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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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References

Alexopoulos, G. S. et al. (2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. American Journal of Psychiatry, 166, 882–890.CrossRefGoogle ScholarPubMed
Beautrais, A. (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32, 1–9.CrossRefGoogle ScholarPubMed
Bonnewyn, A. et al. (2014). Reflections of older adults on the process preceding their suicide attempt: a qualitative approach. Death Studies, 38, 612–618.CrossRefGoogle ScholarPubMed
Carter, G. et al. (2016). Royal Australian and New Zealand college of psychiatrists clinical practice guideline for the management of deliberate self-harm. Australia and New Zealand Journal of Psychiatry, 50, 939–1000.CrossRefGoogle ScholarPubMed
Carter, M. W. and Reymann, M. R. (2014). ED use by older adults attempting suicide. American Journal of Emergency Medicine, 32, 535–540.CrossRefGoogle ScholarPubMed
Chan, J., Draper, B. and Banerjee, S. (2007). Deliberate self-harm in older adults: a review of the literature from 1995 to 2004. International Journal of Geriatric Psychiatry, 22, 720–732.CrossRefGoogle ScholarPubMed
Chan, S. M., Chiu, F. K., Lam, C. W., Wong, S. M. and Conwell, Y. (2013). A multidimensional risk factor model for suicide attempts in later life. Neuropsychiatric Disease and Treatment, 10, 1807–1817.Google Scholar
Chan, S. S. et al. (2011) Outcomes of a two-tiered multifaceted elderly suicide prevention program in a Hong Kong chinese community. The American Journal of Geriatric Psychiatry, 19, 185–196.CrossRefGoogle Scholar
Cheung, G. and Casey, J. (2014). Few older people in New Zealand who commit suicide receive specialist psychogeriatric services. Australasian Psychiatry, 22, 386–389.CrossRefGoogle ScholarPubMed
Cheung, G. and Sundram, F. (2016). Understanding the progression from physical illness to suicidal behavior: a case study based on a newly developed conceptual model. Clinical Gerontologist, doi: 10.1080/073.Google ScholarPubMed
Choi, N. G., Marti, C. N. and Conwell, Y. (2016). Effect of problem-solving therapy on depressed low-income homebound older adults' death/suicidal ideation and hopelessness. Suicide and Life-Threatening Behavior, 46, 323–336.CrossRefGoogle Scholar
Conwell, Y., Rotenberg, M. and Caine, E. D. (1990). Completed suicide at age 50 and over. Journal of the American Geriatrics Society, 38, 640–644.CrossRefGoogle ScholarPubMed
Corcoran, P., Reulbach, U., Perry, I. J. and Arensman, E. (2010). Suicide and deliberate self harm in older Irish adults. International Psychogeriatrics, 22, 1327–1336.CrossRefGoogle ScholarPubMed
Crocker, L., Clare, L. and Evans, K. (2006). Giving up or finding a solution? The experience of attempted suicide in later life. Aging and Mental Health, 10, 638–647.CrossRefGoogle ScholarPubMed
De Leo, D. et al. (2001). Attempted and completed suicide in older subjects: results from the WHO/EURO multicentre study of suicidal behaviour. International Journal of Geriatric Psychiatry, 16, 300–310.CrossRefGoogle ScholarPubMed
De Leo, D. et al. (2002). Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study. Journal of Affective Disorders, 72, 291–295.CrossRefGoogle ScholarPubMed
Dennis, M. S., Wakefield, P., Molloy, C., Andrews, H. and Friedman, T. (2007). A study of self-harm in older people: mental disorder, social factors and motives. Aging and Mental Health, 11, 520–525.CrossRefGoogle ScholarPubMed
Draper, B. (1996). Attempted suicide in old age. International Journal of Geriatric Psychiatry, 11, 577–587.3.0.CO;2-V>CrossRefGoogle Scholar
Fässberg, M. M. et al. (2016). A systematic review of physical illness, functional disability, and suicidal behavior among older adults. Aging and Mental Health, 20, 166–194.CrossRefGoogle ScholarPubMed
Frierson, R. L. (1991). Suicide attempts by the old and the very old. Archives of Internal Medicine, 151, 141–144.CrossRefGoogle ScholarPubMed
Gujral, S., Dombrovski, A. Y., Butters, M., Clark, L., Reynolds, C. F. and Szanto, K. (2014). Impaired executive function in contemplated and attempted suicide in late life. American Journal of Geriatric Psychiatry, 22, 811–819.CrossRefGoogle ScholarPubMed
Gustavson, K. A., Alexopoulos, G. S., Niu, G. C., McCulloch, C., Meade, T. and Arean, P. A. (2016). Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction. American Journal of Geriatric Psychiatry, 24, 11–17.CrossRefGoogle ScholarPubMed
Hawton, K. and Harriss, L. (2006). Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort. International Journal of Geriatric Psychiatry, 21, 572–581.CrossRefGoogle ScholarPubMed
Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E. and Bond, A. (2003). Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychological Medicine, 33, 987–995.CrossRefGoogle ScholarPubMed
Heisel, M. J., Talbot, N. L., King, D. A., Tu, X. M. and Duberstein, P. R. (2015). Adapting interpersonal psychotherapy for older adults at risk for suicide. American Journal of Geriatric Psychiatry, 23, 87–98.CrossRefGoogle ScholarPubMed
Hepple, J. and Quinton, C. (1997). One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry, 171, 42–46.CrossRefGoogle ScholarPubMed
Kato, K. et al. (2013). Frequency and clinical features of suicide attempts in elderly patients in Japan. Psychiatry and Clinical Neurosciences, 67, 119–122.CrossRefGoogle ScholarPubMed
Kim, S. H. (2016). Suicidal ideation and suicide attempts in older adults: influences of chronic illness, functional limitations, and pain. Geriatric Nursing, 37, 9–12.CrossRefGoogle ScholarPubMed
Kim, Y. R. et al. (2011). Elderly suicide attempters by self-poisoning in Korea. International Psychogeriatrics, 23, 979–985.CrossRefGoogle ScholarPubMed
Lebret, S., Perret-Vaille, E., Mulliez, A., Gerbaud, L. and Jalenques, I. (2006). Elderly suicide attempters: characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 1052–1059.CrossRefGoogle ScholarPubMed
Minayo, M. C. D. S. and Cavalcante, F. G. (2015). Suicide attempts among the elderly: a review of the literature (2002/2013). Ciencia & Saude Coletiva, 20, 1751–1762.CrossRefGoogle ScholarPubMed
Ministry of Health . (2012). Suicide Facts: Deaths and Intentional Self-Harm Hospitalisations 2010. Wellington: Ministry of Health.Google Scholar
Murphy, E. et al. (2012). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry, 200, 399–404.CrossRefGoogle ScholarPubMed
New Zealand Ministry of Health . (2015). Suicide facts: 2013 data. Available: http://www.health.govt.nz/publication/suicide-facts-2013-data; last accessed 31 October 2016.Google Scholar
Oude Voshaar, R. C., Cooper, J., Murphy, E., Steeg, S., Kapur, N. and Purandare, N. B. (2011). First episode of self-harm in older age: a report from the 10-year prospective Manchester self-harm project. Journal of Clinical Psychiatry, 72, 737–743.CrossRefGoogle ScholarPubMed
Posner, K., Oquendo, M. A., Gould, M., Stanley, B. and Davies, M. (2007). Columbia classification algorithm of suicide assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. American Journal of Psychiatry, 164, 1035–1043.CrossRefGoogle ScholarPubMed
Ruths, F. A., Tobiansky, R. I. and Blanchard, M. (2005). Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London. International Journal of Geriatric Psychiatry, 20, 106–112.CrossRefGoogle ScholarPubMed
Salib, E., Tadros, G. and Cawley, S. (2001). Elderly suicide and attempted suicide: one syndrome. Medicine, Science and the Law, 41, 250–255.CrossRefGoogle ScholarPubMed
Shah, A., Bhat, R., Zarate-Escudero, S., De Leo, D. and Erlangsen, A. (2015). Suicide rates in five-year age-bands after the age of 60 years: the international landscape. Aging and Mental Health, 20, 131–138.CrossRefGoogle ScholarPubMed
Sharpe, D. (2015). Your chi-square test is statistically significant: now what?. Practical Assessment, Research and Evaluation, 20, 1–10.Google Scholar
Sisask, M., Kolves, K. and Varnik, A. (2009). Severity of attempted suicide as measured by the pierce suicidal intent scale. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 30, 136–143.CrossRefGoogle ScholarPubMed
Statistics New Zealand . (2014). 2013 census district health board tables. Available: http://www.stats.govt.nz/Census/2013-census/data-tables/dhb-tables.aspx.Google Scholar
Suominen, K., Isometsä, E. and Lönnqvist, J. (2004). Elderly suicide attempters with depression are often diagnosed only after the attempt. International Journal of Geriatric Psychiatry, 19, 35–40.CrossRefGoogle ScholarPubMed
Unützer, J. et al. (2006). Reducing suicidal ideation in depressed older primary care patients. Journal of the American Geriatrics Society, 54, 1550–1556.CrossRefGoogle ScholarPubMed
Van Orden, K. A., Wiktorsson, S., Duberstein, P., Berg, A. I., Fässberg, M. M. and Waern, M. (2015). Reasons for attempted suicide in later life. American Journal of Geriatric Psychiatry, 23, 536–544.CrossRefGoogle ScholarPubMed
Wiktorsson, S., Marlow, T., Runeson, B., Skoog, I. and Waern, M. (2011). Prospective cohort study of suicide attempters aged 70 and above: one-year outcomes. Journal of Affective Disorders, 134, 333–340.CrossRefGoogle ScholarPubMed