Self-harm in adults: a comparison between the middle-aged and the elderly

AIM: In New Zealand, men aged 45-49 years and 85 years and above have one of the highest suicide rates. As the population in New Zealand ages, it is anticipated that the absolute number of late-life suicides will rise. Self-harm is one of the better predictors of future suicide. The aims of this study are to: (i) characterise middle-aged (45-64 years) and older-aged people (65+ years) who have self-harmed; and (ii) determine whether there are differences between the two age groups. METHOD: Clinical data were retrospectively collected on people aged 45+ years who presented with a self-harm attempt to a large emergency department in New Zealand from 2010 to 2013. Further clinical information for the 12-month period following their presentation was also collected. RESULTS: Three hundred and seventy-one middle-aged (56.6% female) and 49 older-aged (38.8% female) people presented with a total of 513 and 56 self-harm attempts respectively during the study period. The older-aged group was more likely to report physical illness as a stressor (p=0.001), have a history of depression (p<0.0001) and be diagnosed with depression at the time of their attempt (p<0.0001). Suicidal intent was more common among the older-aged people who have self-harmed (p=0.004), and they had lower survival rates in the 12 months after their self-harm attempt (risk ratio=7.5; 95% CI=3.1 to 18.1). CONCLUSION: The significant differences between older-aged and middle-aged people who have self-harmed highlights the need for age-specific suicide interventions, with particular focus on addressing physical illness and depression in older-aged people.