Hawton Keith, Harriss Louise
Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, UK.
Int J Geriatr Psychiatry. 2006 Jun;21(6):572-81. doi: 10.1002/gps.1526.
Little information is available about older deliberate self-harm (DSH) patients and their outcome.
This study is a prospective investigation and follow-up of 730 consecutive patients (459 females and 271 males) aged 60 years and over who presented to a general hospital following DSH over a 20-year period, 1978-1997. Outcome has been examined in terms of repetition of DSH, and deaths by the end of 2000 identified through official death registers.
DSH involved self-poisoning in 88.6% of cases, 49.3% of the overdoses including paracetamol (acetaminophen), 24.0% minor tranquillizers, and 15.9% antidepressants. Nearly three-quarters of episodes involved high suicidal intent. Common problems preceding DSH were physical illness (46.1%), social isolation (33.5%), relationship problems with family (29.4%) or partner (25.9%), and bereavement or loss (16.7%). Repetition of DSH occurred in 15.3% of cases, 8.2% in the first year following DSH. By the end of 2000, 432/661 (65.4%) of traced patients had died. There were 30 suicides and open verdicts, which were 49 times and 33 times more frequent respectively than expected from general population death rates. Prior DSH before initial presentation was the main risk factor for suicide, with some evidence of high suicide intent being another factor. There were also excess deaths due to several types of physical disorder.
DSH in older people is closely related to suicide, both in terms of suicidal intent and risk of eventual suicide, especially when DSH is repeated. The range of problems experienced by older DSH patients requires extensive and multidisciplinary clinical interventions.
关于老年蓄意自伤（DSH）患者及其预后的信息较少。
本研究是一项对1978年至1997年20年间因蓄意自伤而就诊于综合医院的730例60岁及以上连续患者（459例女性和271例男性）进行的前瞻性调查和随访。已根据蓄意自伤的重复情况以及通过官方死亡登记册确定的截至2000年底的死亡情况对预后进行了检查。
88.6%的蓄意自伤病例涉及自我中毒，49.3%的过量用药包括对乙酰氨基酚（扑热息痛），24.0%为小剂量镇静剂，15.9%为抗抑郁药。近四分之三的发作涉及高度自杀意图。蓄意自伤之前的常见问题包括身体疾病（46.1%）、社会隔离（33.5%）、与家人（29.4%）或伴侣（25.9%）的关系问题以及丧亲或失落（16.7%）。15.3%的病例出现了蓄意自伤的重复情况，在蓄意自伤后的第一年为8.2%。截至2000年底，661例追踪患者中有432例（65.4%）死亡。有30例自杀和死因不明的裁决，分别比一般人群死亡率预期的频率高49倍和33倍。首次就诊前的既往蓄意自伤是自杀的主要危险因素，有证据表明高度自杀意图是另一个因素。还存在因几种身体疾病导致的额外死亡。
老年人的蓄意自伤在自杀意图和最终自杀风险方面都与自杀密切相关，尤其是当蓄意自伤重复发生时。老年蓄意自伤患者经历的问题范围需要广泛的多学科临床干预。
