Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study

Erlangsen, Annette; Stenager, Elsebeth; Conwell, Yeates

doi:10.1007/s00127-015-1051-0

Cited by 146 publications

(162 citation statements)

References 56 publications

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“…Kim et al reported that more diverse factors contribute to suicidal thoughts in the elderly, such as educational level, history of depression, tobacco use, health status, diet and nutrition, and whether or not they have a surviving spouse 37 . Erlangsen et al reported that health problem, such as complex physical conditions, contribute to suicidal thoughts in the elderly, 38 while Chong & Jeong presented both financial crises and health status as factors influencing suicidal thoughts in the elderly 35 . Taken together, our findings suggest that it is worth noting how the effects of income on suicide risk vary across ages.…”

Section: Discussionmentioning

confidence: 99%

Suicide rates across income levels: Retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea

Lee

Jeon

et al. 2017

Journal of Epidemiology

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BackgroundThe relation of income and socioeconomic status with suicide rates remains unclear. Most previous studies have focused on the relationship between suicide rates and macroeconomic factors (e.g., economic growth rate). Therefore, we aimed to identify the relationship between individuals' socioeconomic position and suicide risk.MethodsWe analyzed suicide mortality rates across socioeconomic positions to identify potential trends using observational data on suicide mortality collected between January 2003 and December 2013 from 1,025,340 national health insurance enrollees. We followed the subjects for 123.5 months on average. Socioeconomic position was estimated using insurance premium levels. To examine the hazard ratios of suicide mortality in various socioeconomic positions, we used Cox proportional hazard models.ResultsWe found that the hazard ratios of suicide showed an increasing trend as socioeconomic position decreased. After adjusting for gender, age, geographic location, and disability level, Medicaid recipients had the highest suicide hazard ratio (2.28; 95% CI, 1.87–2.77). Among the Medicaid recipients, men had higher hazard ratios than women (2.79; 95% CI, 2.17–3.59 vs. 1.71; 95% CI, 1.25–2.34). Hazard ratios also varied across age groups. The highest hazard ratio was found in the 40–59-year-old group (3.19; 95% CI, 2.31–4.43), whereas the lowest ratio was found in those 60 years and older (1.44; 95% CI, 1.09–1.87).ConclusionsOur results illuminate the relationship between socioeconomic position and suicide rates and can be used to design and implement future policies on suicide prevention.

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Section: Discussionmentioning

confidence: 99%

Suicide rates across income levels: Retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea

Lee

Jeon

et al. 2017

Journal of Epidemiology

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“…As evidenced by psychological autopsy studies, depression is one of the strongest risk factors for elderly suicide (Beautrais, 2002; Conwell et al, 2002, 2011) while associations of other psychiatric disorders with suicide in older adults varied across samples and cultural backgrounds (Conwell et al, 2011). In addition, physical illnesses in old ages increased the risk for suicide (Juurlink et al, 2004; Conwell et al, 2010; Erlangsen et al, 2015). However, considering that late-life depression and physical illnesses are common risk factors for morbidity and mortality in this population (Schulz et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Resilience Protected against Suicidal Behavior for Men But Not Women in a Community Sample of Older Adults in Korea

You

Park

2017

Front. Psychol.

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Suicide prevention efforts in reducing risk factors have been found to be more beneficial to older women than men, suggesting potential gender differences in effective prevention. The study aimed to examine gender difference in resilience for suicidal behavior in a community sample of older adults in Korea. A community-based survey was conducted to investigate resilience and risk factors of suicidal behavior using the Suicidal Behaviors Questionnaire-Revised, Connor-Davidson Resilience Scale, Center for Epidemiologic Studies Depression Scale (CES-D), as well as questions regarding physical illness and depression history. After accounting for well-known risk factors, resilience was inversely associated with suicidal behavior, but this protective role of resilience was applicable to men only. The findings of this study indicated gender difference in resilience against suicidal behavior in the elderly population. Gender-specific preventive intervention strategies need to be developed for community-based suicide prevention for older adults.

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“…Nevertheless, the findings are striking enough that it is likely that there are true age‐related differences in screening practices between individuals able to answer. The low rate of positive self‐harm, SI, or SA in older adults is interesting, given high suicide rates in older adults and prior work demonstrating high risk of SI and SA after ED or hospital contact and in individuals with physical impairments or declining health (both common in older adults in the ED) . Thus, the current study findings suggest the need for improved provider awareness about risk of suicide in older adults (and the need to screen for it) and enhanced identification systems (e.g., possible adjustment of the screening questions used for older adults).…”

Section: Discussionmentioning

confidence: 74%

“…This suggests that at least some older men were responding to the screening questions, although it is unknown how many men at risk were missed. Older adults face different (and often more severe) social stressors than younger adults; particular stressors associated with suicide risk include social isolation, thwarted belongingness, perceived sense of being a burden on others (often related to physical impairments and need for assistance with activities of daily living), bereavement after loss of a spouse, multiple physical diseases, and declining health . Thus, use of additional or alternative screening tools—such as the Geriatric Suicide Ideation Scale, Geriatric Depression Scale, or Interpersonal Needs Questionnaire—may yield better results in older adults.…”

Section: Discussionmentioning

confidence: 99%

Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department

Betz

Arias

Segal

et al. 2016

J American Geriatrics Society

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Background/Objectives Depression, suicide ideation (SI) and suicide attempts (SA) are common among older adults, representing serious public health problems. Individuals with multiple comorbidities and frequent contact with hospital–based emergency departments (ED) may have elevated – but unrecognized – risk. To inform future interventions, we sought to estimate the prevalence of self-harm/SI/SA among older ED patients, including differences by age group, sex, and race/ethnicity. Design Quasi-experimental, multi-phase, 8-center study with prospective review of consecutive patient charts during enrollment shifts (November 2011–December 2014). Setting 8 EDs located in 7 states, all with protocols for nurses to screen every patient for suicide risk (“universal screening”). Participants Adult (≥18 years) registered ED patients. Measurements Patient demographics, documented screening for self-harm/SI/SA, positive self-harm/SI/SA among those with screening performed. Results Among a total of 142,534 patient visits, 23.3% were by patients aged ≥60 years. Documented screening for self-harm/SI/SA declined with age, from approximately 81% in younger age groups to a low of 68% among those aged ≥85 years. The prevalence of positive screens for self-harm/SI/SA also declined with age, with peaks among young and middle-aged adults (9.0%) and a nadir among patients aged ≥75 years (1.2%). Conclusion Documented screening for suicide risk declined with patient age in this large sample of ED patients. Although the explanation for this finding is unclear, we hypothesize that at least part of the decline is related to increasing rates of altered mentation or other patient-level barriers to screening in the older population. Our findings support the need for more detailed examination of the best methods for identifying – and treating – suicide risk among older adults.

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Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study

Abstract: Multiple physical diseases were linked to increased risks of suicide in older adults. Increased attention to suicidal ideation and risk assessment might be warranted during the diagnosis and treatment of these disorders.

Cited by 146 publications

References 56 publications

Suicide rates across income levels: Retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea

Suicide rates across income levels: Retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea

Resilience Protected against Suicidal Behavior for Men But Not Women in a Community Sample of Older Adults in Korea

Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department

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