| アブストラクト | BACKGROUND: Self-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide. METHODS: The UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001-14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks. FINDINGS: Overall incidence of self-harm in older adults aged 65 years and older was 4.1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11.7%) of 2854 adults were referred to mental health services, 1692 (59.3%) were prescribed an antidepressant, and 336 (11.8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2.10 [95% CI 2.03-2.17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1.20 [1.17-1.23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145.4 [95% CI 53.9-392.3]) was observed in the self-harm cohort. INTERPRETATION: Within primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions. FUNDING: National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre. |
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| 投稿者 | Morgan, Catharine; Webb, Roger T; Carr, Matthew J; Kontopantelis, Evangelos; Chew-Graham, Carolyn A; Kapur, Nav; Ashcroft, Darren M |
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| 組織名 | Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and;Health, NIHR Greater Manchester Patient Safety Translational Research Centre,;Manchester Academic Health Science Centre, The University of Manchester,;Manchester, UK. Electronic address: cathy.morgan@manchester.ac.uk.;Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health,;NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester;Academic Health Science Centre, The University of Manchester, Manchester, UK.;National Institute for Health Research (NIHR) School for Primary Care Research,;Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine;and Health, NIHR Greater Manchester Patient Safety Translational Research Centre,;Manchester, UK.;Research Institute, Primary Care and Health Sciences, West Midlands,;Collaboration for Leadership in Applied Health Research and Care, Keele;University, Staffordshire, UK.;Academic Health Science Centre, The University of Manchester, Manchester, UK;;Centre for Suicide Prevention, Faculty of Biology, Medicine and Health, NIHR;Greater Manchester Patient Safety Translational Research Centre, Manchester;Greater Manchester Mental Health NHS Foundation Trust, Prestwich Hospital,;Prestwich, Manchester, UK. |
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