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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*
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].

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.

Type
Paper of the Month
Copyright
Copyright © International Psychogeriatric Association 2017 

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