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First Episode of Self-Harm in Older Age: A Report From the 10-Year Prospective Manchester Self-Harm Project

J Clin Psychiatry 2011;72(6):737-743
10.4088/JCP.10m06501

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.

J Clin Psychiatry 2011;72(6):737–743

Submitted: August 16, 2010; accepted December 9, 2010 (doi:10.4088/JCP.10m06501).

Corresponding author: Nitin B. Purandare, PhD, Psychiatry Research Group, School of Community Based Medicine, The University of Manchester, Room 3.319, Jean McFarlane Bldg, University Place, Oxford Road, Manchester, United Kingdom M13 9PL (nitin.purandare@manchester.ac.uk).