Abstract
BACKGROUND: Older adults have a high risk of suicide following self-harm. Contemporary information on self-harm in this population is needed to inform care provision.
OBJECTIVES: To examine subgroup differences in the incidence of self-harm, sociodemographic and clinical characteristics, preceding life problems and outcomes in individuals aged 60 years and over presenting to hospital following self-harm.
METHOD: Data on Emergency Department (ED) presentations for self-harm from 2003 to 2016 from three centres in the Multicentre Study of Self-Harm in England were analysed. Changes in self-harm rates were examined using Poisson regression. Univariable logistic regression was used to investigate factors associated with 12-month self-harm repetition.
RESULTS: There were 3850 presentations for self-harm by 2684 individuals aged 60 years and over. Self-harm rates increased over time for 60-74-year-old men (Incident Rate Ratio = 1.04, 95% Confidence Interval 1.02-1.06, p < 0.0001). Problems most frequently reported to have preceded self-harm were mental health (40.5%) and physical health (38.3%) concerns. Problems with alcohol, finances, employment and relationship with partner were found more frequently in 60-74-year-olds compared with those aged over 74 years. Physical health problems were common with increasing age, as were problems with alcohol for men. One in ten (10.8%) individuals presented to hospital with self-harm within 12 months of their index presentation.
CONCLUSIONS: Self-harm-related ED attendances in older men have increased, particularly for men aged 60-74 years. Prevention and clinical management should involve a comprehensive psychosocial assessment to target common precipitants for the wide range of problems preceding self-harm and may include support with physical and mental wellbeing and advice on safer alcohol use.
| Original language | English |
|---|---|
| Article number | e5895 |
| Journal | International Journal of Geriatric Psychiatry |
| Volume | 38 |
| Issue number | 3 |
| Early online date | 25 Feb 2023 |
| DOIs | |
| Publication status | Published - 11 Mar 2023 |
Bibliographical note
Funding Information:Jennifer Ness contributed to study design, analysis and produced an initial draft of the paper. Galit Geulayov contributed to analysis and interpretation of additional data. Anita Patel contributed to analysis and subsequent revisions. All authors provided comments and revisions on the protocol and manuscript. The authors from Derby would like to thank Muzamal Rehman and the clinicians of the Liaison Psychiatry team based at the Royal Derby hospital for assistance with self-harm data collection and processing. The authors from Oxford would like to thank Elizabeth Bale and Fiona Brand for their assistance with data collection and processing, and members of the clinical service in the John Radcliffe Hospital for their support with data collection.
Funding Information:
KH declares grants from the National Institute for Health Research (NIHR) and the Department of Health and Social Care. He is a member of the National Suicide Prevention Strategy for England Advisory Group. He is a NIHR Senior Investigator (Emeritus). NK is a member of the Department of Health's National Suicide Prevention Advisory Group. NK chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer‐term management of self‐harm and is currently Topic Advisor for the new NICE self‐harm guideline. He also chairs the NICE guideline committee for depression in adults. KW is a Non‐Executive Director for Storm Skills Training, a not‐for‐profit Community Interest Company. ET acknowledges support of the UK Research and Innovation (UKRI) Digital Youth Programme award (MRC project reference: MR/W002450/1) which was part of the AHRC/ESRC/MRC Adolescence, Mental Health and the Developing Mind programme. All other authors declare no competing interests. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Publisher Copyright:
© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
