Table 2

Themes and subthemes from participants’ interviews

I. Contextual factors related to self-harm.
Interpersonal factors
  1. Interpersonal conflict with family member, acquaintance, workmate, friend.

  2. To repair the relationship.

  3. Exposure to recent self-harm by someone known/close to client.

Intrapersonal factors
  1. Inability to control emotions such as anger.

  2. Overwhelming sense of hopelessness/despair.

Socio-cultural factors
  1. Financial stressors, employment loss.

  2. Stigma due to perceived promiscuous/sexually provocative behaviour.

  3. Stigma due to infertility.

  4. Fear of losing face/societal respect.

II. Formulation and current feelings about the attempt.
Formulation
  1. Normalising past self-harm attempt as an option to deal with stressor.

  2. Sense of problems being extreme and circumstances exceptional.

  3. Significant stigma related to people who self-harm and difficulty in accepting self as part of that group.

  4. Sense of social isolation.

Current feelings
  1. Remorse about attempt, self-harm a mistake and an act of betrayal towards family members.

  2. Regret about failed attempt.

  3. Considering failed attempt as second chance at life—reflecting on attempt and resolutions about future.

III. Perceived supports, and deterrents.
  1. Family members and friends main support.

  2. Parental concern and familial relationships as deterrent towards future attempts.

IV. Treatment related experiences around self-harm attempt, help-seeking and potential barriers to help-seeking.
  1. In-patient hospital treatment as less useful, psychiatry assessment and management more helpful.

  2. Treatment experiences prior to the attempt unhelpful as clients did not feel heard and understood.

  3. Professional support by doctor considered more useful than by just counsellor.

  4. Counselling useful if tailored to needs.

  5. Impulsive nature of self-harm leading to doubt about usefulness of counselling.

  6. Beliefs about people who harm themselves a barrier to help-seeking.

  7. Talking to stranger a barrier for counselling.

V. Coping strategies found useful to allay self-harm thoughts.
  1. Distraction Strategies useful.

  2. Socialising with friends/going outside of home/when someone talks to them considered as supportive timeout strategy and useful to think clearly.

  3. Confiding in family members supportive.

  4. Exercise as a helpful strategy.

  5. Religious beliefs as protective.

  6. Substance use for emotional regulation.