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Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation

Published online by Cambridge University Press:  28 March 2017

Gary Cheung ,
Gisele Foster ,
Wayne de Beer ,
Susan Gee ,
Tracey Hawkes ,
Sally Rimkeit Open the ORCID record for Sally Rimkeit [Opens in a new window] ,
Yu Mwee Tan ,
Sally Merry  and
Frederick Sundram
Gary Cheung*
Affiliation:
Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
Gisele Foster
Affiliation:
School of Medicine, The University of Auckland, Auckland, New Zealand
Wayne de Beer
Affiliation:
Waikato District Health Board, Hamilton, New Zealand
Susan Gee
Affiliation:
Psychiatry of Old Age Academic Unit, Canterbury District Health Board, Christchurch, New Zealand
Tracey Hawkes
Affiliation:
Psychiatry of Old Age Academic Unit, Canterbury District Health Board, Christchurch, New Zealand
Sally Rimkeit
Affiliation:
Capital Coast District Health Board, Wellington, New Zealand
Yu Mwee Tan
Affiliation:
Auckland Regional Psychiatric Training Programme, Auckland, New Zealand
Sally Merry
Affiliation:
Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
Frederick Sundram
Affiliation:
Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
*
Correspondence should be addressed to: Dr Gary Cheung, Senior Lecturer, Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand. Phone: +64 21 332 823; Fax: +64 9 373 7013. Email: [email protected].
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Abstract

Background:

A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide.

Methods:

Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected.

Results:

The sample included 339 older people (55.2% female) with an age range of 65–96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35–11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20–6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months.

Conclusion:

Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the person's resilience resources.

Keywords

self-harmsuicide attemptsuicideolder people
Type
Paper of the Month
Information
International Psychogeriatrics , Volume 29 , Issue 8 , August 2017 , pp. 1237 - 1245
Copyright
Copyright © International Psychogeriatric Association 2017 

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