title: First episode of self-harm in older age: a report from the 10-year prospective Manchester Self-Harm project.
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.
  
  
  METHODS
  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.
authors: Psychiatry Research Group, School of Community Based Medicine, University of Manchester, Manchester, United Kingdom.
authors: Richard C
authors: RC
authors: Oude Voshaar
authors: Jayne
authors: J
authors: Cooper
authors: Elizabeth
authors: E
authors: Murphy
authors: Sarah
authors: S
authors: Steeg
authors: Nav
authors: N
authors: Kapur
authors: Nitin B
authors: NB
authors: Purandare
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D018709:Statistics, Nonparametric; D013406:Suicide, Attempted / Q000523:psychology