Projects relating to Self-Harm

Associated projects: completed

First episode of self-harm in older age


OBJECTIVE: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm in older age. METHOD: The Manchester Self-Harm (MaSH) project, a prospective cohort study, gathered data from September 1, 1997, through August 31, 2007, for individuals presenting with self-harm at emergency departments of 3 large hospitals in North West England. The characteristics of older patients (aged ≥ 55 years) who presented with a first-ever episode of self-harm are described and compared to those of middle-aged patients (35-54 years) presenting with a first-ever episode of self-harm. Following each episode, the MaSH form, a standard assessment form developed for the MaSH project, was completed by a clinician. Potential risk factors for repetition were examined by Cox regression analyses. RESULTS: A total of 374 older patients and 1,937 middle-aged patients presented with a first-ever episode of self-harm. The circumstances at the time of self-harm suggested higher suicidal intent in older age. In comparison with middle-aged patients, the rate of repetition in older-aged patients was lower (15.4% versus 11.8%, respectively; hazard ratio for older age = 0.65; 95% CI, 0.45-0.93; P = .019), although repetition was more often fatal among the older group (3.3% versus 13.6%, respectively; P = .009). The most important predictor of repetition in older age, ie, physical health problems, had no predictive value in middle-aged patients, whereas psychiatric characteristics had little impact on the risk of repetition in old age. CONCLUSIONS: High suicidal intent and different predictors of repetition in first-ever self-harm in older age highlight the need for age-specific interventions beyond the scope of psychiatric care alone.

Duration of the project


Members of the project

Dr Jayne CooperPrincipal investigator
Richard C Oude VoshaarCollaborator


  • Oude Voshaar, R. C., Cooper, J., Murphy, E., Steeg, S., Kapur, N., & Purandare, N. B. (2011). First episode of self-harm in older age: A report from the 10-year prospective manchester self-harm project. Journal of Clinical Psychiatry, 72(6), 737-743. DOI: 10.4088/JCP.10m06501. Publication link: 13959854-899f-4900-a871-b9cb4eee50ab | PubMed:21733475