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To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period.
Population-based study using data from the National Self-Harm Registry Ireland.
National hospital EDs.
Older adults aged 60 years and over presenting with self-harm to hospital EDs in Ireland between January 1, 2007 and December 31, 2019.
ED self-harm presentations.
Between 2007 and 2019, there were 6931 presentations of self-harm in older adults. The average annual self-harm rate was 57.8 per 100,000 among older adults aged 60 years and over. Female rates were 1.1 times higher compared to their male counterparts (61.4 vs 53.9 per 100,000). Throughout the study time frame, females aged 60–69 years had the highest rates (88.1 per 100,000), while females aged 80 years and over had the lowest rates (18.7 per 100,000). Intentional drug overdose was the most commonly used method (75.5%), and alcohol was involved in 30.3% of presentations. Between the austerity and recession years (2007–2012), self-harm presentations were 7% higher compared to 2013–2019 (incidence rate ratio (IRR): 1.07 95% CI 1.02–1.13, p = 0.01).
Findings indicate that self-harm in older adults remains a concern with approximately 533 presentations per year in Ireland. While in younger age groups, females report higher rates of self-harm, this gender difference was reversed in the oldest age group (80 years and over), with higher rates of self-harm among males. Austerity/recession years (2007–2012) had significantly higher rates of self-harm compared to subsequent years.
In this editorial we, as members of the 2022 NICE Guideline Committee, highlight and discuss what, in our view, are the key guideline recommendations (generated through evidence synthesis and consensus) for mental health professionals when caring for people after self-harm, and we consider some of the implementation challenges.
The COVID-19 pandemic has harmed many people's mental health globally. Whilst the evidence generated thus far from high-income countries regarding the pandemic's impact on suicide rates is generally reassuring, we know little about its influence on this outcome in lower- and middle-income countries or among marginalised and disadvantaged people. There are some signals for concern regarding the pandemic's potentially unequal impact on suicide rates, with some of the affected demographic subgroups and regions being at elevated risk before the pandemic began. However, the evidence-base for this topic is currently sparse, and studies conducted to date have generally not taken account of pre-pandemic temporal trends. The collection of accurate, complete and comparable data on suicide rate trends in ethnic minority and low-income groups should be prioritised. The vulnerability of low-income groups will likely be exacerbated further by the current energy supply and cost-of-living crises in many countries. It is therefore crucial that reassuring messaging highlighting the stability of suicide rates during the pandemic does not lead to complacency among policymakers.
To conduct a local evaluation of the use of the educational resource: Suicide in Children and Young People: Tips for GPs, in practice and its impact on General Practitioners (GPs)’ clinical decision making.
This Royal College of General Practitioners (RCGP) resource was developed to support GPs in the assessment and management of suicide risk in young people.
The dissemination of the educational resource took place over a nine month period (February 2018–October 2018) across two Clinical Commissioning Groups in West Midlands. Subsequently, a survey questionnaire on GPs’ experiences of using the resource was sent to GPs in both Clinical Commissioning Groups (CCGs).
Sixty-two GPs completed the survey: 21% reported that they had used the resource; most commonly for: (1) information; (2) assessing a young person; and (3) signposting themselves and young people to relevant resources. Five out of thirteen GPs (38.5%), who responded to the question about whether the resource had an impact on their clinical decision making, reported that it did; four (30.7%) responded that it did not; and four (30.7%) did not answer this question. Twenty out of thirty-two GPs (62.5%) agreed that suicide prevention training should be part of their NHS revalidation cycle. The generalizability of the findings is limited by the small sample size and possible response and social desirability bias. The survey questionnaire was not validated. Despite the limitations, this work can be useful in informing a future large-scale evaluation of the RCGP online resource to identify barriers and facilitators to its implementation.
Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse.
To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge.
Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001–2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18–64 and ≥65 years with additional stratification by gender and practice-level deprivation.
The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0–2.3) and 14.1% (95% CI 13.6–14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0–292.0) among working-age adults and 125.4 (95% CI 52.6–298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation.
Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.
Little is known around how general practitioners (GP) approach tobacco products beyond traditional cigarettes.
To examine GP perceptions of tobacco and electronic cigarette (EC) products, and their attitudes and behaviours towards product cessation.
A 13-item self-completed anonymous questionnaire measured awareness of waterpipe tobacco smoking (WTS) and smokeless tobacco (ST). Cessation advice provision, referral to cessation services, and the harm perception of these products were asked using five-point Likert scales that were dichotomised on analysis. Correlates of cessation advice were analysed using regression models.
We analysed 312 responses, of whom 63% were aware of WTS and between 5–32% were aware of ST products. WTS and ST were considered less harmful than cigarettes by 82 and 68% of GPs, respectively. WTS, ST, and EC users were less advised (P<0.001) and referred (P<0.001) to cessation services compared to cigarette users. Ethnic minority and senior GPs were more likely to provide cessation advice for WTS and ST users compared to younger white GPs. GPs who were recent tobacco users were less likely to give cessation advice to cigarette users (adjusted odds ratios 0.17, 95% confidence interval 0.03–0.99, P<0.049).
Conclusions (implications for practice and research)
GPs had lower harm perception, gave less cessation advice, and made less referrals for WTS and ST users compared to cigarettes. Our findings highlight the need for targeted tobacco education in general practice. More research is needed to explore GP perceptions in depth as well as patient perspectives.