| Summary: | Methods. Descriptive and case-control studies were conducted. Data were collected on three groups: Successful Suicides - The Leicestershire Mortality list was examined for possible suicides and their psychiatric and general hospital notes scrutinised. 85 deaths were categorised as definite or probable suicide; DSH Group - 76 older adults who had deliberately harmed themselves were interviewed. Information obtained included Beck Suicide Intent score, and Hopelessness Scale. A psychiatric interview determined an ICD 10-diagnosis (70), social contacts and networks. The LEDS-2 interview identified recent life events and chronic difficulties; Depressed control Group - 50 depressed older adults referred to mental health services who had never self-harmed were interviewed in a similar manner. Results. 11(13%) of elderly suicides occurred within one month of contact with psychiatric services, and 11 within one month of discharge from a general hospital ward. The majority of elderly who self-harmed had high suicide intent, 70% were depressed, and 29% had seen their G.P. within one week of the episode. DSH subjects frequently were living alone with an isolated life style and poor physical health. Compared to depressed controls, DSH subjects were significantly more likely to have a poorly integrated social network, were less likely to receive visits from health/social/voluntary services, and were more hopeless. The proportions of DSH subjects and depressed controls experiencing a severe life event were similar. Conclusions. In 'high risk' patients known to services, careful planning of care and continual risk assessment may help to reduce suicides. After-care, including re-socialisation and addressing chronic physical health difficulties may also reduce risk. Improved mental health liaison services to general hospitals are required, as well as more assertive strategies to identify isolated and depressed older adults in the community.
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