Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation,Suicide Attempt,and Self-Harm

ObjectiveOlder adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults.MethodsRetrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare.ResultsOverall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care.ConclusionTimely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.     

A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality versus Enhanced Care as Usual With Suicidal Soldiers

Objective: This study describes a randomized controlled trial called “Operation Worth Living” (OWL) which compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced care as usual (E-CAU). We hypothesized that CAMS would be more effective than E-CAU for reducing suicidal ideation (SI) and suicide attempts (SA), along with secondary behavioral health and health care utilization markers for U.S. Army Soldier outpatients with significant SI (i.e., > 13 on Beck’s Scale for Suicide Ideation). Method: Study participants were 148 Soldiers who presented to a military outpatient behavioral health clinic. There were 73 Soldiers in the experimental arm of the trial who received adherent CAMS; 75 Soldiers received E-CAU. Nine a-priori treatment outcomes (SI, past year SA, suicide-related emergency department (ED) admits, behavioral health-related ED admits, suicide-related inpatient psychiatric unit (IPU) days, behavioral health-related IPU days, mental health, psychiatric distress, resiliency) were measured through assessments at Baseline and at 1, 3, 6, and 12 months post-Baseline (with a 78% retention of intent-to-treat participants at 12 months). Results: Soldiers in both arms of the trial responded to study treatments in terms of all primary and secondary outcomes (effect sizes ranged from 0.63 to 12.04). CAMS participants were significantly less likely to have any suicidal thoughts by 3 months in comparison to those in E-CAU (Cohen’s d = 0.93, p=.028). Conclusions: Soldiers receiving CAMS and E-CAU significantly improved post-treatment. Those who received CAMS were less likely to report SI at 3 months; further group differences were not otherwise seen.     

Suicidal and self-harm behaviour associated with adolescent attention deficit hyperactivity disorder-A study in the Northern Finland Birth Cohort 1986

Background: Suicidal behaviour, i.e. suicidal ideation and suicidal acts, as well as self-harm behaviour, are relatively common among adolescents. Depression and/or female gender seem to be risk factors for suicidal behaviour. However, the role of attention deficit hyperactivity disorder (ADHD) in these behaviours is still unclear. Aim: To study the effect of ADHD on suicidal or self-harm behaviour in adolescents from a general population sample. Methods: The sample was derived from a population-based Northern Finland Birth Cohort 1986 (n = 9432). Based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version (Kiddie-SADS-PL) interview performed in a subpopulation (n = 457), the associations between suicidal behaviour and deliberate self-harm (DSH) and the diagnosis of ADHD were studied. Results: Compared with adolescents without ADHD (n = 169), those with ADHD (n = 104) had more suicidal ideation (57% vs. 28%, P < 0.001) and DSH (69% vs. 32%, P < 0.001). In binary logistic models, the effect of ADHD on suicidal ideation remained strong (OR = 6.1) after controlling for several other predictors. Other contributing factors in suicidal behaviour included female gender, childhood emotional and behavioural problems, concurrent depression and anxiety, and, specifically in DSH, behavioural disorder, substance abuse and strains in family relations. Discussion and clinical implications: ADHD is a risk factor for suicidal ideation and DSH. These findings in a general population sample speak for a need to target mental health interventions at children and adolescents with relevant symptoms of ADHD.     

Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data

ObjectiveTo determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI).MethodsMeta-analysis of randomized controlled trials (RCTs) comparing psychotherapy interventions and treatment as usual (TAU; including also enhanced usual care, psychotropic treatment alone, cognitive remediation, short-term problem-oriented approach, supportive relationship treatment, community treatment by non-behavioral psychotherapy experts, emergency care enhanced by provider education, no treatment) for SA/NSSI. RCTs were extracted from MEDLINE, EMBASE, PsycINFO and Cochrane Library and analyzed using the Cochrane Collaboration Review Manager Software and Comprehensive Meta-analysis.ResultsIn the 32 included RCTs, 4114 patients were randomly assigned to receive psychotherapy (n = 2106) or TAU (n = 2008). Patients who received psychotherapy were less likely to attempt suicide during the follow-up. The pooled risk difference for SA was −0.08 (95% confidence intervals = −0.04 to −0.11). The absolute risk reduction was 6.59% (psychotherapy: 9.12%; TAU: 15.71%), yielding an estimated number needed to treat of 15. Sensitivity analyses showed that psychotherapy was effective for SA mainly in adults, outpatients, patients with borderline personality disorder, previously and non-previously suicidal patients (heterogeneous variable that included past history of SA, NSSI, deliberate self-harm, imminent suicidal risk or suicidal ideation), long- and short-term therapies, TAU only as a control condition, and mentalization-based treatment (MBT). No evidence of efficacy was found for NSSI, with the exception of MBT. Between-study heterogeneity and publication bias were detected. In the presence of publication bias, the Duval and Tweedie's “trim and fill” method was applied.ConclusionPsychotherapy seems to be effective for SA treatment. However, trials with lower risk of bias, more homogeneous outcome measures and longer follow-up are needed.     

Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition

Objective: To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults. Methods: Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation. Results: Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation. Conclusions: The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.     

Suicide Ideation and Deliberate Self-Harm among Ex-Prisoners of War

The current study aims to assess the relations among war captivity, PTSD, suicidal ideation (SI), and deliberate self-harm (DSH) among former prisoners of war (ex-POWs). Israeli ex-POWs (N = 176) and a matched control group of combat veterans (controls; N = 118) were assessed using self-report measures. Ex-POWs with PTSD reported higher levels of both SI and DSH compared to ex-POWs and comparable veterans without PTSD. Furthermore, captivity-related variables as well as PTSD symptom clusters were positively related to both SI and DSH. However, only loss of emotional control in captivity and posttraumatic intrusion and emotional numbing symptoms, predicted SI. Ex-POWs with PTSD endorse high levels of SI and DSH. Among ex-POWs, both SI and DSH share similar captivity-related and posttraumatic symptoms correlates but only posttraumatic intrusion and emotional numbing symptoms predict SI.     

Suicidal and self-harm behaviour associated with adolescent attention deficit hyperactivity disorder—A study in the Northern Finland Birth Cohort 1986

Background: Suicidal behaviour, i.e. suicidal ideation and suicidal acts, as well as self-harm behaviour, are relatively common among adolescents. Depression and/or female gender seem to be risk factors for suicidal behaviour. However, the role of attention deficit hyperactivity disorder (ADHD) in these behaviours is still unclear. Aim: To study the effect of ADHD on suicidal or self-harm behaviour in adolescents from a general population sample. Methods: The sample was derived from a population-based Northern Finland Birth Cohort 1986 (n = 9432). Based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version (Kiddie-SADS-PL) interview performed in a subpopulation (n = 457), the associations between suicidal behaviour and deliberate self-harm (DSH) and the diagnosis of ADHD were studied. Results: Compared with adolescents without ADHD (n = 169), those with ADHD (n = 104) had more suicidal ideation (57% vs. 28%, P < 0.001) and DSH (69% vs. 32%, P < 0.001). In binary logistic models, the effect of ADHD on suicidal ideation remained strong (OR = 6.1) after controlling for several other predictors. Other contributing factors in suicidal behaviour included female gender, childhood emotional and behavioural problems, concurrent depression and anxiety, and, specifically in DSH, behavioural disorder, substance abuse and strains in family relations. Discussion and clinical implications: ADHD is a risk factor for suicidal ideation and DSH. These findings in a general population sample speak for a need to target mental health interventions at children and adolescents with relevant symptoms of ADHD.     

Suicidal ideation,suicide attempts,and psychological distress among intoxicated adolescents in the pediatric emergency department

Background: Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments.

Aims: This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support.

Methods: The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient’s psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales.

Results: Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients.

Conclusions: Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.     

Do patients who self-harm consult their general practitioner soon after hospital discharge?

BACKGROUND: Deliberate self-harm (DSH, attempted suicide) is one of the most common reasons for emergency hospital admission in Great Britain. Approximately 20 % of patients repeat self-harm in the 12 months after admission. The GP's role in DSH aftercare and the prevention of repeat episodes is unclear. METHODS: The data were obtained from a 12-month follow-up of a series of 968 consecutive patients from 49 practices who attended an accident and emergency (A&E) department in Bristol or Bath, UK, following an episode of self-harm between 26(th) May 1997 and 1(st) March 1999. RESULTS: Information on consultation patterns were available for 681 (70 %) of the patients. Two hundred and fourteen (31 %) of these consulted their GP in the week following the episode, 360 (53 %) within 4 weeks. Of the subjects, 44 % were discharged directly from A & E; these patients were more likely to consult their GP in the 4 weeks after the episode. Over the 12-month follow-up, 117 (17 %) attended hospital for a repeat episode of DSH; 9 % of these repeats occurred within 1 week and 28 % within 4 weeks of the index event. Although few (2 out of 11 patients--18 %) of those repeating in the first week after the index episode consulted their GP prior to repeating, 50 % (11/22) of those who repeated in the 1-4 weeks after an episode did so. CONCLUSIONS: Consultation patterns indicate that most people who deliberately self-harm consult their GP soon after the episode. This consultation may provide an opportunity for preventing repeat DSH and suicide.     

Life-Weariness,Wish to Die,Active Suicidal Ideation,and All-Cause Mortality in Population-Based Samples of Older Adults

ObjectivesTo investigate potential differences in the strength of associations between different levels of passive and active suicidal ideation and all-cause mortality in older adults.DesignProspective cohort study.SettingPopulation-based samples of older adults in Gothenburg, Sweden.ParticipantsOlder adults aged 79 and above who participated in any wave of the Gothenburg H70 Birth Cohort Studies or the Prospective Population Study of Women between 1986 and 2015 (n = 2,438; 1,737 women, 701 men; mean age 86.6).MeasurementsMost intense level of passive or active suicidal ideation during the past month: life-weariness, wish to die, or active suicidal ideation. The outcome was all-cause mortality over 3 years.ResultsDuring follow-up, 672 participants (27.6%) died. After adjustments for sex, age, and year of examination, participants who reported a wish to die (HR 2.01; 95% CI 1.55–2.60) as the most intense level of ideation, but not participants who reported life-weariness (HR 1.40; 95% CI 0.88–2.21) or active suicidal ideation (HR 1.10; 95% CI 0.69–1.76) were at increased risk of all-cause mortality. Reporting a wish to die remained associated with mortality in a fully adjusted model, including somatic conditions, dementia, depression, and loneliness (HR 1.70; 95% CI 1.27–2.26).ConclusionIn older adults, reporting a wish to die appears to be more strongly associated with all-cause mortality than either life-weariness or active suicidal ideation     

Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide

OBJECTIVES: Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. METHODS: The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed. RESULTS: Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment. CONCLUSION: A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.     

Prevalence of psychological distress,depression and suicidal ideation in an indigenous population in Panamá

Objective

The aim of this study was to investigate the prevalence of serious psychological distress (SPD), depression, and suicidal ideation in an adult Indigenous population in Panamá.

Methods

Data were collected from 211 Kuna adults using a paper-based survey. Depression and suicidal ideation were measured using the Patient Health Questionnaire (PHQ-9), and SPD was measured using the Kessler-6. Univariate analyses were used to describe demographic variables, followed by chi² tests to compare differences in demographic variables for each of the mental health outcomes (depression, serious psychological distress, suicidal ideation). A regression model, adjusted for all demographic variables, was then run for each mental health outcome to understand independent correlates.

Results

Within the sample surveyed, 6.2% (95% CI 3.4–10.4) reported serious psychological distress, 32.0% (95% CI 25.7–38.9) reported depression, and 22.9% (95% CI 17.4–29.1) reported suicidal ideation. Significant demographic differences existed with 14% of individuals between the age of 60–90 and 17% of individuals with no education reporting SPD. Women were nearly 5 times more likely to report depression than men (OR 4.90, 95% CI 1.27–19.00) and those with higher incomes were less likely to report depression (OR 0.32, 95% CI 0.13–0.78).

Conclusion

High levels of depression, SPD, and suicidal ideation were present in an Indigenous Kuna community in Panamá. Women and individuals with low income were more likely to report depression, and SPD was more common in older individuals and those with low levels of education. Suicidal ideation was high across all demographic factors, suggesting that a community-wide program to address suicide may be warranted.

     

Social relationships as predictors of depression and suicidal ideation in older adults

The prevalence of depression and suicidal ideation among older adults is considered to be a major mental health concern among this age group. The present study investigated the human relatedness variables of marital status, social support resources and sense of belonging as predictors of depression and suicidal ideation in older adults. A community sample of 110 older adults (M age 76.67 years, SD = 8.11) completed the Social Support Subscale of the Coping Resources Inventory, the Sense of Belonging Instrument, the Zung Depression Inventory and the Suicide Subscale of the General Health Questionnaire. Results indicated that fewer social support resources were associated with higher levels of depression and suicidal ideation. Sense of belonging to the community was not an additional predictor of mental health. The results of the present study suggest that enhancing social support resources in older adults could reduce depression and suicidal ideation.     

Beyond Depression: Estimating 12-Months Prevalence of Passive Suicidal Ideation in Mid- and Late-Life in the Health and Retirement Study

ObjectivesTo provide valid estimates of the 12-month prevalence of passive suicidal ideation among older adults, without conditioning on depression status, using the Health and Retirement Study (HRS).MethodsData come from the 2012 HRS (n = 17,434) and 2004/5 Baltimore Epidemiologic Catchment Area (ECA) Study (n = 755). In the HRS, passive suicidal ideation (i.e., thought a lot about death—your own, someone else's, or death in general) is only assessed on respondents who reported dysphoria/anhedonia; in the ECA, ideation is assessed on all respondents, regardless of depression. We compare two approaches to estimating the 12-month prevalence of passive suicidal ideation in the HRS without conditioning on depression symptoms: 1) a probit selection model within the HRS, and 2) a prediction model developed using appended ECA data applied to the HRS.ResultsUsing observed data alone on those who screened positive for depression, 6% of older adults reported passive suicidal ideation in the past year. Depending on the approach used, between 5.4% and 9.2% of HRS respondents who screened negative for depression would have reported passive suicidal ideation had they been assessed. Correcting for this selection bias, between 10.9% and 13.4% of U.S. adults over age 50 experienced passive suicidal ideation in 2012.ConclusionsPopulation surveillance of suicidal ideation among older adults is biased by survey approaches that only assess ideation in the context of depression.     

Borderline personality disorder and depression severity predict suicidal outcomes: A six-month prospective cohort study of depression,bipolar depression,and borderline personality disorder

Background

Suicide risk is high in patients with major depressive disorder (MDD), bipolar disorder (BD) and borderline personality disorder (BPD). Whether risk levels of and risk factors for suicidal ideation (SI) and suicide attempts (SA) are similar or different in these disorders remains unclear, as few directly comparative studies exist. The relationship of short-term changes in depression severity and SI is underinvestigated, and might differ across groups, for example, between BPD and non-BPD patients.

Methods

We followed, for 6 months, a cohort of treatment-seeking, major depressive episode (MDE) patients in psychiatric care (original n = 124), stratified into MDE/MDD, MDE/BD and MDE/BPD subcohorts. We examined risks of suicide-related outcomes and their risk factors prospectively. We examined the covariation of SI and depression over time with biweekly online modified Patient Health Questionnaire 9 surveys and analysed this relationship through multi-level modelling.

Results

Risk of SA in BPD (22.2%) was higher than non-BPD (4.23%) patients. In regression models, BPD severity was correlated with risk of SA and clinically significant SI. During follow-up, mean depression severity and changes in depression symptoms were associated with SI risk regardless of diagnosis.

Conclusions

Concurrent BPD in depression seems predictive for high risk of SA. Severity of BPD features is relevant for assessing risk of SA and SI in MDE. Changes in depressive symptoms indicate concurrent changes in risk of SI. BPD status at intake can index risk for future SA, whereas depressive symptoms appear a useful continuously monitored risk index.     

Association between deliberate self-harm-related Internet searches and the mental states and lifetime suicidal behaviors of Japanese young adults

This study aimed to clarify the association between the experience of searching for deliberate self‐harm (DSH)‐related Internet content and the mental states and lifetime suicidal behaviors of Japanese young adults (n = 1000) using an online questionnaire. The results were assessed using χ² and t‐tests, which revealed that the experience of DSH‐related Internet searches may be significantly associated with lifetime suicidal behaviors (including DSH), suicidal ideation, and tendencies towards depression/anxiety. We discussed the possibility of using search engines to increase the motivation of Japanese young adults who deliberately harmed themselves with regard to seeking help.     

Gambling Disorder Symptoms,Suicidal Ideation,and Suicide Attempts

Objective Gambling disorder (GD) patients have a higher suicide risk compared to the general population. The present study investigates the suicide-related risk factors of GD patients by analyzing GD diagnosis-related symptoms and suicide-related behaviors of subjects. Methods This study investigated which symptoms among GD diagnosis criteria are related to suicide risk in 142 patients diagnosed with GD. To analyze the relationship between GD symptoms and suicidal ideation and suicide attempt, the odds ratio (OR) was determined through multivariate logistic regression. Results The number of symptoms was significantly higher in the subjects who had suicidal ideation group and attempt group. In the cases of past suicide attempts, responses to withdrawal and escape questions were significantly higher; in the cases of ongoing suicidal ideation, responses to negative consequences and bailout questions were significantly higher. When depression was corrected, the ‘bailout’ item was, indicating that ‘bailout’ increased suicidal ideation (OR=4.937, 95% CI=1.009–24.164). In the suicide attempt group, ‘relieve’ item may increase suicide attempt (OR=6.978, 95% CI=1.300–35.562). Conclusion Past suicide attempts in GD patients correlated with withdrawal symptoms, and financial problem correlated with suicidal ideation. This suggests that evaluating suicide risk is important when evaluating GD patients, and evaluation of financial problems is important for GD patients with suicide risks.     

Panic and suicidal ideation and suicide attempts: results from the National Comorbidity Survey

Our objective was to determine the association between panic attacks (PAs) and panic disorder (PD), and suicidal ideation (SI) and suicide attempts (SAs) in a nationally representative sample of adults in the community. Data were drawn from the National Comorbidity Survey (n=5,877), a representative household sample of adults ages 15-54 in the United States. Multiple logistic regression analyses were used to examine the relationship between current and lifetime PA and PD and SI and SA, adjusting for differences in demographic characteristics, comorbid mental disorders (major depression, alcohol dependence, and substance dependence), childhood trauma (physical and sexual abuse), and number of lifetime mental disorders. Past-year and lifetime PA and PD were associated with increased SI (both past year and lifetime), and persisted after adjusting for comorbidity and early trauma. Associations between PA and SA were no longer statistically significant after adjusting for comorbidity. Past-year and lifetime PD were associated with lifetime SA, but these associations were no longer statistically significant after adjusting for comorbidity. Past-year and lifetime PD were associated with past-year SA, and this association persisted after adjusting for demographics, comorbidity, and number of lifetime mental disorders. These findings are consistent with previous results, and further help to clarify the relationships between panic and suicide behavior by identifying potential methodological reasons for inconsistencies in results from previous studies.     

Prevalence of and risk factors for suicide-related outcomes in the World Health Organization World Mental Health Surveys Japan

Aim:  Suicide is a major public health concern in Japan but little is known about the prevalence of and risk factors for suicidal ideation, plans, and attempts. The aim of the present study was to clarify the prevalence of and risk factors for important suicide-related outcomes.
Methods:  Important suicide-related outcomes and risk factors were assessed in face-to-face interviews with 2436 adult respondents in seven areas as part of the World Health Organization (WHO) World Mental Health Survey Initiative. Mental disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Results:   The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 10.9%, 2.1%, and 1.9%, respectively. Risk of suicide plans and attempts was highest when suicidal ideation occurred at an early age and within the first year of ideation. In middle-aged individuals, the period after first employment and the presence of mental disorders were risk factors.
Conclusions:  Risk of suicide plans and attempts is highest when suicidal ideation occurred at an earlier age and within the first year of ideation. Mental disorders are as predictive of the suicide-related outcomes examined here, and comorbidity is an important predictor.     

Deliberate self-harm in older people revisited

BACKGROUND: Deliberate self harm (DSH) in later life is under researched and is believed to be related to both mental illness and suicide. AIMS: The aim of the study was to examine deliberate self-harm (DSH) in older people presenting to acute hospital services over three years. METHOD: This was a retrospective observational study. We reviewed 97 episodes of DSH involving 82 patients aged 65 and over referred to the Liaison Psychiatric Service of the Tees and North East Yorkshire NHS Trust South Locality from 2000 to 2002. RESULTS: There was a year on year increase in the number of older people presenting with DSH, especially in men. Twenty-one percent of older men had no discernible psychiatric diagnosis. There were a small number of people who repeated DSH within a year and males were as likely to be repeaters as females. Twenty-three percent of all patients saw a General Practitioner (GP) in the 7 days before the episode of DSH and this increased to 58% in the 4 weeks preceding the episode of DSH. More males (56%) than females (26%) who presented with DSH were married. The most common method of DSH (93%) was medication overdose of which 66% used prescribed medication. There was no difference in the methods used to self-harm between men or women. CONCLUSION: DSH in the elderly may start to mirror some of the characteristics seen in younger adults with DSH. While the numbers of DSH per year are small among the elderly compared to younger adults, the observations suggest an increase in DSH in men. Marriage may no longer be a protective factor in prevention of DSH among older men. Longer-term observational studies of DSH in older people are required to confirm these changing patterns. GPs may have an important role to play in prevention of DSH in later life.