Predictors of repeated self-harm in older New Zealanders

Transcription

1 Predictors of repeated self-harm in older New Zealanders Summer Studentship : Gisele Foster Supervisor: Gary Cheung, Old Age Psychiatrist Department of Psychological Medicine

2 Shah et al. (2015) Aging & Mental Health

3 Rates per 100, Male Suicide Rates 2001 to 2010 NEW ZEALAND year age group

4 Late-life Suicide: Risk Factors psychiatric illness (particularly depression) history of previous suicide attempts physical illness pain functional impairment social disconnectedness Cattell, 2000; Conwell and Thompson, 2008; Conwell et al., 2011; Fassberg et al., 2012

5 Suicidality: A continuum Death wish Suicidal ideation Suicide Plan Suicide attempt Completed suicide % 28% 11.5% Choi et al., 2015

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7 9 to 18% older people who had made a suicide attempt would make further attempt within 12 months

8 Study: Aims (i) to characterise older suicide attempters in Auckland, Hamilton, Wellington and Christchurch; and (ii) to determine the predictors of repeat suicide attempt in 12 months.

9 Methods: Inclusion criteria Age 65 presented to ED following an episode of self-harm from 1st July 2010 to 30th June locations Auckland City Hospital, North Shore Hospital, Waitakere Hospital, Middlemore Hospital, Waikato Hospital, Wellington Hospital and Christchurch Hospital

10 Methods: Databases (i) the existing electronic coding for selfharm, suicide attempt, deliberate selfharm in the emergency department and medical records department e.g. ICD10 Codes X60 to X84; (ii) the consultation-liaison referral database

11 Methods: Exclusion criteria accidental self injury/overdose e.g. took the wrong medication purely by mistake those who died from a suicide attempt (i.e. these cases are classed as suicide) repeated episodes during the 3 years period

12 Methods: Classification of self-harm The Columbia Classification Algorithm of Suicide Assessment (C-CASA) (Posner et al., 2007): (i) Suicide attempt (ii) Self-injurious behaviour, no suicidal intent (iii) Self-injurious behaviour, suicidal intent unknown

13 Summer Studentship Gisele Foster - To combine data from the 7 hospitals and perform statistical analysis - Learning included data management, SPSS, statistics, referencing, academic writing

14 Results: older people (age 65-96; mean=74) Female 55.2% European 92.3% Married 44.2%; widow 25.4% Lived alone 38.1%

15 Results: 2 Non-psychiatric hospital admission in previous 12 months: 46.9% Past mental health history: 64.6% Under MH service at time of self harm: 33.6% Depression: 55.8% Depressive symptoms: 17.7% Past attempts: 34.2% Positive blood alcohol: 14.2%

16 Results: 3 C-CASA Classification Suicide attempt 76.5% Self-injurious behaviour, no suicide intent 13.0% Self-injurious behaviour, suicide intent unknown 10.3% Methods Overdose 68.7% Laceration 9.1%

17 Acute stressors associated with self harm legal difficulties employment change financial trouble separation changed relationship/death of family discord terminal illness in 1st degree percieved physical illness death of 1st degree relative

18 Results: prognosis in 12 month 7 (2.1%) committed suicide 50 (14.7%) repeated self-harm

19 Results: repeat self-harm in 12 months Repeat Self-harm within 12 months P-value Odds ratio Under Mental health* Yes No 58% 29.4% Past attempts 46% 32.2% Taking antidepressant 70% 46.4% Positive blood alcohol* 28.0% 11.8% * Remained significant in final logistic regression model; Chi 2 =15.4, p=0.032, df=7, R 2 = 16.9%

20 Conclusion Predictors of self harm: under mental health; positive blood alcohol Role of physical illness in suicidal behaviour in older people A very risk group Suicide 2100 per 100,000 people Suicide rate for the general older adult population = 6 to 19 per 100,000 people