title: Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation.
abstract: A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide.
  
  
  
  Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected.
  
  
  
  The sample included 339 older people (55.2% female) with an age range of 65-96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35-11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20-6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months.
  
  
  
  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.
authors.affiliation: Department of Psychological Medicine,The University of Auckland,Auckland,New Zealand.
authors.forename: Gary
authors.initials: G
authors.lastname: Cheung
authors.affiliation: School of Medicine,The University of Auckland,Auckland,New Zealand.
authors.forename: Gisele
authors.initials: G
authors.lastname: Foster
authors.affiliation: Waikato District Health Board,Hamilton,New Zealand.
authors.forename: Wayne
authors.initials: W
authors.lastname: de Beer
authors.affiliation: Psychiatry of Old Age Academic Unit,Canterbury District Health Board,Christchurch,New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Gee
authors.affiliation: Psychiatry of Old Age Academic Unit,Canterbury District Health Board,Christchurch,New Zealand.
authors.forename: Tracey
authors.initials: T
authors.lastname: Hawkes
authors.affiliation: Capital Coast District Health Board,Wellington,New Zealand.
authors.forename: Sally
authors.identifier: 0000-0002-2952-1921
authors.initials: S
authors.lastname: Rimkeit
authors.affiliation: Auckland Regional Psychiatric Training Programme,Auckland,New Zealand.
authors.forename: Yu Mwee
authors.initials: YM
authors.lastname: Tan
authors.affiliation: Department of Psychological Medicine,The University of Auckland,Auckland,New Zealand.
authors.forename: Sally
authors.initials: S
authors.lastname: Merry
authors.affiliation: Department of Psychological Medicine,The University of Auckland,Auckland,New Zealand.
authors.forename: Frederick
authors.initials: F
authors.lastname: Sundram
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062787:Drug Overdose / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: older people; self-harm; suicide; suicide attempt