Loneliness and hopelessness increase risk of self-harm among older people

A poorly integrated social network and hopelessness are signs of an increased likelihood of self-harm among older people with depression.

The aims of this study, published in the June issue of the British Journal of Psychiatry, were to determine clinical factors that might help to identify those older adults with depression who are most at risk of self-harm and suicide.

76 adults aged 65 and over who had self-harmed were studied prospectively. They were assessed for depression, hopelessness and suicidal intent, and interviewed by a psychiatrist.

Levels of social support from statutory and voluntary agencies, and from family and friends, were also assessed, and information obtained about life events and difficulties during the six months before the episode of self-harm.

The comparison group consisted of 50 people aged 65 or over referred to their local community mental health team for the elderly with a diagnosis of depression. The assessment process was similar to that in the self-harm group, but the reference point for life events was six months before the onset of the current depressive episode.

It was found that 66% of those in the self-harm group showed significant suicidal intent, and in 67% of cases the researcher felt that the participant had wished to die at the time of their self-harm episode.

A similar proportion of participants in both the self-harm and the control group had first-episode depression, compared with recurrent depression or bipolar affective disorder.

Participants in the self-harm group were much more likely to respond 'yes' to the question 'Do you feel that your situation is hopeless?' and 'no' to the question 'Do you think it is wonderful to be alive now?'

Participants in the self-harm group were also more likely to score higher on thoughts of suicide and self-harm than the control group, and rate themselves as more sad, but were less likely to cry than the controls.

Both groups had similar rates of severe life events (around 40%) during the six months before the episode of self-harm or onset of depression.

The authors of the study comment that although life events are important in leading to self-harm and depression, they do not act alone as precipitating factors for self-harm in elderly people with depression.

The role of life events in interaction with other factors, especially social support, appears to be influential. Loneliness, lack of support from services and poor integration in the community are significant factors in determining suicidal behaviour in older adults.

This study has important service and clinical implications for older people, in particular those with depression who have self-harmed. Such individuals should receive a skilled and detailed assessment of both risk and need.