Suicide in the elderly in Austria

In most countries men and women have the highest suicide rates in age groups over 60 years. We investigated suicide rates for the elderly in Austria, a country with one of the highest suicide rates in the world, for the period 1980–1991, using data from the Federal Statistical Division. Suicide rates remained stable over the last decade at a very high level. The mean rate for men was 85.2, for women 28.6/100 000. In men and women rates rise with age. The mean rate of men rises from 51.2 (60–64 years) to 117.3/100 000 (over 85 years); in women there is an increase from 21.4 (60–64 years) to 32.8/100 000 (over 85 years). We did not confirm findings in other countries, where suicide rates have increased in recent years.     

Gender in elderly suicide: analysis of coroners inquests of 200 cases of elderly suicide in Cheshire 1989-2001

OBJECTIVES: The aim of this study is to review gender differences in elderly suicide in relation to specific social aspects of the suicidal process and health care contact before death. Such information may have practical value in identifying and targeting vulnerable elderly in whom suicide may be potentially preventable. METHODS: Data were extracted from the records of coroner's inquests into all reported suicide of persons aged 60 and over, in Cheshire over a period of 13 years 1989-2001. The Coroner's office covers the whole county of Cheshire (population 1 000 000). RESULTS: Men were less likely to have been known to psychiatric services (Odds Ratio [OR] 0.4 95% 0.2-0.6) and with less frequently reported history of previous attempted suicide compared to women (OR 0.5 95% Confidence Intervals [CI] 0.2-1). All deceased from ethnic minorities were men, none of whom had been known to psychiatric services. There was no significant difference between women and men in relation to, physical or psychiatric morbidity, GP contact prior to suicide, intimation of intent or living alone. Of suicide victims not known to services a surprisingly high proportion of 38% and 16% were found to have psychiatric morbidity in men and women respectively. CONCLUSION: Suicide is an important problem in the elderly with gender playing an important part in their social behaviour but a high proportion of the deceased were not known to local services. Primary Care professionals have an important role to play in reducing elderly suicide as most contact with the health service in elderly suicide seem to be with GPs.     

Trends in mortality from suicide, 1965-99

OBJECTIVE: To analyse trends in mortality from suicide over the period 1965-99. METHOD: Data were derived from the WHO database, including data for 47 countries. RESULTS: In the European Union (EU), all age suicide mortality peaked at 16.1/100,000 in men in 1980-84, and declined thereafter to 14.4/100,000 in 1995-98. In females, the fall was 29% to reach 4.6/100,000. A similar pattern of trends was observed in several eastern European countries. In contrast, mortality from suicide rose substantially in the Russian Federation, from 37.7/100,000 in males in 1985-89 to 58.3/100,000 in 1995-98 (+55%), and to 9.5/100,000 (+12%) in females. In the USA and most other American countries providing data, no consistent pattern was evident for males, but falls were observed in females. Steady declines were registered for Japan, starting from the highest suicide rates worldwide in the late 1950s. Suicide rates were upwards in Ireland, Italy, Spain, the UK, Cuba, Australia and New Zealand. Substantial rises were observed in a few countries (Ireland, Cuba, Mexico, Australia and New Zealand) for young males. CONCLUSION: In spite of mixed trends, suicide remains a significant public health problem worldwide.     

Elderly suicide rates in Asian and English-speaking countries

OBJECTIVE: Asian culture venerates elderly people. It was hypothesized that elderly suicides would be proportionately lower in Asian societies than in English-speaking countries (ESC). METHOD: Elderly (i.e. aged 75 years or more) to general population suicide ratios were compared for six Asian societies and six ESC, based upon the latest 5-year suicide rates. RESULTS: Males: The general population suicide rate was highest in rural China (227 per million) and third highest in Japan (217 per million), but other countries with high rates were all ESC (ranging from 224 to 198 per million). Asian countries had the six highest elderly suicide rates, 1327-1373 per million, whilst the highest ESC elderly rate was in the United States (507 per million). Asian societies had the widest range of elderly/general ratios, ranging from 6.62 to 2.6. Females: The overall suicide rates were higher in Asian countries (57-95 per million) than in ESC (40-56 per million). Asian elderly suicide rates differed (932 per million in rural China to 154 per million in Korea) but the highest ESC rate was in Australia (76 per million). The Asian countries elderly/general ratios ranged from 5.82 : 1 to 2.70 : 1, but the widest ESC ratio was 1.71 : 1, in the United Kingdom. CONCLUSION: There is a need for country-specific prevention measures in elderly people, and particularly for older women in Asian countries.     

Suicide in the People's Republic of China categorized by age and gender: evidence of the influence of culture on suicide

Pritchard C. Suicide in the People's Republic of China categorized by age and gender: evidence of the influence of culture on suicide. Acta Psychiatr Scand 1996: 93: 362–367. © Munksgaard 1996. Throughout the developed world suicide is predominantly associated with psychiatric disorders and substance misuse. The main social factors are age, as suicide increases with each decade, and gender, as suicide is more frequent among men than women, and proportionately more young men die than their female peers. An analysis of suicide in the People's Republic of China found that the profile was the opposite to that reported in the rest of the world, as more female subjects kill themselves than males, particularly younger women. Also, unlike the situation in other countries, suicide occurred more often in rural than in urban areas. It is argued that the Chinese data provide evidence of a greater cultural influence upon suicide rates than had previously been realized.     

One-year prevalence of death thoughts,suicide ideation and behaviours in an elderly population

BACKGROUND: Suicidality is constituted by all those phenomena that are apparently positioned along a continuum, with the two extremes represented by death wishes and completed suicide. OBJECTIVES: The aim of this paper is to show the one-year prevalence of the phenomena constituting this possible continuum in the elderly population (aged 65 years and over) of a northern Italian city and to evaluate the relationship between some of these phenomena with psychological suffering. METHOD: Emotional feelings and suicidal thoughts have been investigated by an epidemiological survey conducted in a central quarter of that city. Data on attempted and completed suicide derived from the data bank of the Padua's WHO Collaborating Centre for Research and Training in Suicide Prevention that monitors these phenomena since 1989. RESULTS AND CONCLUSIONS: Results suggest the existence of some continuity in suicidal phenomena, where prevalence decreases from those of emotional/ideational nature to most extreme behaviour. Subjects presenting with more severe suicidal ideation were those also obtaining highest scores in a number of sub-scales of the Brief Symptom Inventory.     

Risk factors of attempted suicide in the elderly: The role of cognitive impairment

The authors’ aim was to assess the prevalence and importance of dementia and cognitive impairment in relation to suicidal behaviour in elderly psychiatric inpatients. The level of cognitive functioning (according to the Mini Mental State Examination – MMSE) of the elderly suicidal inpatients (N=62) were compared to the general elderly inpatients (N=152). There were significant differences in cognitive functioning between the two groups, in the non-suicidal group the level of cognitive function was significantly lower. However, mild cognitive deficit or mild dementia were registered in 60% of the suicide attempters. The results indicate that not only mood disorders, but other risk factors (especially mild cognitive impairment), have a key role in developing suicidal behaviour in the elderly. Thus, in the treatment and prevention of suicidal behaviour in the elderly, it is important to apply the complex bio-psycho-social model, in which (besides adequate pharmacotherapy) psychotherapeutic approaches and procedures to enhance cognitive functioning are of outstanding significance.     

Suicide and attempted suicide in general practice, 1979-1986

Using data from the Continuous Morbidity Registration Sentinel Stations over the period 1979-1986, the authors tried to determine the incidence and the characteristics of patients in general practice who attempted or committed suicide. Almost half of the suicide attempts and suicides had contacted their general practitioner (GP) shortly before the suicidal act. A minority of these cases were recognized by the GP as having a high suicide risk. In almost 70% of the suicides and 58% of the suicide attempters the GPs reported the existence, currently or previously, of a depressive episode. About half of both the suicides and the suicide attempters had been treated or seen by mental health professionals or social workers. Given the fact that suicide and suicide attempt are relatively rare events in general practice, and given the fact that for the patients who contact their GP shortly before the suicidal act, it is not at all certain whether they present clearly recognizable signs of suicide risk at that time, the authors conclude that GPs cannot play an important role in the prevention of suicidal behaviour.     

Rates of lifetime suicide attempt and rates of lifetime major depression in different ethnic groups in the United States

OBJECTIVE: Rates of major depression and suicide vary across ethnic groups within the US. This also may be true of suicide attempts. METHOD: Data on lifetime suicidal behavior and major depression among Mexican American, Cuban American, and Puerto Rican adults who participated in the Hispanic Health and Nutrition Epidemiologic Survey were pooled with Epidemiological Catchment Area Study data for Blacks, Whites and Hispanics. RESULTS: Rates of major depression ranged from 9.3 (Puerto Ricans) to 3.24% (Cuban Americans). Puerto Ricans and whites had the highest rates of depression. Similarly, suicide attempt rates ranged from 9.1% for Puerto Ricans to 1.9% for Cuban Americans. Puerto Ricans had higher suicide attempt rates compared with other groups. CONCLUSION: This study underscores that there are differences between Hispanic ethnic groups. The impact of the migration process, socioeconomic status, and acculturation may underlie differences in major depression and suicide attempt rates across ethnic groups.     

Age, period and cohort effects on suicide rates in Australia, 1919-1999

OBJECTIVE: To examine age, period and cohort effects on Australian suicide rates. METHOD: Male suicide rates for successive 5-year periods between 1919 and 1998, and for 1999 were displayed graphically to examine interactions between age, period and cohort effects. RESULTS: There has been a pronounced period effect on male suicide rates in all age groups over the last few decades, with lower rates in wartime and peak rates for most cohorts in the 1960s. Peak rates of all adult female 5-year age cohorts occurred in the 1960s or early 1970s. CONCLUSION: Most so-called cohort effects appear to be associated with environmental changes that may not be a function of the cohort itself. While much attention has focused on the rising suicide rates in young males in Australia, local media and health authorities have given little emphasis to the high rates found in elderly males.     

Elderly suicide and the 2003 SARS epidemic in Hong Kong

BACKGROUND: Hong Kong was struck by the community outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003. In the same year, the elderly suicide rate in Hong Kong showed a sharp upturn from a previous downward trend. METHODS: Secondary analyses using Poisson Regression Models on the suicide statistics from the Census and Statistics Department of the Hong Kong Government were performed. RESULTS: In a Poisson Regression Model on the annual suicide rates in elders aged 65 and over in years 1986-2003, 2002 served as the reference year. Suicide rates in 1986-1997 were significantly higher than the reference year, with an Incident Rate Ratio (IRR) of 1.34 to 1.61. However, rates in 1998-2001 did not differ from the reference year significantly, representing stabilization of suicide rates for 4 years after 1997. The elderly suicide rate increased to 37.46/100,000 in 2003, with an IRR of 1.32 (p=0.0019) relative to 2002. Such trend is preserved when female elderly suicide rates in 1993-2003 were analyzed, while suicide rates in elderly men and younger age groups did not follow this pattern. DISCUSSIONS: Mechanistic factors such as breakdown of social network and limited access to health care might account for the findings. These factors could have potentiated biopsychosocial risk factors for suicide at individual levels, particularly in elderly. Female elders, by way of their previous readiness to utilize social and health services instituted in the past decade, are thus more susceptible to the effects of temporary suspension of these services during the SARS epidemic. CONCLUSIONS: The SARS epidemic was associated with increased risk of completed suicide in female elders, but not in male elders or the population under 65 years of age.     

Are suicide trends among the young reversing? Age,period and cohort analyses of suicide rates in Sweden

Allebeck P, Brandt L, Nordstrom P, Åsgård U. Are suicide trends among the young reversing? Acta Psychiatr Scand 1996: 93: 43–48. © Munksgaard 1996. We analyzed suicide rates in Sweden 1952–1992 with the main purpose of following up the previously observed increasing suicide rate in young men, and applying age-period-cohort (APC) analyses to the trends in suicide mortality. APC analyses were performed by a graphical method and by multivariate log-linear regression. The suicide rate among 20–40 year-old men increased throughout the 1950s and 60s, but the increase has levelled off since the middle of the 1970s, and in some narrow age groups possibly even reversed. The suicide rate among men over 45 years has declined throughout the period. The suicide rate among women has remained more stable. APC analyses did not give clear evidence for a specific cohort or period effect, although addition of a cohort term in the analyses of men slightly improved the fit of the model. A longer follow-up of younger birth cohorts is needed to see whether the changes in male suicide rates will remain as a cohort effect.     

Comparison of suicide in people aged 65-74 and 75+ by gender in England and Wales and the major Western countries 1979-1999

BACKGROUND: The factors most strongly associated with suicide are age and gender--more men than women, and, more people over 65 kill themselves. As a number of Governments have targets to reduce suicide levels we compare elderly suicide rates over a 20-year period in England and Wales. And the major Western countries focusing upon age and gender. METHOD: WHO mortality data were used to calculate three-year average General Population Suicide Rates (GPSR) for 1979-1981 to 1997-1999 and rates of people aged 65-74 and 75+ suicide by gender to provide ratios of change and a statistical comparison of England and Wales and the Major Western countries over the period. RESULTS: Male GSPR: '65-74' suicide ratios fell significantly in six countries and in three for the '75+'. Female GSPR: '65-74' suicide ratios fell in every country except Spain. Proportionately, there were more suicides in the over 65s in countries with an 'extended family' tradition, Spain, Italy, Germany, France and Japan, than in the five 'secular' countries. England and Wales male '65-74' suicide fell significantly more than Canada, France, Germany, Italy, Japan, Spain, Netherlands and the USA, and did significantly better than the other countries for all female senior citizen suicides. CONCLUSION: Suicide of the over-65s has improved in seven countries, especially in England and Wales, who had the greatest proportional reduction, which reflects well upon the psycho-geriatric and community services. However, in all countries, male 65-74 rates did not match the female out so extra efforts are needed to improve male rates.     

Substances used in deliberate self-poisoning 1985-1997: trends and associations with age, gender, repetition and suicide intent

Background: Rates of deliberate self-poisoning have increased in recent years. While over-the-counter availability and prescribing patterns may influence trends in substances used in overdose, these may also be related to clinical characteristics of patients. We investigate trends in substances used for self-poisoning and the influence of age, gender, suicidal intent and repetition status on the substances used. Method: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends and patterns of self-poisoning between 1985 and 1997. Results: There were substantial increases in self-poisoning with paracetamol and antidepressants. While the increase in antidepressant self-poisoning closely paralleled local prescribing figures during 1995–97, SSRI antidepressant overdoses occurred somewhat more often than expected compared with tricyclic overdoses. Paracetamol overdoses were more common in first-timers and young people, whereas overdoses of antidepressants and tranquillizers were more common in repeaters and older people. Self-poisoning with gas and non-ingestible poisons was associated with high suicidal intent. Conclusions: There have been marked changes in the substances used for self-poisoning, which seem primarily to reflect availability, as do the influences of age and repeater status on choice of substances used. Degree of suicidal intent may also influence choice of method of self-poisoning. Accepted: 31 January 2001     

Consistency of immigrant and country-of-birth suicide rates: a meta-analysis

Objective: Multifaceted evidence (family, twin, adoption, molecular genetic, geographic and surname studies of suicide) suggests genetic risk factors for suicide. Migrant studies are also informative in this context, but underused. In particular, a meta‐analysis of the associations of immigrant (IMM) and country‐of‐birth (COB) suicide rates is unavailable. Method: Thirty‐three studies, reporting IMM suicide rates for nearly 50 nationalities in seven host countries (Australia, Austria, Canada, England, the Netherlands, Sweden and the USA), were retrieved. Results: Total‐population IMM and COB suicide rates were strongly positively associated (combined rank‐order correlation across 20 eligible studies: 0.65, 95% CI: 0.56–0.73, P < 10^?9). The effect generalized across both sexes, host countries and study periods. Conclusion: Following the logic of the migrant study design of genetic epidemiology, the correspondence of IMM and COB suicide rates is consistent with the assumption of population differences in the prevalence of genetic risk factors for suicide.