Exploring the difference between self-harm and suicidal ideation among older people who present to emergency departments: national cohort study.

Abstract

Background: Older people have higher rates of death by suicide, and both self-harm and suicidal ideation are major risk factors for suicide. There is limited data relating to this group internationally.

Aims: The objective of this study was to identify the clinical and sociodemographic variables associated with psychiatric admissions for older people who present with self-harm and suicidal ideation to emergency departments in Ireland.

Method: This is a cohort study of older people in Ireland, utilising data collected by the National Clinical Programme for Self-Harm and Suicide-Related Ideation (NCPSHI). It is a national data-set including anonymised data from all participating emergency departments in Ireland, comprising 72 810 presentations over 5 years (2018-2020). We examined the characteristics of people aged over 60 presenting with self-harm and suicidal ideation (n = 4866). The variables associated with suicidal ideation and behaviours were explored using multivariable analysis.

Results: Nationally, 7% of the patients presenting were aged over 60 years. One-quarter (26.8%) of older people presenting with self-harm required psychiatric admission (16.3% all-ages). On multivariable analysis, the relationship between self-harm and psychiatric admission was not statistically significant (reference group was those with suicidal ideation), after controlling for gender, year of presentation, substance use and need for medical admission odds ratio 0.977 (CI0.936-1.020).

Conclusions: Our results outline the characteristics of older people presenting to Irish emergency departments with self-harm and suicidal ideation, which are associated with psychiatric admission. Further research is needed to understand the factors driving these presentations and to tailor our services to meet the needs of older people.