Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation

Abstract

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.

Deliberate self‐harm in older adults: A national analysis of US emergency department visits and follow‐up care

“…In the US, approximately half a million patients present annually to EDs for treatment of deliberate self-harm, 1 which includes intentional self-injury and self-poisoning irrespective of suicidal intent. 9 Prior research suggests that a large majority of self-harm events in older adults are suicide attempts, [10][11][12] rather than nonsuicidal selfinjury which is more prevalent in younger persons. 2,3 Suicide risk increases substantially after age 65,4 and the geriatric population is growing rapidly.…”

“…5 In the US, there have been recent increases in the ED visits for deliberate self-harm, 6 suicide ideation, 7 and mental and substance use disorders among aging adults. 17,18 Geriatric self-harm is associated with greater suicidal intent than in younger persons 11,12 as older adults tend to formulate a more lethal suicide plan, to use more lethal means, and to be in poorer physical health and more isolated, making self-harm behavior more fatal. 9 Prior research suggests that a large majority of self-harm events in older adults are suicide attempts, [10][11][12] rather than nonsuicidal selfinjury which is more prevalent in younger persons.…”

“…20,21 However, mental disorders are not coded in 25% to 45% of standard ED visits for self-harm. 11,12,[35][36][37][38] However, no national study has focused on the mental health care received after self-harm in the US geriatric population. In United States studies of youth and adults younger than 65 years, 47.1% to 58.8% of discharged patients did not receive any outpatient care within 30 days after an ED visit for self-harm.…”

“…8 As compared with younger adults, suicide prevention in older adults tends to be more challenging because self-harm behavior is more immediately lethal and has fewer warning signs. 9 Prior research suggests that a large majority of self-harm events in older adults are suicide attempts, [10][11][12] rather than nonsuicidal selfinjury which is more prevalent in younger persons. [13][14][15] In the US, the prevalence of ED visits for self-harm peaks in early adulthood then decreases with age.…”

“…16 On the other hand, case fatality rates for selfharm increase with age and are highest in older adults. 17,18 Geriatric self-harm is associated with greater suicidal intent than in younger persons 11,12 as older adults tend to formulate a more lethal suicide plan, to use more lethal means, and to be in poorer physical health and more isolated, making self-harm behavior more fatal. 19 Research underscores the importance of assessment of and treatment initiation for mental health problems in the emergency management of older adults with self-harm.…”