pain and give them a fleeting sense of control. Self-harm often led to feelings of shame and guilt, but some used it to communicate pain and get help from others: “I wasn’t a good talker, like, back then, so…that’s why I knew that they would kind of help me in some way.”
Experiences with health services were mixed. Some people were offered counselling; cognitive behavioural therapy was particularly effective. People said clinicians showed empathy and understanding. Others mistrusted health services and thought professionals outside their community would not understand their culture. Language difficulties, and the fear of being judged by clinicians from their community, prevented some from seeking help. Some felt clinicians did not listen.
Many participants said their faith helped them manage unbearable circumstances, and voluntary work offered a sense of purpose. People valued community-based organisations and charities, which offered support with housing and benefits, and could refer them to other services.
Why is this important?
Cultural, economic, and political factors play a role in self-harm among South Asian communities. The researchers call for clinicians and policymakers to consider the challenges South Asian people face (such as racism or protecting family honour) when providing care to those who self-harm.
South Asian and white people gave similar meaning to self-harm (providing emotional release and a sense of control, for example). This suggests that culture alone does not determine the experience of self-harm. Instead of focusing solely on cultural background, patients would benefit from personalised approaches to explore their unique experiences.
Only 1 study included men, which may mean that the findings are most relevant to women. Some studies were relatively old (from 1999), and others were unpublished (doctoral theses), which reduces the strength of the findings. The researchers caution that ‘South Asian’ covers many nationalities, ethnicities, languages and cultures. Pooling the experiences of these diverse groups could hide nuances in the findings.
What’s next?
The researchers encourage more open discussion of mental health issues within South Asian communities. They suggest that care for South Asian people who have self-harmed could be improved with:
- cultural sensitivity training for clinicians
- culturally-adapted psychological interventions
- better access to services.
The research team has explored the views of South Asian people who have self-harmed. Another study on clinicians’ views on caring for this group is currently under review.
You may be interested to read
This is a summary of: Büşra Özen-Dursun and others. Understanding self-harm and suicidal behaviours in South Asian communities in the UK: systematic review and meta-synthesis. BJPsych Open 2023; 9: 1–9.
A presentation on the study by the lead author.
Other research on self-harm from the Manchester Self-Harm Project.
Useful contacts that provide mental health support.
Information on taking part in NIHR research on self-harm.
Funding: This study was supported by the NIHR Greater Manchester Patient Safety Translational Research Centre.
Conflicts of Interest: No relevant conflicts of interest.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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