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J Clin Psychiatry. 2011 Jun;72(6):737-43. doi: 10.4088/JCP.10m06501.

First episode of self-harm in older age: a report from the 10-year prospective Manchester Self-Harm project.

Author information

1
Psychiatry Research Group, School of Community Based Medicine, University of Manchester, Manchester, United Kingdom.

Abstract

OBJECTIVE:

Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm in older age.

METHOD:

The Manchester Self-Harm (MaSH) project, a prospective cohort study, gathered data from September 1, 1997, through August 31, 2007, for individuals presenting with self-harm at emergency departments of 3 large hospitals in North West England. The characteristics of older patients (aged ≥ 55 years) who presented with a first-ever episode of self-harm are described and compared to those of middle-aged patients (35-54 years) presenting with a first-ever episode of self-harm. Following each episode, the MaSH form, a standard assessment form developed for the MaSH project, was completed by a clinician. Potential risk factors for repetition were examined by Cox regression analyses.

RESULTS:

A total of 374 older patients and 1,937 middle-aged patients presented with a first-ever episode of self-harm. The circumstances at the time of self-harm suggested higher suicidal intent in older age. In comparison with middle-aged patients, the rate of repetition in older-aged patients was lower (15.4% versus 11.8%, respectively; hazard ratio for older age = 0.65; 95% CI, 0.45-0.93; P = .019), although repetition was more often fatal among the older group (3.3% versus 13.6%, respectively; P = .009). The most important predictor of repetition in older age, ie, physical health problems, had no predictive value in middle-aged patients, whereas psychiatric characteristics had little impact on the risk of repetition in old age.

CONCLUSIONS:

High suicidal intent and different predictors of repetition in first-ever self-harm in older age highlight the need for age-specific interventions beyond the scope of psychiatric care alone.

PMID:
21733475
DOI:
10.4088/JCP.10m06501
[Indexed for MEDLINE]

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