Trends in suicide rates of the elderly in Austria, 1970-2004: an analysis of changes in terms of age groups, suicide methods and gender

BACKGROUND: Suicides of the elderly (persons aged 65 and older) make up a large proportion of total suicides. Since suicide rates of the elderly are highest in western populations, addressing them as a risk group in prevention plans has been recommended. In order to assess possible approaches to prevention strategies, this study examines high-risk groups of the elderly. METHODS: We examined official statistics on suicides that occurred in Austria between 1970-2004 (18,101 Suicides of the elderly). We analyzed time trends and differences in suicide methods as well as in age groups and both genders of the elderly. RESULTS: Three major high-risk groups were identified: elderly male suicides by firearms; elderly female suicides by poisoning, which occur more often with increasing age; and suicides of both genders by jumping from heights. CONCLUSION: Besides conducting treatment of psychiatric disorders of the elderly, restricting the means to commit suicide may help to prevent it among the elderly. Such specific prevention strategies should be implemented in national suicide prevention plans for the high-risk groups identified in this study.     

Suicide in New Zealand 1957-1986: the influence of age, period and birth-cohort

New Zealand suicide rates from 1957 to 1986 were analysed for age, period and cohort effects. Cumulative suicide rates were relatively stable but more complex patterns were revealed by detailed analysis. There was a steadily increasing rate in young men and a recent increase in elderly men. Reduced mortality rates in equivalent categories of accidental and "undetermined" deaths could have accounted for only a proportion of these increases. A cohort effect was noted in men, with increasing risks of suicide in the young for successive birth-cohorts born from 1947 onwards. In women a period effect was likely, with increasing rates for all age-groups between 1957-61 and 1962-66, followed by a decline recently among all except the youngest age-groups. These trends in women may have been largely due to changes in barbiturate prescribing. In both sexes poisoning declined as a method of suicide, while hanging and carbon monoxide poisoning increased. Firearm suicides also increased in men. The implications of these results for prevention are considered.     

Recent trends in elderly suicide rates in England and Wales

The proportion of elderly in the population is increasing due to increased life expectancy and falling birth rate, and suicide rates increase with age. This study examined the following in England and Wales: (i) recent trends in the elderly suicide rate; (ii) recent trends in method-specific elderly suicide rate; (iii) the relationship between elderly population size and elderly suicide rate in recent years; and (iv) the sex difference in overall and method-specific elderly suicide rate. Data on the various suicide variables were ascertained from the annually published mortality data for years 1985 to 1996. The main findings of this study were: (i) there is a trend towards decline in the overall pure and combined suicide rates for elderly men and women over the 12 year study period; (ii) the main contributors to this decline are suicides due to poisoning by solid and liquid substances (E950), hanging, strangulation and suffocation (E953), drowning (E954), firearms and explosives (E955), and jumping from high places (E957); (iii) the overall pure and combined suicide rates and that for most categories of suicide was higher in men compared to women; and (iv) suicide rates decreased with an increase in the elderly population size. Suicide rates can decline due to a number of reasons. The challenge now is to ensure further decline in suicide rates to meet the Our Healthier Nations target.     

Suicide in the elderly in Kaniyambadi block, Tamil Nadu, South India

BACKGROUND: Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles in investigating suicide in the developing world. Very high rates of suicide have been recorded in the region in the general population and among younger people. OBJECTIVE: This paper describes the suicide rate among the elderly in Kaniyambadi block, Tamil Nadu, South India for the years 1994-2002 using verbal autopsies. METHOD: The setting for the study was a comprehensive community health program in a development block in rural South India. The main outcome measure was death by suicide diagnosed by a detailed verbal autopsy and census, birth and death data to identify the population base. RESULTS: The average annual suicide rate was 189 per 100,000 for people over 55 years of age. The ratio of male to female suicides was 1: 0.66. The age-specific suicide rate for men and women increased with age. Hanging (52%) and poisoning with organo-phosphorus compounds (39%) were the commonest methods employed for committing suicide. Significantly more women chose drowning or burning than men who preferred poisoning or hanging (chi2 19.75; df 1; p < 0.001). CONCLUSIONS: The suicide rate documented in this study among the elderly is very high. The reasons for the high suicide rate observed in older people are not known. There is a need to develop innovative strategies to reduce deaths by suicide.     

Firearms and suicide in Australia

Australia has a moderate overall suicide rate but an extremely high male firearm suicide rate. Using data covering the years 1961-1985, a series of multiple regression based analyses were performed. During this period, overall suicide rates fell but firearm suicides remained constant with a resulting increase in the proportion of suicides by firearms. There has been an increase in suicides in the young offset by a decline in the elderly. Young males showed the greatest proportional increase in the use of firearms. A limited regional analysis supported the hypothesis that lack of legislative restrictions on long guns in Queensland with a greater household prevalence of such weapons and different cultural attitudes were associated with higher overall and firearm suicide rates. Such findings are consistent with reports from North America, although trends in Australia are more modest. Reducing the availability and cultural acceptance of firearms is likely to decrease suicide rates, especially in males.     

Suicide in Australia--a comparison with suicide in England and Wales.

This study reports changes of suicide rate in Australia and in England and Wales in the twenty years up to 1976. Rates in both places reached a peak in 1963, related to increases in poisoning as a means of suicide. Decreases since then can be attributed partly to reduced likelihood of death after inhalation of domestic gas or after ingestion of poisons. There has been an increase in suicide deaths among younger people, but a decrease among older age groups. The two countries have patterns of suicide which are similar in many respects, the most striking difference being the frequency with which firearms are used by male suicides in Australia. There is good reason to believe that variation in availability of a means of suicide is the factor which has most effect on rates of suicide, though cultural attitude towards each method also is an important determinant of how much it will be used for suicide.     

The significance of suicide notes in the elderly

Suicide notes are traditionally considered as markers of the severity of the suicide attempt and are said to provide valuable insight into the thinking of suicide victims before the fatal act. Few studies have described the characteristics of elderly suicide note-writers and their final thoughts. This study is a retrospective view of suicide notes obtained from coroners' records of all elderly suicides in Cheshire over a period of 10 years, 1989-1998. Out of 125 suicides, 54 (43%) had suicide notes, which were reported in the coroner's records. Of these there were 31 (57%) male and 23 (43%) female subjects. Elderly suicide note-leavers were more likely to be unknown to psychiatric services (p < 0.01) and to have used a non-violent method of suicide (p < 0.01). Sex, marital status, social isolation, mental or physical morbidity did not appear to be linked with leaving a suicide note. More cases that took an overdose, used plastic bags, electrocuted themselves, or used car exhaust also left suicide notes. Those who died by more violent means such as hanging, drowning, jumping from height, immolation or wounding appeared less likely to have left a suicide note. No statistically significant difference in the content of the suicide notes was observed in relation to sex or age. Many elderly are isolated and may have no one to write a note to, while others have lost the ability to express themselves. Therefore, it is not possible to say that the different incidence of note leaving observed for suicide was due to differing levels of suicidal intent. Although only a proportion of elderly suicide victims leave suicide notes, the absence of a suicide note must not be considered an indicator of a less serious attempt.     

Suicide among the elderly in Honolulu County: a multiethnic comparative study (1987-1992)

Suicide rates for the elderly continue to be the highest for any age group. Although these rates are known to be significant, little study has been given to the ethnic variability associated with this phenomenon. This retrospective study was undertaken to explore this issue and involved a review of the coroner's reports for completed elder suicides (65 years of age or older) for Honolulu County from 1987 through 1992 inclusive. The results showed a mean age of 75 years, with the highest incidence of completion in the 80+ age group. The predominant method of suicide completion in this study group was found to be hanging, followed by jumping, firearms, and poisoning. There were significant gender and ethnic differences in the method of suicide completion. Almost half of the sample saw a healthcare provider within the 6 months before their death. Comparisons with other elder suicide studies are presented.     

Causative factors as cues for addressing the rapid increase in suicide in Mie Prefecture, Japan: comparison of trends between 1996-2002 and 1989-1995

The number of suicides in Japan has increased from approximately 22 000 per year from 1988 to 1997 to >30 000 per year since 1998. Likewise, the number of suicides has been increasing in Mie Prefecture. The purpose of the present study was to examine the incidence of and circumstances surrounding all suicide cases during 1996-2002 in Mie Prefecture and to compare the data with those from 1989 to 1995. In Mie Prefecture, the age-specific suicide rate during the second 7-year period included marked increases among men aged 50-59 and 60-69 years. Among women, the age-specific suicide rate increased with age during both 7-year periods. During the second period, psychiatric disorders as causative factors increased in all generations. They were especially important for women of the younger generation, whereas economic problems were the most common causative factor among men aged 40-64. Physical illness as a causative factor in suicide was high among the elderly, but among the other age groups this factor trailed behind economic difficulties for men and psychiatric disorders for women. To prevent suicide, social cooperation as well as a plenitude of visiting nurses and psychiatric care is required, and early detection and treatment are also important.     

Antidepressant drug consumption and public health indicators in Italy, 1955 to 2000

OBJECTIVE: This study investigated the impact of the increasing consumption of selective serotonin reuptake inhibitors (SSRIs) and newer anti-depressants on the following public health indicators: (1) suicide rates, (2) proportion of completed suicides by poisoning with solid or liquid substances, and (3) hospital admissions for depression and proportion of admissions for depression that were first admissions. METHOD: Data collected by IMS Health on antidepressants dispensed in Italy from 1983 to 2000 were obtained from the Italian Ministry of Health, while data on suicide deaths from 1955 to 2000 were obtained from the Italian National Institute of Statistics. RESULTS: In Italy from 1983 to 2000, the use of tricyclic antidepressants remained substantially stable, and the use of SSRIs and newer agents dramatically increased. In contrast, suicide rates for males decreased from 1955 to 1974 and subsequently increased, reaching a peak in 1985 and then declining. In females, suicide rates remained substantially stable until 1978. A subsequent increase occurred up to 1985, followed by a steady decline. Suicide by poisoning using solids or liquids dropped by nearly 50% from 1986 to 2000. Admissions to the hospital for depression showed an erratic pattern; however, no decline was observed. No change was observed in the rate of first admissions for depression. CONCLUSION: Despite a reduction in suicides by poisoning using solids or liquids, the analysis of long-term trends in suicide did not suggest that increases in antidepressant prescribing lie behind recent reductions in population suicides. Furthermore, in Italy, newer antidepressants had no impact on the total number of admissions for depression or on the proportion of all admissions that were first admissions.     

Age and methods of fatal self harm (FSH). Is there a link?

OBJECTIVES: To examine the methods of fatal self harm (FSH) used by the elderly compared to young adults. METHODS: We compared the methods of FSH used by all the elderly over 60 years of age to those used by all younger adults, over 16 and under 60, in the city of Birmingham and Solihull over a period of 4 years, 1995-1998. We applied the term FSH to all deceased who were subjects of Coroner's inquests and attracted verdicts of suicide and open verdicts. FINDINGS: A significantly higher proportion of the elderly who fatally harmed themselves did so by drowning and asphyxia compared to the younger age group (p < 0.05 and p < 0.01, respectively). Significantly more women over the age of 60 committed acts of FSH by tying a plastic bag around the neck than those under 60 (p < 0.05). Method of death was not ascertained in a much higher proportion of elderly FSH (p < 0.01). The most common method of suicide among elderly men and women were hanging and self-poisoning by overdose, respectively. CONCLUSION: The study shows that the most common method of suicide in the elderly is poisoning by drug overdose. It raises the question about the quantity of drugs prescribed for the elderly, e.g. antidepressants, sedatives and pain killers. The study did not confirm previous reports that violent methods are used more frequently with increasing age.     

Suicide in the elderly

In the vast majority of countries the suicide rate of elderly persons (referring to those aged 65 years and above) is significantly higher than in younger age groups. In the US, by age 80 the suicide rate ranges from 3/100 000 among African American women to 60/100 000 among Caucasian men. Although in all age groups men have higher suicide rates than women, the difference is the most striking in older men living in industrialized countries. In the US the elderly have the highest suicide rate of all age groups, with men accounting for 81% of completed suicides in late-life. It seems that certain life events such as widowhood pose a higher risk for suicide on men than women. It is also possible that the aging process has different effects among men than women and/or elderly women may possess distinct protective factors that could explain the dramatic gender difference. The clinical profile of depressed elderly suicide victims suggests that, if treated for depression, these patients would have had a favorable prognosis. In older people suicidal ideation, suicide attempt, and completed suicide occur most frequently in the context of major depression. Studies have observed that depression in elderly suicide victims is more often without comorbid substance abuse or personality disorders than in younger age groups. Furthermore, while the elderly carry out high lethality attempts, the time to intervene may be longer as the elderly are less impulsive, contemplating suicide for months. Psychological autopsy studies may overestimate the number of elderly suicides that occur in the first episode of late onset depression. It is possible that in a subgroup of suicidal elderly men previous depressive episodes may have been undetected. The detection of suicide in the elderly (especially in men) is more challenging, as they are less likely to communicate their depressed mood and overt suicide intent and are often present with symptoms of masked depression. Although 50% of elderly suicide victims visited their GP the month before their death, more than half of the visits were exclusively for physical complaints. Following an overview of epidemiology and risk factors, we report data on the development and preliminary testing of the Yale Evaluation of Elderly Suicidality Scale and summarize interventions that can be effective in treating suicidal elderly. Finally, we briefly describe two prevention and treatment studies that are currently underway in primary care settings. The aim of these studies is to determine whether the improved detection of depression, improved compliance, and state of-art pharmacotherapy and/or psychotherapy will reduce the prevalence of depressive symptoms, hopelessness and suicidal ideation. These studies aim to investigate whether all the above decrease the rate of suicide attempts and lethal suicide in older adults.     

Are suicide rates in Sweden associated with changes in the prescribing of medicines?

A key issue in the debate on suicide prevention is the extent to which suicide rates are affected by the availability of means of committing suicide. The aim of this study was to analyse the changes in rates of suicides committed by poisoning in Sweden between 1969 and 1992, and to determine to what extent these were associated with changes in the prescribing of medicines. We compared suicide rates from 1969 to 1992 with trends in the sales of antidepressants, barbiturates, neuroleptics and analgesics during the same period. The incidence of suicide by poisoning decreased during the 1970s, especially in younger and middle-aged men. This was mainly due to a decrease in suicides by barbiturate poisoning, which closely followed a decrease in sales of barbiturates. Sales of analgesics and antidepressants increased during the study period, and so did the rates of suicide using these drugs. We conclude that the availability of medicines is an important factor influencing suicide rates, and that changes in the prescribing of medicines may influence suicide rates.     

Gun Control and Suicide: Possible Impact of Canadian Legislation to Ensure Safe Storage of Firearms

In 1992, the Canadian Firearms Act aimed at ensuring safe storage of firearms was promulgated. This study compares suicide methods 6 years prior to the enactment of the law and 5 years after its enactment. The study encompassed 426 suicide cases from Abitibi-Témiscamingue (Northern Quebec), the region with the highest suicide rate and the highest firearm suicide rate in Quebec. Suicide by firearms decreased in the male and female population. Suicide by hanging increased among youths of both sexes, and suicide by poisoning doubled in the female population. A decrease in firearm suicides was most noticeable in the under-25 age group, although it was in this same age group that the general suicide rate increased the most. The reduction of firearm suicides was not accompanied by a decrease in overall suicide rates.     

Gun control and suicide: possible impact of Canadian legislation to ensure safe storage of firearms.

In 1992, the Canadian Firearms Act aimed at ensuring safe storage of firearms was promulgated. This study compares suicide methods 6 years prior to the enactment of the law and 5 years after its enactment. The study encompassed 426 suicide cases from Abitibi-Témiscamingue (Northern Quebec), the region with the highest suicide rate and the highest firearm suicide rate in Quebec. Suicide by firearms decreased in the male and female population. Suicide by hanging increased among youths of both sexes, and suicide by poisoning doubled in the female population. A decrease in firearm suicides was most noticeable in the under-25 age group, although it was in this same age group that the general suicide rate increased the most. The reduction of firearm suicides was not accompanied by a decrease in overall suicide rates.     

Rates and previous disease history in old age suicide

OBJECTIVE: Suicide rates in persons over 65 have been reported to be higher than those of younger age groups. Since the absolute number of suicides in the elderly is expected to rise, more precise ways to identify potential risk factors for elderly suicides are needed. METHODS: On the basis of forensic examinations suicide rates and methods in elderly Finns of northern Finland were compared with those of adults aged 18-64 years. Data from earlier illnesses of the suicide victims were scrutinized for records of multiple physical disorders. RESULTS: Over the 15-year period the mean annual suicide rate per population of 100,000 was significantly lower in the elderly (22.5) than adults aged 18-64 years (38.4). A decrease in suicide rates over time occurred in both groups. Suicide methods among elderly were more often violent, and they were seldom under the influence of alcohol. They also had a high prevalence of previous hospital-treated depressive episodes and hospital-treated physical illnesses. A lifetime history of hospital-treated depression was more common among elderly victims who had received hospital treatment for genitourinary diseases, injuries or poisonings after their 50th birthday. CONCLUSIONS: Our results from elderly suicide victims suggest an association between multiple physical illnesses and a history of depression. Especially, genitourinary diseases as well as hospital treatment due to injuries or poisonings were shown to associate with depression. Elderly Northern Finns showed lower suicide rates, and they decreased during the study period suggesting that active preventive measures against suicide are also feasible in the elderly.     

Burning charcoal: an indigenous method of committing suicide in Hong Kong

BACKGROUND: Carbon monoxide (CO) poisoning by burning charcoal has become one of the most common ways of committing suicide in Hong Kong since late 1998. The evolution of the phenomenon was explored in the current study. METHOD: Information about completed suicides between January 1996 and December 1999 was obtained from the Hong Kong death registry and hospital authority, and information about ambient temperature and humidity was obtained from the Hong Kong Observatory. News on completed suicides by burning charcoal was collected by computer search using the data bank of 6 major Hong Kong newspapers. The data were analyzed. RESULTS: CO poisoning by burning charcoal rose from 0% of all Hong Kong suicides in 1996 and 1997 to 1.7% in 1998 and 10.1% in 1999. The monthly incidence rate bore a reciprocal relationship with the ambient temperature. Suicidal pacts were overrepresented, and past history of mental illness was uncommon. Both demographic and clinical features of suicides by burning charcoal resembled those of suicides by domestic gas poisoning. The overall suicide rate remained unchanged in the above period. CONCLUSION: Suicide by burning charcoal is a new variant of domestic gas poisoning. A host of biopsychosocial and ethnological factors are responsible for the birth and indigenization of the method.