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Objectives: This study aimed to examine mortality for people living with dementia/mild cognitive impairment who self-harmed. Methods: We conducted a retrospective cohort study in New South Wales, Australia, using data ranging from 2001 to 2015. From people who accessed hospital services in the study period, we identified 154,811 people living with dementia/mild cognitive impairment, 28,972 who self-harmed and 1511 who had a record of both dementia/mild cognitive impairment and self-harm. We examined rates, causes and predictors of death for people with dementia/mild cognitive impairment and/or self-harm diagnoses using flexible parametric survival analyses. We explored rates of repeat self-harm in people living with dementia who self-harmed. Results: Circulatory disorders accounted for 32.0% of deaths in people with a living with dementia who self-harmed, followed by neoplasms (14.7%), and mental and behavioural disorders (9.6%). Death was more likely for someone who had self-harmed if they developed dementia/mild cognitive impairment. Predictors of death included male sex, greater physical comorbidity, a history of delirium, more previous emergency department presentations and fewer previous mental health ambulatory service days. Greater engagement with outpatient mental health services predicted a decreased likelihood of repeat self-harm. Discussion: We found that mortality increases when people who self-harm develop dementia. We argue post-diagnosis support offers a potential opportunity to reduce mortality rates in people with both dementia and self-harm diagnoses. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the prevalence and types of young onset dementia (YOD) in New South Wales (NSW), Australia, in 1891 with comparisons to 21st century estimates. Changes might inform future service planning for persons with YOD. Methods: Medical case books of two Hospitals for the Insane were examined at the State Archives and clinical and sociodemographic information extracted of persons who were under the age of 65 in April 1891, when a NSW Census occurred, and were given a dementia diagnosis or had symptoms consistent with dementia. Consensus 21st century 'probable' and 'possible' all cause dementia and major neurocognitive disorder diagnoses were determined by two psychiatrists. Prevalence estimates of moderate‐severe dementia were determined and compared with 21st century estimates and dementia types. Results: Of 161 potential dementia cases, 123 were given a consensus 'probable' dementia diagnosis, 28 a 'possible' dementia diagnosis, and ten were given a non‐dementia diagnosis, with 'all cause dementia' and 'major neurocognitive disorder' diagnoses identical. Most dementia cases were male (n = 119, 78.8%). 'Unspecified dementia' was the most frequent diagnosis (n = 47, 31.1%), followed by dementia secondary to syphilis (n = 35, 23.2%), epileptic dementia (n = 30, 19.9%), alcohol‐related dementia (n = 17, 11.3%), and mixed dementia (n = 16, 10.6%). Epileptic dementia had the youngest average age of admission (34.9 years). Other than epileptic dementia, all other dementia types were more frequent in males. Prominent clinical symptoms included neurological signs (n = 79, 52.3%), psychosis (n = 77, 51.0%), agitation (n = 75, 49.7%), and aggression (n = 45, 29.8%). Most dementia cases either died in hospital (n = 79, 52.3%) or were transferred to a long stay hospital (n = 57, 37.7%). The estimated point prevalence of YOD in persons aged 30–59 in 1891 (86 per 100,000) was higher than current Australian and global estimates in this age group due to the high rates in males (126 per 100,000), but in those aged 60–64, the prevalence in 1891 (159 per 100,000) was much lower than current estimates. Conclusions: This first examination of YOD in the nineteenth century found high rates of dementia in those under the age of 60 compared with current estimates, particularly in men aged between 30 and 59 years old, and largely due to syphilis, alcohol and epilepsy, conditions that are now treatable and thus demonstrating the potential of effective treatments for YOD. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. Design: A longitudinal whole-of-population record linkage study was conducted (2014–2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. Setting: Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. Participants: Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. Intervention: CMH care within 14 days from index, versus not. Measurements: Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. Results: Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. Conclusions: CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care. [ABSTRACT FROM AUTHOR]

Men are less likely than women to engage with formal mental health services for suicidality. We describe the sources of support, barriers to service use, and coping strategies of men with past-year suicidal ideation who are not receiving formal mental health services. Australian men experiencing past-year suicidal ideation who also did not receive formal mental health services within the past year (n = 176) completed a survey that assessed help-seeking behaviors, coping strategies and styles, use of general services, barriers to service use, and individual-level characteristics. Analyses included descriptive statistics and bivariate analyses. The most common type of support was self-help resources, and self-reliance was the most common barrier to formal mental health service use. Most participants had seen a GP for non-mental-health-related reasons in the past year. Men who did not seek any help for their suicidality experienced lower instrumental barriers and perceived need for support, and lower levels of certain coping styles. Limitations included a cross-sectional design and small sample size. The current study provides insight into the help-seeking experiences of men with past-year suicidality and not receiving formal mental health services. The findings suggest it may be helpful to improve the linkage between online and informal sources of support and evidence-based interventions. Online self-help, friends, and partners were the most commonly used sources of help. A subset of men (42%) with lower perceived need for help did not seek any support. Despite no past-year formal mental health service use, 80% of the men had seen a GP. [ABSTRACT FROM AUTHOR]

Objective: To characterize the features of aged care users who died by suicide and examine the use of mental health services and psychopharmacotherapy in the year before death. Design: Population-based, retrospective exploratory study Setting and participants: Individuals who died while accessing or waiting for permanent residential aged care (PRAC) or home care packages in Australia between 2008 and 2017. Measurements: Linked datasets describing aged care use, date and cause of death, health care use, medication use, and state-based hospital data collections. Results: Of 532,507 people who died, 354 (0.07%) died by suicide, including 81 receiving a home care package (0.17% of all home care package deaths), 129 in PRAC (0.03% of all deaths in PRAC), and 144 approved for but awaiting care (0.23% of all deaths while awaiting care). Factors associated with death by suicide compared to death by another cause were male sex, having a mental health condition, not having dementia, less frailty, and a hospitalization for self-injury in the year before death. Among those who were awaiting care, being born outside Australia, living alone, and not having a carer were associated with death by suicide. Those who died by suicide more often accessed Government-subsidized mental health services in the year before their death than those who died by another cause. Conclusions: Older men, those with diagnosed mental health conditions, those living alone and without an informal carer, and those hospitalized for self-injury are key targets for suicide prevention efforts. [ABSTRACT FROM AUTHOR]