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(berwick D 2005) One Of The Landmark Papers In This Area Is By Hepple And ...

(Berwick D 2005)

One of the landmark papers in this area is by Hepple and Quinton (Hepple J et al. 1997) which provided a benchmark, not only on the aetiology of the subject, but also in the long term outcomes, which, in terms of potential nursing care input, is extremely important. The paper points to the fact that there is a good understanding of the absolute risk factors for suicide in the elderly but a comparative lack of good quality follow up studies in the area. It set out to identify 100 cases of attempted suicide in the elderly and then follow them up over a period of years. The study was a retrospective examination of 100 consecutive cases of attempted suicide that were referred to the psychiatric services over a four year period. The authors were able to make a detailed investigation (including an interview of many of the survivors), about four years later. Their findings have been widely quoted in the literature.

Of particular relevance to our considerations here we note that they found that of the 100 cases identified, 42 were dead at the time of follow up. Of these, 12 were suspected suicides and five more had died as a result of complications of their initial attempt. There were 17 further attempts at suicide in the remaining group. Significantly, the twelve women in the group all made non-lethal attempts whereas all five of the men made successful attempts. The authors were able to establish that the risk of further attempts at suicide (having made one attempt) was in excess of 5% per year and the success rate was 1.5% per year in this group. From this study we can also conclude that the risk of successful repeat attempted suicide is very much greater if the subject is male. The authors were also able to establish that, because of their initial attempt, those at risk of self harm were likely to be in contact with the Psychiatric services and also suffering from persistent severe depression.

We can examine the paper by Dennis (M et al. 2005) for a further insight into the risk factors that are identifiable in the at risk groups. This paper is not so detailed as the Hepple paper, but it differs in its construction as it is a control matched study which specifically considered the non-fatal self harm scenario. The study compared two groups of age matched elderly people both groups had a history of depression but the active study group had, in addition, a history of self harm. The significant differences highlighted by this study were that those in the self harm group were characterised by a poorly integrated social network and had a significantly more hopeless ideation.


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