Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort

• Published in: International journal of geriatric psychiatry Vol. 21; no. 6; pp. 572 - 581
• Main Authors: Hawton, Keith, Harriss, Louise
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.06.2006; Wiley; Wiley Subscription Services, Inc
• Subjects: Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Cause of Death; Clinical outcomes; deaths from natural causes; deliberate self-harm; England - epidemiology; Epidemiologic Methods; Female; follow up; Fundamental and applied biological sciences. Psychology; Geriatric psychiatry; Geriatrics; Humans; Interpersonal Relations; Male; Marital Status; Medical sciences; Middle Aged; Miscellaneous; Older people; Poisoning - epidemiology; Prognosis; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recurrence; repetition of self-harm; Self destructive behavior; Self-Injurious Behavior - epidemiology; Self-Injurious Behavior - etiology; Self-Injurious Behavior - psychology; self-injury; self-poisoning; Social Isolation; suicide; Suicide - statistics & numerical data; suicide intent; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; England; United Kingdom > UK; Self injury; Relapse; self-poisoning; Prognosis; Self; Suicide; follow up; Cohort study; Evolution; deliberate self-harm; Repetition; Public health; repetition of self harm; Human; Characteristic; self-injury; Suicide attempt; Characteristics; Follow up study; suicide intent; deaths from natural causes; Poisoning; older people; Self destruction; Elderly
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.1526

Background Little information is available about older deliberate self‐harm (DSH) patients and their outcome. Methods This study is a prospective investigation and follow‐up of 730 consecutive patients (459 females and 271 males) aged 60 years and over who presented to a general hospital following DSH over a 20‐year period, 1978–1997. Outcome has been examined in terms of repetition of DSH, and deaths by the end of 2000 identified through official death registers. Results DSH involved self‐poisoning in 88.6% of cases, 49.3% of the overdoses including paracetamol (acetaminophen), 24.0% minor tranquillizers, and 15.9% antidepressants. Nearly three‐quarters of episodes involved high suicidal intent. Common problems preceding DSH were physical illness (46.1%), social isolation (33.5%), relationship problems with family (29.4%) or partner (25.9%), and bereavement or loss (16.7%). Repetition of DSH occurred in 15.3% of cases, 8.2% in the first year following DSH. By the end of 2000, 432/661 (65.4%) of traced patients had died. There were 30 suicides and open verdicts, which were 49 times and 33 times more frequent respectively than expected from general population death rates. Prior DSH before initial presentation was the main risk factor for suicide, with some evidence of high suicide intent being another factor. There were also excess deaths due to several types of physical disorder. Conclusions DSH in older people is closely related to suicide, both in terms of suicidal intent and risk of eventual suicide, especially when DSH is repeated. The range of problems experienced by older DSH patients requires extensive and multidisciplinary clinical interventions. Copyright © 2006 John Wiley & Sons, Ltd.