Psychiatry Research Group, School of Community Based Medicine, University of Manchester, Manchester, United Kingdom.
J Clin Psychiatry. 2011 Jun;72(6):737-43. doi: 10.4088/JCP.10m06501.
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.
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.
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.
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.
自残行为与自杀行为密切相关，尤其是在老年人群中。鉴于老年人群中自残行为的实证研究较为匮乏，且尚无研究专门针对老年人群中的首次自残发作，我们对老年人群中首次自残发作的临床特征和重复自残风险进行了研究。
曼彻斯特自伤项目（MaSH）是一项前瞻性队列研究，自 1997 年 9 月 1 日至 2007 年 8 月 31 日，在英格兰西北部 3 家大型医院的急诊科，对因自残而就诊的个体进行数据收集。描述并比较了首次因自残而就诊的老年患者（年龄≥55 岁）和首次因自残而就诊的中年患者（35-54 岁）的特征。在每次发作后，由临床医生填写 MaSH 表格，这是专为 MaSH 项目开发的标准评估表。通过 Cox 回归分析，检查了重复自残的潜在风险因素。
共有 374 名老年患者和 1937 名中年患者首次因自残而就诊。自残时的情况表明老年患者的自杀意图更高。与中年患者相比，老年患者的重复自残率较低（分别为 15.4%和 11.8%；老年组的重复自残风险比为 0.65；95%CI，0.45-0.93；P=0.019），但老年组的重复自残更常导致死亡（分别为 3.3%和 13.6%；P=0.009）。对老年人群中重复自残最重要的预测因素，即身体健康问题，在中年患者中没有预测价值，而精神特征对老年人群中重复自残的风险影响较小。
首次自残的高自杀意图和不同的重复自残预测因素凸显了需要针对老年人群实施特定干预措施，而不仅仅是针对精神健康护理。
