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Van Hove L, Baetens I, Vanderstichelen S. Conceptualizing Self-Harm through the Experiences of Psychogeriatric Experts. Psychopathology 2024:1-9. [PMID: 38599197 DOI: 10.1159/000537809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/11/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Fewer studies thus far have focused on self-harm and its specific forms among older adults. Moreover, the limited available literature applies varying terminology. The categorization of self-harm used in younger populations may not be as appropriate for this population. This means that less is known about this phenomenon in older adults. The current study aimed to reduce this gap. METHODS Nine Flemish psychogeriatric experts participated in a semi-structured interview. Transcripts were thematically analyzed. RESULTS Themes emerging from the interviews suggest that self-harm in older adults may also include distinct elements, such as the omission of certain behaviours and engagement in indirect self-harm to cause bodily harm. According to the experts, self-harm may be engaged in to cope with emotions, express life fatigue, hasten death, and communicate a cry for help. DISCUSSION Self-harm is prevalent in older adults, and some characteristics may be specific to self-harm in an older age group. These findings may enable clinicians to be more alert to self-harm in older adults and consequently prevent serious suicidal behaviour. More research is needed to further uncover this phenomenon.
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Affiliation(s)
- Lisa Van Hove
- Brussels University Consultation Center (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Imke Baetens
- Brussels University Consultation Center (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Vanderstichelen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels/Ghent University, Ghent, Belgium
- Compassionate Communities Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels/Ghent University, Ghent, Belgium
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2
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Laflamme L, Lindholm E, Möller J. Repeated hospital admission for intentional poisonings among older adults - a Swedish national register-based study. BMC Geriatr 2024; 24:157. [PMID: 38360600 PMCID: PMC10870539 DOI: 10.1186/s12877-024-04717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event. METHODS We conducted a nationwide register-based cohort study of people aged 50-100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006-2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)). RESULTS Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45-2.01 and 1.89 (95% CI = 1.60-2.19) respectively). CONCLUSION Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect.
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Affiliation(s)
- L Laflamme
- Department of Global Public Health , Karolinska Institutet, Widerströmska huset Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - E Lindholm
- Department of Global Public Health , Karolinska Institutet, Widerströmska huset Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Jette Möller
- Department of Global Public Health , Karolinska Institutet, Widerströmska huset Tomtebodavägen 18A, 17177, Stockholm, Sweden.
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Hetrick SE, Hobbs M, Fortune S, Marek L, Wiki J, Boden JM, Theodore R, Ruhe T, Kokaua JJ, Thabrew H, Milne B, Bowden N. Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure. Aust N Z J Psychiatry 2024; 58:152-161. [PMID: 37888830 PMCID: PMC10838485 DOI: 10.1177/00048674231203909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. METHODS This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. RESULTS Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. CONCLUSIONS The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.
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Affiliation(s)
- Sarah E Hetrick
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Suicide Prevention Office, Auckland, New Zealand
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
| | - Matthew Hobbs
- Te Taiwhenua o te Hauora–GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
- The Cluster for Community and Urban Resilience (CURe), University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Sarah Fortune
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Lukas Marek
- Te Taiwhenua o te Hauora–GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Epidemioloigy and Biostatistics, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago, Christchurch, Canterbury, New Zealand
| | - Reremoana Theodore
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
| | - Troy Ruhe
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Jesse J Kokaua
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Hiran Thabrew
- Te Ara Hāro, Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), The University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
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Hedna K, Jonson M, Sigström R, Åberg M, Wilhelmson K, Waern M. Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75. Aging Ment Health 2023; 27:2052-2060. [PMID: 36803189 DOI: 10.1080/13607863.2023.2179974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode. METHOD Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode. RESULTS There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care. CONCLUSION The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna AB, Gothenburg, Sweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Affective Clinic, Gothenburg, Sweden
| | - Robert Sigström
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Christensen M, Chan HY, Chan YY, Cheng KY, Cheung TY, Li TY, Situ JL, Tam PL, Tse CC, Ma H. Suicide ideation in older people: a qualitative review and Meta-aggregation of Asian studies. Front Psychiatry 2023; 14:1169820. [PMID: 37671288 PMCID: PMC10475554 DOI: 10.3389/fpsyt.2023.1169820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/10/2023] [Indexed: 09/07/2023] Open
Abstract
Aims To appraise and synthesize qualitative studies examining older Asian people's experiences of suicidal ideation. Design Qualitative review and meta-aggregation. Data sources Four databases were accessed to retrieve papers published between 1990 and 2022 including the grey literature, hand-searching of reference lists of retrieved papers and key journals. The phenomenon of interest included participants older than 60 years old, must have experienced a form of suicidal ideation and/or an unsuccessful attempt, had actively thought about harming themselves and be of Asian ethnicity. Review methods This review was conducted according to Consolidated Criteria for Reporting Qualitative Research and the Joanna Briggs Institute's System for the Unified Management of the Assessment and Review of Information. Results Of the 289 potential studies, seven papers met the inclusion criteria. Two synthesized findings resulted from this review-The Suffering Situation: A Life without Meaning in Older Age and The Healing Situation: A Life Worth Living. The experiences of older Asian people varied from feelings of loneliness, despair and isolation to wanting to live a fruitful life into old age. Conclusion Suicidal ideation in the older person is a growing concern especially with the rise in suicide in this age group. Rising health care costs and erosion of traditional family values means that the older person views themselves as a burden. However, because of the limited number of qualitative studies from an Asian perspective it is difficult to ascertain the full extent of the issues surrounding suicide in older people.
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Affiliation(s)
- Martin Christensen
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
- Interdisciplinary Centre for Qualitative Research, School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Hiu Yin Chan
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Yuen Yi Chan
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Yee Cheng
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz Yan Cheung
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz Yan Li
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jia Ling Situ
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Po Lam Tam
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Cheuk Chi Tse
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Haixia Ma
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Bøe AS, Mehlum L, Melle I, Qin P. Psychiatric disorders among adults treated for deliberate self-harm in general hospital: A national register study. J Affect Disord 2022; 319:490-496. [PMID: 36162670 DOI: 10.1016/j.jad.2022.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Psychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. AIM To examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. METHOD Data from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008-2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. RESULTS Altogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. LIMITATIONS Data was restricted to variables available in the registers. CONCLUSIONS Psychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.
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Affiliation(s)
- Anne Seljenes Bøe
- The National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Lars Mehlum
- The National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, Norway
| | - Ping Qin
- The National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
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Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services. Int Psychogeriatr 2022; 34:813-826. [PMID: 33336632 DOI: 10.1017/s1041610220003853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand. METHODS interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales. RESULTS A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36-181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51-5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26-4.03), at-risk alcohol use (2.38, 1.30-4.35), and bipolar disorder (2.18, 1.25-3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36-0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35-0.89). CONCLUSION Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.
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Schmutte T, Olfson M, Xie M, Marcus SC. Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm. Am J Geriatr Psychiatry 2022; 30:478-491. [PMID: 34563430 PMCID: PMC10563141 DOI: 10.1016/j.jagp.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. RESULTS Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. CONCLUSION Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
| | - Mark Olfson
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University, New York, New York
| | - Ming Xie
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania
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Wei YX, Liu BP, Zhang J, Wang XT, Chu J, Jia CX. Prediction of recurrent suicidal behavior among suicide attempters with Cox regression and machine learning: a 10-year prospective cohort study. J Psychiatr Res 2021; 144:217-224. [PMID: 34700209 DOI: 10.1016/j.jpsychires.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Research on predictors and risk of recurrence after suicide attempt from China is lacking. This study aims to identify risk factors and develop prediction models for recurrent suicidal behavior among suicide attempters using Cox proportional hazard (CPH) and machine learning methods. METHODS The prospective cohort study included 1103 suicide attempters with a maximum follow-up of 10 years from rural China. Baseline characteristics, collected by face-to-face interviews at least 1 month later after index suicide attempt, were used to predict recurrent suicidal behavior. CPH and 3 machine learning algorithms, namely, the least absolute shrinkage and selection operator, random survival forest, and gradient boosting decision tree, were used to construct prediction models. Model performance was accessed by concordance index (C-index) and the time-dependent area under the receiver operating characteristic curve (AUC) value for discrimination, and time-dependent calibration curve along with Brier score for calibration. RESULTS The median follow-up time was 7.79 years, and 49 suicide attempters had recurrent suicidal behavior during the study period. Four models achieved comparably good discrimination and calibration performance, with all C-indexes larger than 0.70, AUC values larger than 0.65, and Brier scores smaller than 0.06. Mental disorder emerged as the most important predictor across all four models. Suicide attempters with mental disorders had a 3 times higher risk of recurrence than those without. History of suicide attempt (HR = 2.84, 95% CI: 1.34-6.02), unstable marital status (HR = 2.81, 95% CI: 1.38-5.71), and older age (HR = 1.51, 95% CI: 1.14-2.01) were also identified as independent predictors of recurrent suicidal behavior by CPH model. CONCLUSIONS We developed four models to predict recurrent suicidal behavior with comparable good prediction performance. Our findings potentially provided benefits in screening vulnerable individuals on a more precise scale.
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Affiliation(s)
- Yan-Xin Wei
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China; Shandong University Center for Suicide Prevention Research, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China; Shandong University Center for Suicide Prevention Research, China
| | - Jie Zhang
- Shandong University Center for Suicide Prevention Research, China; Department of Sociology, State University of New York College at Buffalo, Buffalo, NY, 14222, USA
| | - Xin-Ting Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China; Shandong University Center for Suicide Prevention Research, China
| | - Jie Chu
- Shandong Center for Disease Prevention and Control, Jinan, 250014, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China; Shandong University Center for Suicide Prevention Research, China.
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Hedna K, Montuori C, Forte A, Pompili M, Waern M. Use of antidepressants and risk of repeat self-harm in older adults 75+ with nonfatal self-harm: A 1-year prospective national study. Pharmacoepidemiol Drug Saf 2021; 31:206-213. [PMID: 34687250 DOI: 10.1002/pds.5375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess exposure to antidepressants (AD) before and after nonfatal self-harm (SH) in older adults and to examine 1-year rates and risk factors for subsequent SH. METHODS Longitudinal national register-based retrospective cohort study of Swedish residents aged 75+ (N = 2775) with treatment at hospital or specialist outpatient clinic in connection with SH between January 1, 2006, and December 31, 2013. The cohort was followed for 1 year after the index episode. Exposure to AD was assessed at index and at subsequent SH. Cox regression analysis was used to assess factors associated with 1-year repeat SH. RESULTS At the index episode, 51% were prevalent AD users; 23% started AD during the following year. Overall 12% of prevalent AD users, 8% of AD nonusers, and 6% of AD new users repeated SH or died by suicide. About two-thirds of these subsequent behaviors occurred within 3 months after the index episode. Men had increased risk of subsequent SH (Hazard ratio [HR] 1.38, 95% CI: 1.09-1.74); older age (>85 years) was associated with a lower risk (HR 0.72, CI 95% 0.55-0.93). Users of AD did not have an increased risk of repeat SH. CONCLUSIONS Half of older adults who self-harmed were prevalent AD users and a further one fourth started an AD within 1 year after the index SH. Antidepressant use was not associated with increased risk of subsequent SH in this high-risk cohort of older adults.
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Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden.,Statistikkonsulterna AB, Gothenburg, Sweden
| | - Chiara Montuori
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alberto Forte
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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11
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Negative life events and self-harm among the elderly: Result from a survey of 7070 people aged≥60 in China. Psychiatry Res 2021; 298:113727. [PMID: 33588172 DOI: 10.1016/j.psychres.2021.113727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/11/2021] [Indexed: 11/21/2022]
Abstract
PURPOSES Negative life events have been reported as a risk factor for elderly self-harm. The aim of this study was to examine the relationship between negative life events and self-harm in a large sample of people aged 60 and older, and explore the role of some previously identified influential factors in this relationship. METHODS Multi-stage stratified sampling method was used to select the elderly people over 60 years old in Shandong, China. Information were collected through face-to-face interviews. Univariate and multivariable logistic regression were used for initial analysis. Karlson-Holm-Breen (KHB) method was used for mediating effect analysis. RESULTS A total of 7070 participants were included in the study, 160 reported they had a history of self-harm (2.3%), 756 reported they had negative life event experience (10.7%). After model adjustment, the association between negative life events, loneliness, economic status and self-harm was still statistically significant. Mediation analysis showed that the association is explained by loneliness (proportion of mediation 48.86%), self-rated economic status (16.13%). CONCLUSIONS Negative life events, loneliness and economic status were associated with self-harm among the older adults. Loneliness and economic status may play an intermediary role in the relationship between negative life events and self-harm, especially loneliness. More psychological and social functions intervention strategies and prevention measures on the self-harm of the elderly should be provided for the elderly who have experienced negative life events.
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12
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Liu BP, Lunde KB, Jia CX, Qin P. The short-term rate of non-fatal and fatal repetition of deliberate self-harm: A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2020; 273:597-603. [PMID: 32560959 DOI: 10.1016/j.jad.2020.05.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Deliberate self-harm (DSH) is often recurrent, but the reported rate of short-term repetition of DSH has varied greatly. This systematic review and meta-analysis aim to synthesize findings through providing pooled rate estimates and to explore their differences by age, gender, and other factors. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted to include longitudinal studies from 1999 to 2018. Random effects model was applied to pool rates of non-fatal and fatal repetition at 0.5, 1, 2, and 3 years intervals. RESULTS Of 9201 potentially eligible articles 76 studies were included for this systematic review and meta-analysis. The pooled rates of non-fatal repetition were 15.01%, 17.03%, 20.82%, and 24.20% during the 0.5-year, 1-year, 2-year, and 3-year follow-up, respectively. The corresponding rates of fatal repetition were 0.77%, 1.34%, 1.49% and 2.46%, respectively. When focusing on the 1-year follow-up, the pooled rate of fatal, not non-fatal, repetition was significantly higher in males than females. The rate of non-fatal DSH repetition was highest in middle-aged adults, while the rate of fatal repetition was highest among the elderly. Geographically, Europe had higher rate of non-fatal repetition whilst Asia had higher rate of repetition leading to death. LIMITATION Search was limited to English language and publication bias was observed. CONCLUSIONS Both non-fatal and fatal repetitions are common among people with DSH, but the rates differ considerably by gender, age and geographical location. These insights may guide provision of follow-up care and effort of suicide prevention for this high-risk population.
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; Shandong University Center for Suicide Prevention Research, Shandong University School of Public Health, Jinan 250012, China; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway
| | - Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway
| | - Cun-Xian Jia
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; Shandong University Center for Suicide Prevention Research, Shandong University School of Public Health, Jinan 250012, China
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway.
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13
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Jackson M, McGill K, Lewin TJ, Bryant J, Whyte I, Carter G. Hospital-treated deliberate self-poisoning in the older adult: Identifying specific clinical assessment needs. Aust N Z J Psychiatry 2020; 54:591-601. [PMID: 31957465 DOI: 10.1177/0004867419897818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. OBJECTIVE To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45-64 years) during an index episode of hospital-treated deliberate self-poisoning. METHODS A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003-2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. RESULTS There were (n = 157) older-aged and (n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. CONCLUSION Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.
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Affiliation(s)
- Mariann Jackson
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Terry J Lewin
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Ian Whyte
- Calvary Mater Newcastle, Waratah, NSW, Australia.,Discipline of Clinical Pharmacology, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, Australia
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14
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Schmutte T, Olfson M, Xie M, Marcus SC. Self-Harm, Suicidal Ideation, and Attempted Suicide in Older Adults: A National Study of Emergency Department Visits and Follow-Up Care. Am J Geriatr Psychiatry 2020; 28:646-658. [PMID: 31917069 PMCID: PMC7246137 DOI: 10.1016/j.jagp.2019.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Emergency department visits for self-harm and suicidal ideation have increased for US older adults. The purpose of this study was to examine discharge disposition, clinical recognition of mental disorder, and 30-day follow-up mental health outpatient care of older adults treated in emergency departments for suicide attempt (SA), suicidal ideation (SI), or deliberate self-harm (DSH). METHODS Retrospective cohort analysis using 2015 Medicare claims for adults ≥65 years of age with suicide-related emergency encounters (N = 52,383). Demographic, clinical, and service use characteristics from claims were merged with county-level Area Health Resource File data. Rates and adjusted risk ratios were assessed for discharge to the community, mental health diagnosis in the emergency department, and outpatient mental health visits with 30 days after the emergency encounter. RESULTS Encounters for SA (7.8%) and SI (17.2%) were less likely than those for DSH (29.1%) to be discharged to the community. Among community discharges, SA (95.6%) and SI (95.1%) encounters were more likely than DSH (52.3%) encounters to be diagnosed with a mental disorder in the emergency department. Encounters for SA (52.1%) and SI (59.9%) were also more likely than DSH (31.3%) encounters to receive follow-up mental care. CONCLUSIONS Although most older adults treated in EDs for suicide-related reasons are hospitalized, a substantial proportion of patients discharged back to the community do not receive follow-up mental healthcare within 30 days.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University (TS), Westport, CT.
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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15
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Schmutte T, Olfson M, Xie M, Marcus SC. Deliberate self-harm in older adults: A national analysis of US emergency department visits and follow-up care. Int J Geriatr Psychiatry 2019; 34:1058-1069. [PMID: 30933388 PMCID: PMC6579649 DOI: 10.1002/gps.5109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine mental health care received by older adults following emergency department (ED) visits for deliberate self-harm. METHODS This retrospective cohort analysis examined 2015 Medicare claims for adults ≥65 years of age with ED visits for deliberate self-harm (N = 16 495). We estimated adjusted risk ratios (ARR) for discharge disposition, ED coding of mental disorder, and 30-day follow-up mental health outpatient care. RESULTS Most patients (76.9%) were hospitalized with lower likelihoods observed for African American patients (ARR = 0.86, 99% CI = 0.79-0.94) and patients with either one medical comorbidity (ARR = 0.91, 99% CI = 0.83-0.99) or two to three comorbidities (ARR = 0.93, 99% CI = 0.88-0.99). Hospitalization was associated with recent depression (ARR = 1.09, 99% CI = 1.03-1.16) and recent psychiatric inpatient care (ARR = 1.13, 99% CI = 1.04-1.22). Among patients discharged to the community (n = 3818), 56.4% received an ED mental disorder diagnosis. Predictors of an ED mental disorder diagnosis included younger age (65-69 years; ARR = 1.53, 99% CI = 1.31-1.78), recent mental health care in ED (ARR = 1.50, 99% CI = 1.29-1.74) or outpatient (ARR = 1.62, 99% CI = 1.44-1.82) settings, recent diagnosis of mental disorder (ARR = 1.61, 99% CI = 1.43-1.80), and other/unknown lethality methods of self-harm (ARR = 1.24, 99% CI = 1.01-1.52). Among community discharged patients, 39.0% received 30-day follow-up outpatient mental health care, which was most strongly predicted by an ED diagnosis of mental disorder (ARR = 2.65, 99% CI = 2.25-3.12) and prior outpatient mental health care (ARR = 2.62, 99% CI = 2.28-3.00). CONCLUSION Most older adult Medicare beneficiaries who present to EDs with self-harm are hospitalized. Of those who are discharged to the community, many are not diagnosed with mental disorder in the ED or receive timely follow-up mental health care.
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Affiliation(s)
- Timothy Schmutte
- Yale University, Department of Psychiatry, Program for Recovery and Community Health
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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16
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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17
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Troya MI, Babatunde O, Polidano K, Bartlam B, McCloskey E, Dikomitis L, Chew-Graham CA. Self-harm in older adults: systematic review. Br J Psychiatry 2019; 214:186-200. [PMID: 30789112 DOI: 10.1192/bjp.2019.11] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-harm is a major public health concern. Increasing ageing populations and high risk of suicide in later life highlight the importance of identification of the particular characteristics of self-harm in older adults.AimTo systematically review characteristics of self-harm in older adults. METHODS A comprehensive search for primary studies on self-harm in older adults was conducted in e-databases (AgeLine, CINAHL, PsycINFO, MEDLINE, Web of Science) from their inception to February 2018. Using predefined criteria, articles were independently screened and assessed for methodological quality. Data were synthesised following a narrative approach. A patient advisory group advised on the design, conduct and interpretation of findings. RESULTS A total of 40 articles (n = 62 755 older adults) were included. Yearly self-harm rates were 19 to 65 per 100 000 people. Self-poisoning was the most commonly reported method. Comorbid physical problems were common. Increased risk repetition was reported among older adults with self-harm history and previous and current psychiatric treatment. Loss of control, increased loneliness and perceived burdensome ageing were reported self-harm motivations. CONCLUSIONS Self-harm in older adults has distinct characteristics that should be explored to improve management and care. Although risk of further self-harm and suicide is high in all age cohorts, risk of suicide is higher in older adults. Given the frequent contact with health services, an opportunity exists for detection and prevention of self-harm and suicide in this population. These results are limited to research in hospital-based settings and community-based studies are needed to fully understand self-harm among older adults.Declaration of interestNone.
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Affiliation(s)
- M Isabela Troya
- Research Institute for Primary Care and Health Sciences,Keele University,UK
| | - Opeyemi Babatunde
- Research Associate,Research Institute for Primary Care and Health Sciences,Keele University,UK
| | - Kay Polidano
- Research Institute for Primary Care and Health Sciences,Keele University,UK
| | - Bernadette Bartlam
- Senior Research Fellow,Family Medicine and Primary Care,Lee Kong Chian School of Medicine,Nanyang Technical UniversitySingapore
| | - Erin McCloskey
- School of Nursing,Midwifery and Social Work,Canterbury Christ Church University,UK
| | - Lisa Dikomitis
- Senior Lecturer in Sociology and Health,Research Institute for Primary Care and Health Sciences,Keele University; andSchool of Medicine, Keele University,UK
| | - Carolyn A Chew-Graham
- Professor of General Practice Research,Research Institute for Primary Care and Health Sciences,Keele University and West Midlands Collaboration for Leadership in Applied Health Research and Care; andHonorary Professor of Primary Care Mental Health,Midlands Partnership Foundation Trust,UK
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18
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Self harm attempt in the older population of the UK. Lancet Psychiatry 2019; 6:92. [PMID: 30686391 DOI: 10.1016/s2215-0366(18)30473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
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19
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Schmutte T, Olfson M, Xie M, Marcus SC. National study of emergency department disposition for high suicide risk geriatric patients. Gen Hosp Psychiatry 2019; 58:67-70. [PMID: 30933688 PMCID: PMC6500465 DOI: 10.1016/j.genhosppsych.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/17/2019] [Accepted: 03/26/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine predictors of hospitalization among older adults at high risk for suicide treated in emergency departments (EDs). METHODS This retrospective cohort analysis used national 2015 Medicare claims for adults ≥65 years with ED visits for suicide ideation or deliberate self-harm (N = 50,472) merged with data from the Area Health Resource File. Rates and adjusted risk ratios (ARR) of hospital admission were assessed. RESULTS A majority of ED episodes resulted in hospital admission (81.9%) with most being admitted to a psychiatric unit (62.8%). Visits for self-harm with suicide ideation were most likely to result in hospitalization (94.7%) compared to suicide ideation alone (84.0%) or self-harm alone (73.1%). Current diagnosis of depression, bipolar, anxiety, cognitive, and personality disorder were associated with hospitalization. Co-occurring mental and substance use disorders were the most predictive mental health condition of admission. Overall, severity of current medical comorbidity was the strongest predictor of hospital admission. CONCLUSIONS Most older adults treated in EDs for suicide ideation or self-harm are hospitalized. Medical morbidity plays a more prominent role than other patient factors in admission status.
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Affiliation(s)
- Timothy Schmutte
- Yale University, Department of Psychiatry, Program for Recovery and Community Health, New Haven, CT, USA.
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute, New York, NY, USA
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Steven C. Marcus
- University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA, USA
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20
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Intoxication with alcohol at the time of self-harm and pre-existing involvement with mental health services are associated with a pre-disposition to repetition of self-harming behavior in a large cohort of older New Zealanders presenting with an index episode of self-harm. Int Psychogeriatr 2017; 29:1235. [PMID: 28685703 DOI: 10.1017/s104161021700093x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The paper on predictors of repeat self-harm and suicide by Cheung et al. (2017), which has been chosen by the editorial team as paper of the month for this issue of International Psychogeriatrics, makes a very useful contribution to the study of self-harm and suicide in late life. Of 339 individuals presenting with an index episode of self-harm to one of seven Emergency Departments (EDs) in New Zealand, close to 15% harmed themselves again within one year and for nearly one in six of these 50 people, the repeat episode was fatal. Having alcohol in the blood and already being engaged with mental health services at the time of the index episode both had some utility in predicting the occurrence of a further self-harm episode. While it is encouraging that mental health services look to have been focusing on those who turned out to be at highest risk, clinicians may need to be particularly vigilant when following up individuals who had been drinking alcohol at the time of an initial self-harm presentation. This study also emphasizes the high risk of recurrent self-harm and completed suicide in those older adults who harm themselves and survive the initial episode. It deserves to be widely cited and gives some direction for future research on interventions designed to diminish the recurrence of self-harm in those of our patients who have presented to an ED with an initial self-harm episode.
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