Suicide in older people without psychiatric disorder

OBJECTIVE: To determine the psychological characteristics and nature of life problems, including physical illness, in people 60 years and over dying through suicide in the absence of psychiatric disorder. METHODS: Psychological autopsy interviews with relatives and friends for 23 people aged 60 years or over who had died through suicide and did not have a psychiatric disorder at the time of death. RESULTS: Three (13%) of the sample had significant psychiatric symptoms, one had a diagnosis of personality disorder, and ten (43.5%) had significantly abnormal personality traits. Physical illness and recent bereavement were the commonest life problems associated with suicide. Five (21.7%) of the sample were suffering from severe physical illness at the time of death. CONCLUSION: Sub-syndromal psychiatric disorder may be less important than personality factors, physical illness, and recent bereavement as important contributory factors to suicide in older people not suffering from psychiatric illness at the time of death.     

A study of self-harm in older people: mental disorder, social factors and motives

Data was collected on seventy-six older people who presented to a specialist self-harm team. Data included: diagnosis, suicide intent, motives for self-harm, social contacts and life events and difficulties. The majority of elderly who harmed themselves had high suicide intent and 69% were depressed. Patients were frequently living alone with an isolated life-style and poor physical health. Depressed self-harm subjects had higher suicide intent scores than non-depressed and to gain relief from an unbearable state of mind was a frequently recorded motive for these patients. Other motives for self-harm appear to be similar between depressed and non-depressed self-harmers. It is important that older people who self-harm receive an appropriate assessment of both risk and need by an experienced mental-health professional skilled at recognising depression in later life. The need for adequate recognition and management of depression in older people in primary care is also highlighted.     

Suicide, assisted suicide, and medical illness

Medical illness is an important part of the motivation for suicide--a significant factor in about 50% of suicides in patients over the age of 50 years and 70% of suicides in patients over the age of 70 years. Depression, anxiety, and ambivalence about dying characterize both medical patients who attempt suicide and those who request assisted suicide. When the physical and psychological sources of the desperation that underlies requests for assisted suicide are addressed, the desire for death diminishes and patients are usually grateful for the time remaining to them. Improved psychiatric and medical care for those who are terminally ill offer significant possibilities for suicide prevention.     

Suicide in China: Unique demographic patterns and relationship to depressive disorder

Recent research on suicide in China reveals several unique findings: 1) female suicides outnumber male suicides by a 3:1 ratio; 2) rural suicides outnumber urban suicides by a 3:1 ratio; 3) a large upsurge of young adult and older adult suicides has occurred; 4) a comparatively high national suicide rate two to three times the global average is evident; and, most startlingly, 5) a low rate of psychiatric illness, particularly depression, exists in suicide victims. The strongest empirical data suggest that these trends result from a high number of rural, young females who experience acute interpersonal or financial crises and then impulsively attempt suicide using lethal pesticides or poisons. Other suicide risk factors in China are similar to those that are well known internationally. Interactive sociological, cultural, and economic hypotheses unique to China provide further insight. Among those, the cultural-socioeconomic disadvantages of the Chinese rural female and cultural attitudes toward suicide are particularly noteworthy.     

Suicide risk in relation to socioeconomic,demographic, psychiatric,and familial factors: a national register-based study of all suicides in Denmark, 1981-1997

OBJECTIVE: Suicide risk was addressed in relation to the joint effect of factors regarding family structure, socioeconomics, demographics, mental illness, and family history of suicide and mental illness, as well as gender differences in risk factors. METHOD: Data were drawn from four national Danish longitudinal registers. Subjects were all 21,169 persons who committed suicide in 1981-1997 and 423,128 live comparison subjects matched for age, gender, and calendar time of suicide by using a nested case-control design. The effect of risk factors was estimated through conditional logistic regression. The interaction of gender with the risk factors was examined by using the log likelihood ratio test. The population attributable risk was calculated. RESULTS: Of the risk factors examined in the study, a history of hospitalization for psychiatric disorder was associated with the highest odds ratio and the highest attributable risk for suicide. Cohabiting or single marital status, unemployment, low income, retirement, disability, sickness-related absence from work, and a family history of suicide and/or psychiatric disorders were also significant risk factors for suicide. Moreover, these factors had different effects in male and female subjects. A psychiatric disorder was more likely to increase suicide risk in female than in male subjects. Being single was associated with higher suicide risk in male subjects, and having a young child with lower suicide risk in female subjects. Unemployment and low income had stronger effects on suicide in male subjects. Living in an urban area was associated with higher suicide risk in female subjects and a lower risk in male subjects. A family history of suicide raised suicide risk slightly more in female than in male subjects. CONCLUSIONS: Suicide risk is strongly associated with mental illness, unemployment, low income, marital status, and family history of suicide. The effect of most risk factors differs significantly by gender.     

Increased risk of death in community-dwelling older people with white matter hyperintensities on MRI

BACKGROUND: Previous studies in subjects with a history of stroke have shown that white matter hyperintensities (WMH) on MRI are associated with increased risk of death. However, it has not been determined whether WMH are independently related to death in community-dwelling older people without stroke. METHODS: In a sample of community-dwelling people over 75 years with no history of stroke or other neurological diseases, WMH on brain MRI T2-weighted sequences were classified as grade 0, grade 1, or grade 2. Grade 2 WMH were identified in 36 subjects. Age- and sex-matched grade 0 and grade 1 WMH groups were selected for comparison to the grade 2 WMH group. All subjects underwent an initial clinical evaluation and were followed for a median of 11.8 years (interquartile range=10.7 to 12.2 years). Cox proportional-hazards analysis was used to determine the independent association between WMH and time to death from any cause. RESULTS: In an unadjusted analysis, grade 2 WMH was associated with death from any cause (hazard ratio=1.98; 95% confidence interval=1.06, 3.70). After adjustment for hypertension, high cholesterol, diabetes, and coronary artery disease, grade 2 WMH remained significantly associated with death (hazard ratio=2.31; 95% confidence interval=1.21, 4.40) in these age- and sex-matched groups. CONCLUSIONS: Severe WMH increase the risk of death, even in community-dwelling elderly without stroke or other neurological disease, independent of other covariates including hypertension, age, and coronary artery disease.     

Suicide on railway networks: epidemiology, risk factors and prevention

The aim of the present study was to review international literature on the incidence of suicide on railway networks, describe risk factors associated with it, and examine existing prevention practices. Searches on Medline and PsycINFO for the period 1966-2007 were performed. Thirty original studies published in English on epidemiology of rail suicide were included in the review along with peer-reviewed articles on risk factors and prevention of rail suicide. Internationally, suicide by collision with a train accounted for 1-12% of all suicides, with up to 94% of all attempts resulting in death. Suicide by train seriously affects not only survivors, but also train drivers and bystanders. Correlations between density of rail network, number of passengers and number of suicides by train have been found. Conflicting data exist on gender ratio of this type of suicide, but studies are homogenous in identifying young adults (20-40 year of age) as those most exposed to train suicide. Documented psychiatric diagnoses were found in up to 83% of cases. Mid-seasonal peaks were also identified, with events occurring mostly during late morning and early afternoon. Limited evidence exists for effective suicide prevention practices. Successful examples are represented by pits and sliding door systems (Singapore Mass Rapid Transit System) and responsible media reporting (Viennese Subway). Suicide by train involves emotional and financial costs to individuals and society as a whole. A combination of different strategies might significantly reduce its effect.