By: Natalie Akoorie
Key findings of new research:
- People over 65 more likely to report physical illness as a stressor, have a history of depression and be diagnosed with depression at the time of their self-harming;
- Those aged 45-64 more likely to report relationship separation and financial trouble as stressors;
- Older people who self-harmed were more likely to do so with suicidal intent compared with middle-aged group, and their suicide attempts were more likely to be fatal, and more likely (82 per cent) to happen at home;
- 33 per cent of middle-aged people who self-harmed had a positive blood alcohol level;
- Older-aged people were less often tested for blood alcohol level, even though those who were tested had the same blood alcohol levels on average, as the middle-aged group;
- In the middle-aged group, 19 per cent were Māori, however no Māori were in the older group.
Elderly Kiwi men are committing suicide at high rates, but there’s no targeted screening or treatment for them, new research shows.
Psychiatrist Dr Gary Cheung, who led the University of Auckland study published in the New Zealand Medical Journal today, said the Ministry of Health needed to find a new face for a campaign aimed at encouraging pensioners to seek help for depression, similar to the John Kirwan ads.
“We need an older John Kirwan, another great All Black, an older well-respected person to raise awareness, to come out and say it’s okay to talk to your GP about your emotions.”
Ministry of Health figures from 2008-2017 show that for men, suicide rates spike around ages 15-25 and then slowly decline to age 65, when they start climbing again, peaking at 32 per 100,000 in men aged 85 and over.
In women, the suicide rate peaked at 11 per 100,000 in ages 15-20.
Cheung, a lecturer at the university’s Faculty of Medical and Health Sciences, said a “one-size-fits-all” approach to suicide prevention would not work.
“There has been a lack of focus on older people in the Ministry of Health’s suicide prevention strategy,” Cheung said.
“Specific suicide prevention strategies are needed for older people who have different needs.”
The retrospective study of patient notes, conducted over two years by Dr Yu Mwee Tan and supervised by Cheung, revealed a distinctly different pattern of stressors and behaviours in middle-aged and older people who self-harmed and made suicide attempts.
Physical illnesses and depression were common factors associated with self-harm and attempted suicide in older people, those over age 65, while the stressors of relationship separation and financial trouble featured more strongly in middle-aged people, those aged between 45-64, the study showed.
Cheung hoped the findings would help policymakers and health workers develop age-group-targeted screening and treatment to prevent mid-life and late-life suicides.
He said the topic had received little scrutiny despite the high rates of suicide in ageing men.
“As the baby boomers age, the issue of suicide and suicidal behaviours in later life will become even more pressing,” Cheung said.
With a history of self-harm a strong predictor for suicide, Cheung and Tan analysed patient records of middle-aged and older men and women who visited the emergency department of Middlemore Hospital for self-harming from 2010-2013.
They defined self-harm as “the direct, deliberate act of hurting or injuring the body without necessarily wanting to die, as in suicide attempt”.
The pair identified 420 people who made 569 self-harm attempts in the three-year period.
Most of them (379) were in the middle-age group, of whom more (57 per cent) were female. In the older group 61 per cent were men.
“The older-aged people were a particularly vulnerable group,” Cheung said. “In this age group, physical illnesses may cause or exacerbate depression.
“Other studies have shown that pain and loss of functioning commonly lead to feelings of hopelessness and distress in dealing with physical illnesses.
“These emotional struggles could increase suicide risk, particularly when independence and dignity is threatened and the person starts perceiving themselves as a burden.”
Depression was often under-reported and under-diagnosed in older people, who were more likely to report bodily symptoms than emotional.
Internationally, there was little research into how to help older people who have self-harmed, but several studies suggested “talk therapy” could reduce suicidal thoughts.
“Since depression is often associated with self-harm and suicide in older people, better screening for and treatment of depression is a very promising intervention.”
Data showed many older people who committed suicide had visited their GP within the previous month for physical ailments and Cheung said this was an opportunity to raise awareness of depression.
He is involved in international research into using an assessment tool for identifying older people at high risk of suicide, which could lay the foundation for standard reporting and monitoring of elderly suicide.
In a separate study about specialist mental health care for older Kiwis also published in the New Zealand Medical Journal today, 2.2 per cent of New Zealanders aged 65-plus were found to access specialist mental health services in one year for dementia, schizophrenia and depression.
The survey of northern DHBs and Ministry of Health information found older people were often overlooked in reporting about mental health services, partly due to inconsistent service provision and the lack of national data.
Missing information on diagnosis was a major problem in data on mental health service use.
WHERE TO GET HELP:
If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.
If you need to talk to someone, the following free helplines operate 24/7:
DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234
There are lots of places to get support. For others, click here.