SUMMARYThis article details the results of a retrospective case note study on deliberate self-harm in the elderly in the London Borough of Tower Hamlets. There were 56 females and 32 males included in the study. The ages of the patients ranged from 65 to 90. Fifty-seven per cent of the sample had a depressive illness, most commonly found in the younger females and the older males. Over 50% of the sample had evidence of multiple health problems, particularly heart disease and arthritis. Over 900/0 of cases used self-poisoning as the means of self-harm. Sixty-one per cent used benzodiazepines and 25% salicylates. Over 30% used multiple drug combinations. Thirty-eight per cent of the sample had evidence of previous self-harm, 17% had repeated self-harm within a year and 6% were dead through suicide. Although the characteristics of the patients bore some resemblance to those identified in the literature as being risk factors for self-harm among younger patients, they bore a much closer resemblance to known risk factors for suicide. This may have ramifications for further research into the prevention of suicide.KEY woms-Elderly, attempted suicide.Deliberate self-harm has been defined as 'a deliberate non fatal act, whether physical, drug overdosage or poisoning, done in the knowledge that it was potentially harmful, and in the case of drug overdosage that the amount taken was excessive' (Morgan et al., 1975).The elderly account for over 15% of the population and more than 25% of suicides. Although it is known that a previous episode of deliberate selfharm is one of the highest risk factors for subsequent suicide, very little work has been directed towards the similarities and differences between the elderly who commit an act of self-harm and those who commit suicide. In fact, the vast majority of studies on deliberate self-harm have concentrated on the younger population. Those which sampled the total population demonstrated that the elderly accounted for a very small proportion of the total cases, ranging from 4% to 6% (Bancroft et al., 1975;Morgan et al., 1975;Pierce, 1977). A few more recent papers have concentrated on the elderly

This review summarizes the published literature on suicide by jumping, in particular focusing on the social and psychological characteristics of people who have chosen this method of suicide, and the opportunities for prevention. Suicide by jumping accounts for 5% of suicides in England and Wales, and there are marked variations in the use of this method world-wide. A number of locations have gained notoriety as popular places from which to jump. Such sites include The Golden Gate Bridge and Niagara Falls in the USA, and Beachy Head and the Clifton Suspension Bridge in the UK. There is no consistent evidence that those who commit suicide by jumping differ sociodemographically or in their psychopathology from those who use other methods of suicide, although this method is more often used for in-patient suicides, possibly due to lack of access to other means. Survivors of suicidal jumps experience higher subsequent rates of suicide and mental ill health, but the majority do not go on to kill themselves, suggesting that preventive efforts may be worthwhile. This view is supported by other evidence that restricting access to the means of suicide may prevent some would-be suicides. Such measures may also reduce the emotional trauma suffered by those who witness these acts. Health authorities and coroners should consider reviewing local patterns of suicide by jumping, and if necessary institute preventive measures.

We assessed the effect of the installation of barriers on the Clifton suspension bridge, Bristol, England, in 1998 on local suicides by jumping. Deaths from this bridge halved from 8.2 per year (1994-1998) to 4.0 per year (1999-2003; P=0.008). Although 90% of the suicides from the bridge were by males, there was no evidence of an increase in male suicide by jumping from other sites in the Bristol area after the erection of the barriers. This study provides evidence for the effectiveness of barriers on bridges in preventing site-specific suicides and suicides by jumping overall in the surrounding area.