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Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study

  • Elizabeth Murphy (a1), Navneet Kapur (a1), Roger Webb (a1), Nitin Purandare (a1), Keith Hawton (a2), Helen Bergen (a2), Keith Waters (a3) and Jayne Cooper (a4)...
Abstract
Background

Older adults have elevated suicide rates. Self-harm is the most important risk factor for suicide. There are few population-based studies of self-harm in older adults.

Aims

To calculate self-harm rates, risk factors for repetition and rates of suicide following self-harm in adults aged 60 years and over.

Method

We studied a prospective, population-based self-harm cohort presenting to six general hospitals in three cities in England during 2000 to 2007.

Results

In total 1177 older adults presented with self-harm and 12.8% repeated self-harm within 12 months. Independent risk factors for repetition were previous self-harm, previous psychiatric treatment and age 60–74 years. Following self-harm, 1.5% died by suicide within 12 months. The risk of suicide was 67 times that of older adults in the general population. Men aged 75 years and above had the highest suicide rates.

Conclusions

Older adults presenting to hospital with self-harm are a high-risk group for subsequent suicide, particularly older men.

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Copyright
Corresponding author
Ms Elizabeth Murphy, Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. Email: elizabeth.murphy@manchester.ac.uk
Footnotes
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See editorial, pp. 356–358, this issue.

We acknowledge financial support from the UK Department of Health under the National Health Service Research and Development programme (DH/DSH2008). K.H. is a National Institute for Health Research senior investigator.

Declaration of interest

None.

Footnotes
References
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Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study

  • Elizabeth Murphy (a1), Navneet Kapur (a1), Roger Webb (a1), Nitin Purandare (a1), Keith Hawton (a2), Helen Bergen (a2), Keith Waters (a3) and Jayne Cooper (a4)...
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eLetters

Risk factors for repetition and suicide following self-harm in older adults

Nagamani Gollapenne, Core trainee Psychiatry, Roseberry Park Hospital
Itoro Udo, Speciality Registrar, TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST
06 August 2012



We read with interest this paper by Elizabeth Murphy et al. This is a multicentre prospective cohort study with a large cohort at each centre. The analysis has been very comprehensive to identify the risk factors leading to self-harm and suicide. Age and gender specific categorization and comparison to general population is very useful to identify risk groups for early intervention to prevent suicide. We agree that the small number of suicides in comparison to the cohort has effect on the power of the study. It is unclear if the comorbidities of the subjects have been taken into account for those who have had suicide. We note several similarities to the findings after analysing all the serious and untoward incidents in people who use MHSOP (Mental Health Services for Older People)[1] in our trust. It has been noted that majority of suicides are in men (as is the case in a previous study [2]); they are known to have depression and were in recovery phase rather than in acute phase. The highest risk period was immediately after discharge. In this paper there were 14 men as compared to 10 women who died by suicide. 67% died within 12months and 83% in 18months. It has also been noted that men used more violent methods. This paper also reports suicide rates to be higher in men, especially men aged over 75, which has been reported previously [4], but was not statistically different to the rates observed in women. In our trust majority of suicides were noted in men, although of late, there have been suicides in older women. We also note that they often live in isolation and lack a confiding relationship, which has also been reported in a WHO multi-centre study [3] .Depression and contact with psychiatric services also seem to be noticed in persons who complete suicide in our trust as is the case in a previous study [5]. Somatic complaints were universally seen in our group and often noncompliance to medication. We also note these patients are more focussed on pharmacological treatment rather than being able to be engaged in psychological treatment. Identification of such group is important. Following interventions such as regular mental state examinations in them, checking for suicide intentions, considering psychological treatment along with pharmacological treatment and assessment just prior to discharge may be useful.

1. Medical Director's Report - March 2012; Tees, Esk and Wear Valleys NHS foundation Trust

2. Frierson RL. Suicide attempts by the old and very old. Arch Intern Med 1991; 151: 141-4.

3. De Leo D, Padoani W, Scocco P, Lie D, Bille-Brahe U, Arensman E, et al. Attempted and completed suicide in older subjects: results from the WHO/ EURO Multicentre study of suicidal behaviour. Int J Geriatr Psychiatry 2001;16: 300-10

4. Shah A, Bhat R, MacKenzie S, Koen C. Elderly suicide rates: cross- national comparisons of trends over a 10-year period. Int Psychogeriatr 2008; 20:673-86.

5. Hepple J, Quinton C. One hundred cases of attempted suicide in the elderly. Br J Psychiatry 1997; 171: 42-6.

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Conflict of interest: None declared

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