Abstract
BackgroundLate-life self-harm (SH) is often linked to depression. However, very few studies have explored the role of other factors and their interaction with depression in the occurrence of late-life SH. The objective of this research was to examine sociodemographic and gender factors associated with non-fatal SH, in older adults with and without antidepressant therapy.MethodsWe used national longitudinal register data from a total cohort of all Swedish residents aged ≥75 years between 2006 and 2014 (N = 1,413,806). Using personal identity numbers, we linked individuals’ data from numerous national registers. We identified all those with at least one episode of non-fatal self-harm (regardless of level of intent to die) and matched 50 controls to each case. A nested case–control design was used to investigate sociodemographic factors associated with non-fatal SH in the total cohort and among antidepressant users and non-users. Risk factors were analysed in adjusted conditional logistic regression models for the entire cohort and by gender.ResultsIn all, 2242 individuals had at least one episode of a non-fatal SH (980 men and 1262 women). Being unmarried was a risk factor for non-fatal SH in men but not in women. Among users of antidepressants, higher non-fatal SH risk was observed in those born outside the Nordic countries (IRR: 1.44; 95% CI: 1.11–1.86), whereas in AD non-users increased risk was seen in those from Nordic countries other than Sweden (IRR: 1.58; 95% CI: 1.08–2.29). Antidepressant users with higher education had an increased risk of non-fatal SH (IRR: 1.34; 95% CI: 1.12–1.61), in both men and women.ConclusionsForeign country of birth was associated with increased risk for non-fatal SH in older adults with and without AD therapies. Being married was a protective factor for non-fatal SH in men. The complex association between sociodemographic factors and use of antidepressants in the occurrence of self-harm in older men and women indicates the need for multifaceted tailored preventive strategies including healthcare and social services alike.
Highlights
Late-life self-harm (SH) is often linked to depression
Given the high rates of suicide in persons aged 70 and above, especially in men [2], and the high intent to die observed in older adult suicide attempters [3], exploring factors associated with non-fatal SH may help to inform interventions to prevent suicide
Lower risk for non-fatal SH was found in those living in institutions at baseline (IRR: 0.23; 95% Confidence interval (CI): 0.19–0.29) and those aged 80 and above, The risk for non-fatal SH was slightly higher in those with higher education compared to those with only compulsory education (IRR: 1.18, 95% CI: 1.01–1.37)
Summary
Late-life self-harm (SH) is often linked to depression. Very few studies have explored the role of other factors and their interaction with depression in the occurrence of late-life SH. The objective of this research was to examine sociodemographic and gender factors associated with non-fatal SH, in older adults with and without antidepressant therapy. Given the high rates of suicide in persons aged 70 and above, especially in men [2], and the high intent to die observed in older adult suicide attempters [3], exploring factors associated with non-fatal SH may help to inform interventions to prevent suicide. It is critical to explore the role of sociodemographic factors and their interaction with depression in the occurrence of late-life SH [1]. Very few studies have investigated the associated gender differences, and studies that focus on those above the age of 75 are uncommon [8]
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