A photo of Dr Isabela Troya

Understanding self-harm in older adults – An interview with Dr Isabela Troya

A photo of Dr Isabela Troya

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A Clinical Psychologist by background, Dr Isabela Troya completed her degree in her home country of Ecuador. Soon after completing her degree, she moved to London to study a master's degree in Global Mental Health at King’s College London.

The knowledge and experience that she gained during the master’s degree led her to develop a strong interest and passion for research within her field. It was then that she made the decision to pursue a PhD…

Dr Troya’s PhD aimed to explore the motivations of self-harm behaviour in older adults and identify the barriers and facilitators to access to care for older adults who self-harm.

As part of her research, she conducted a systematic review of the international evidence of the characteristics of self-harm in older adults. 

Now a Postdoctoral Researcher at the School of Public Health at University College Cork and the Irish National Suicide Research Foundation, Dr Troya is currently working on a Health Research Board programme titled – ‘Individual and Area Level Determinants of Self-Harm and Suicide in Ireland: Enhancing Prediction, Risk Assessment and Management of Self-Harm by Health Services’ which is led by Professor Ella Arensman.

Throughout her career, Dr Troya has gained a wealth of knowledge and experience in research into self-harm behaviour, and we know that her research into self-harm in older adults would be of particular interest to the STORM Community.

We caught up with Dr Troya to find out more about her work…

“My career started in psychology. I am a Clinical Psychologist by background, qualifying for this degree in my home country of Ecuador. When completing this degree I developed several interests, one of these understanding self-harm behavior.

My clinical psychology background allowed me to approach the field of mental health, which was always of interest to me, especially the prevention of mental health disorders, as well as the improvement of people’s quality of life and well-being.

The last year of my profession consisted mostly of attending patients using the different branches of psychotherapy (systemic-family, cognitive behaviour, psychoanalysis). Seeing the differences in the evidence provided by each of these branches, I became more interested in research and its contribution to mental health.

Soon after completing my degree, I moved to London to complete a master’s degree in Global Mental Health at King’s College London given it addressed the issue of prevention and development of mental health programs worldwide.

Up until my Master’s degree, my experience in understanding mental health had been limited to a psychological perspective, focusing on treating the individual and their symptom. During my clinical psychology degree we did indeed study broader issues that could affect mental health (e.g. social psychology), but it was in the year of my master’s degree that I could truly start to understand all the social determinants that affect an individual’s well-being and mental health (including social, political, historical, economic issues)

The experience I gained during the year of the master’s degree led me to develop a strong interest and passion for research within my field. Being surrounded by so many academics and colleagues who encouraged maintaining critical and deep dialogues is something that certainly marked my professional career and led me to want to pursue a PhD.

I then relocated to Ireland, where both at a professional and personal level was a great timing and opportunity for me.”

“I completed my PhD at the School of Primary, Community and Social Care at Keele University, where I conducted my research in Exploring Self-harm behavior in older adults.

This research was conducted under the supervision of Prof Carolyn Chew-Graham, academic GP, Prof Lisa Dikomitis, social anthropologist, and Dr Opeyemi Babatunde. My PhD aimed to explore the motivations of self-harm behavior in older adults and identify the barriers and facilitators to access to care for older adults who self-harm.

As part of my PhD research, I conducted a systematic review of the international evidence of the characteristics of self-harm in older adults. Then I conducted interviews with older adults with self-harm experience, and support workers to further understand self-harm behavior within this age group.

During the 3 years of my PhD, I had active Patient and public involvement, meaning I relied on a group of people with lived-experience to help inform my research.

“There are similar risk factors to self-harm in young and older people such as previous history of self-harm, psychiatric history.

However, there are also different risk factors that make older adults particularly vulnerable to self-harm. Physical illness, including complex health conditions and comorbidities (diagnosis of 2 or more illnesses), isolation, loneliness, are risk factors for self-harm in older people. In particular, increased access to medication, which can potentially become access to means for self-harm (e.g. overdose).”

“Understanding lived experience is important in all health related research.

In research conducted with people who self-harm, including older people, it is important to learn their experiences and understanding of their self-harm. If we are conducting research that aims to prevent suicide and self-harm, and improve people’s mental health and wellbeing, it is fundamental to have people’s perspective.

With older adults, gaining their particular views and experiences is even more important as many researchers will not gain full access to their insight if not.”

“One of the most common misconceptions (that is being slowly challenged) is that self-harm in older adults does not exist.

Although self-harm rates in older adults are lower when compared to other age groups, evidence from different countries have seen an increase in rates in this age group, in particular with more lethal methods. It is important for clinicians and people supporting older adults who self-harm to engage with them, in order to understand their motivations for self-harming and to provide appropriate support and referral for further management.”

“I think one of the key factors to improve awareness of self-harm in older adults (and in all populations) is to break the stigma that exists around self-harm. Stigma can prevent help-seeking, and can therefore be detrimental to people who self-harm. However, given that stigma and shame is further accentuated in older adults according to findings from my PhD, I would really encourage the public, people working or supporting older adults, to be mindful of the existence of self-harm in older adults so adequate support and provision of care can be given.

The video we co-created with the PPIE group summarises the findings from my PhD research regarding self-harm in older adults. It also encourages for those older adults who are struggling, to reach out and ask for help. This may not be easy and is different for each individual but I think by sharing the message and having the adequate support, help can be sought. We would love for the video to be shared via your network.”

“Being invited to present at the 2020 NSPA conference was a great experience and a highlight in my career. NSPA is a great conference to present at with a diverse audience, including researchers, policy makers, clinicians, people working in the third sector or voluntary sector, and members of the public.

Sharing findings from my research with a diverse audience is important, and throughout my career I have tried to ensure sharing findings with as many people as possible. This can be difficult for researchers, as we spend a lot of our time and effort doing the research but forget that equal time and effort should be put in getting the findings out there. For me this is an ethical responsibility.

I was pleased to see interest in our workshop, from diverse delegates and representatives. Sharing my research at NSPA allowed me to further connect and network with other members I would have not been in contact with. Including doing this interview.”

“I would like to continue conducting research that has implications for policy and practice, specifically in mental health, self-harm and suicide prevention.”

“I enjoy travelling, reading, and cooking. But mostly spending time with my family and loved ones is something I enjoy and is essential to my wellbeing.”

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