Longitudinal big data needs to meet the individual to inform self-harm and suicide prevention in older adults

Abstract

Longitudinal big data needs to meet the individual to inform self-harm and suicide prevention in older adultsA well-established close relationship exists between self-harm and suicide in older adults, yet the detailed longitudinal outcome data needed to guide pathways for identification of at-risk individuals and intervention are lacking. The big data study of Cheung and colleagues extends our knowledge of self-harm in older adults by moving beyond simply identifying risk factors for self-harm crosssectionally, to ranking their relative importance, and longitudinally examining the incidence of self-harm in a large community-dwelling cohort (Cheung et al., 2020). This brings us a step closer to understanding factors contributing to self-harm in older people. However, we already know much about these population-level risk factors (Troya et al., 2019). Research in this field needs to delve deeper, and explore the clinical trajectories and broader outcomes of older adults who self-harm in combination with qualitative data derived from the individuals themselves.In older adults, there are common risk factors for self-harm and suicide, and self-harm is more likely to be lethal with greater reported intent to die (Fassberg et al., 2019;Schmutte et al., 2019). However, not all people who self-harm do so with suicidal intent, and the two groups may be distinct (DeJong et al., 2010), with the outcome of death following self-harm sometimes related to external factors rather than intent or another meaning of the behavior (Linden and Barnow, 1997). Nonetheless, knowledge of the risk factors for self-harm provides opportunities to understand a proportion of suicides and effectively intervene.The epidemiological risk factors for self-harm in older adults have been well described (Troya et al., 2019), and include physical illness, functional disability, mental illness (especially depression; alcohol misuse), and social issues (such as loneliness, social isolation, financial difficulties, and interpersonal problems). However, these potential risk factors are common in older adults in general, most of whom do not self-harm. Further, most of these data have been derived from quantitative research and hospital-based cohorts, rather than from community-dwellers and the older adult themselves (Troya et al., 2019;Wand et al., 2018b). Thus it is difficult for clinicians, especially in primary care,

Risk factors for dementia and self‐harm: A linkage study

“…Poor mental health, dementia, and self‐harm are substantially intertwined in older adults. Qualitative research with people with lived experience of dementia and self‐harm may shed further light on the relationships among these factors 39 . Greater support for people with lived experience is required to address this health burden.…”

A systematic review of evidence-based aftercare for older adults following self-harm

“…The review highlights multiple gaps in the contemporary aftercare literature and opportunities for further older-adult-specific research. Mixed methods approaches incorporating qualitative collaborative research with older adults, their carers and clinicians will help to understand why aftercare interventions work (or do not) for older adults (Wand and Reppermund, 2021).…”

A qualitative study of multiple voices to inform aftercare services for older persons following self‐harm

“…The review highlighted gaps in the Aftercare literature and opportunities for dedicated older‐adult research, including a need for qualitative research with older adults, their families, and clinicians, to understand why Aftercare interventions do or do not work 7,8 . Qualitative research can provide insight into how clinical interventions are experienced or work in the real world and how various systems and services interact 8,9 . It examines the nuances of clinical interactions and explores meaning with those directly involved 9 .…”

“…Most effective Aftercare interventions were older‐adult specific and adopted a multifaceted, assertive follow‐up approach accompanied by systemic change. The review highlighted gaps in the Aftercare literature and opportunities for dedicated older‐adult research, including a need for qualitative research with older adults, their families, and clinicians, to understand why Aftercare interventions do or do not work 7,8 . Qualitative research can provide insight into how clinical interventions are experienced or work in the real world and how various systems and services interact 8,9 .…”

“… 7 , 8 Qualitative research can provide insight into how clinical interventions are experienced or work in the real world and how various systems and services interact. 8 , 9 It examines the nuances of clinical interactions and explores meaning with those directly involved. 9 Such knowledge is essential to informing evidence‐based interventions for older persons' Aftercare with the ultimate aim of preventing suicide.…”