Risk factors for suicide in later life

Conwell, Yeates; Duberstein, Paul R.; Caine, Eric D.

doi:10.1016/s0006-3223(02)01347-1

Cited by 620 publications

(519 citation statements)

References 58 publications

(69 reference statements)

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“…Other factors that increase the risk of suicide or suicide attempt in this group include impulsivity and aggression, social isolation, unemployment, divorce or other loss or conflict with other economic difficulties, physical illness, and having been subjected to physical or sexual abuse (Pirkola et al, 2004). In other words, the association between alcohol abuse and suicidal behaviour is compounded by other risk factors for suicide and attempted suicide (Beautrais 2000;Conwell, Duberstein et al 2002).…”

Section: Alcohol and Suicidal Behaviour At The Individual Levelmentioning

confidence: 99%

“…Alcohol use is a well-established risk factor for suicide and deliberate self-harm (Stack 2000;Conwell, Duberstein et al 2002;Evans, Hawton et al 2004;Yoshimasu, Kiyohara et al 2008;Darvishi, Farhadi et al 2015), two phenomena that account for a substantial proportion of premature deaths and loss of healthy life years (Bertolote and Fleischmann 2009;Rehm, Mathers et al 2009;Kerkhof 2012). …”

Section: Introductionmentioning

confidence: 99%

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Alcohol Consumption as a Risk Factor for Suicidal Behavior: A Systematic Review of Associations at the Individual and at the Population Level

Norstrøm¹,

Rossow

2016

Archives of Suicide Research

120

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Objectives: To provide an updated review of the magnitude of the relationship between alcohol use and suicidal behaviour at the individual and the population level. Methods: Systematic literature searches retrieved 14 reviews of individual level studies and 16 primary population level studies. Results: Alcohol abuse and alcohol intoxication are often present in suicidal behaviour; risk of suicide is elevated in alcohol abusers ; and increasing population drinking tends to be associated with increase in suicide rates. Estimated magnitude of the relationship differs for men and women and it varies at the population level across cultures with different drinking pattern. These variations probably reflect gender differences and cultural variation in drinking behaviour generally. Conclusion: Empirical evidence for a causal relationship is still urgently needed.

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Section: Alcohol and Suicidal Behaviour At The Individual Levelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Alcohol Consumption as a Risk Factor for Suicidal Behavior: A Systematic Review of Associations at the Individual and at the Population Level

Norstrøm¹,

Rossow

2016

Archives of Suicide Research

120

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“…6 Anxiety and depression may also severely impact quality of life 2,7 and are risk factors for suicidal behavior, 8 especially in the elderly. [9][10][11][12] Current standard pharmacologic treatments for depression in this population consist of the usual armamentarium of more than 24 antidepressants with at least 7 different mechanisms of action. 13 Many of these are also indicated for anxiety, as are other medications, all of which have significant associated risks.…”

Section: Introductionmentioning

confidence: 99%

Daily Oral Ketamine for the Treatment of Depression and Anxiety in Patients Receiving Hospice Care: A 28-Day Open-Label Proof-of-Concept Trial

Irwin

Iglewicz

Nelesen

et al. 2013

Journal of Palliative Medicine

140

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Background: Depression and anxiety are prevalent and undertreated in patients receiving hospice care. Standard antidepressants do not work rapidly or often enough to benefit most of these patients. Ketamine has many properties that make it an interesting candidate for rapidly treating depression and anxiety in patients receiving hospice care. To test this hypothesis, a 28-day, open-label, proof-of-concept trial of daily oral ketamine administration was conducted in order to evaluate the tolerability, potential efficacy, and time to potential efficacy in treating depression and anxiety in patients receiving hospice care. Methods:In this open-label study, 14 subjects with symptoms of depression or depression mixed with anxiety warranting psychopharmacological intervention received daily oral doses of ketamine hydrochloride (0.5 mg/ kg) over a 28-day period. The primary outcome measure was the Hospital Anxiety and Depression Scale (HADS), which was used to rate overall depression and anxiety symptoms at baseline, and on days 3, 7, 14, 21, and 28. Results: Over the 28-day trial there was significant improvement in both depressive symptoms (F 5,35 = 8.03, p = 0.002, g 2 = 0.534) and symptoms of anxiety (F 5,35 = 14.275, p < 0.001, g 2 = 0.67) for the eight subjects that completed the trial. One hundred percent of subjects completing the trial responded to ketamine for both anxiety and depression. A significant response in depressive symptoms occurred by day 14 for depression (mean D = 3.5, d = 1.14, 95% CI = 1.09-5.9, p = 0.01) and day 3 for anxiety (mean D = 2.4, d = 0.67, 95% CI = 1.0-3.7, p = 0.004). These improvements remained significant through day 28 for both depression (mean D = 4.0, d = 1.34, 95% CI = 2.3-5.9, p = 0.001) and anxiety (mean D = 6.09, d = 1.34, 95% CI = 3.6-8.6, p < 0.001). Side effects were rare, the most common being diarrhea, trouble sleeping, and trouble sitting still. Conclusions: Patients who received daily oral ketamine experienced a robust antidepressant and anxiolytic response with few adverse events. The response rate for depression is similar to those found with IV ketamine; however, the time to response is more protracted. The findings of the potential efficacy of oral ketamine for depression and the response of anxiety symptoms are novel. Further investigation with randomized, controlled clinical trials is necessary to firmly establish the efficacy and safety of oral ketamine for the treatment of depression and anxiety in patients receiving hospice care or other subject populations.

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“…The prevalence of major depression ranges from 6 to 9% of geriatric primary care patients, and is higher on medical in-patient services or in nursing homes (Katon and Schulberg, 1992). Depression is further associated with poorer outcomes of medical illnesses (Rovner et al, 1991;Frasure-Smith et al, 1993;Nemeroff et al, 1998;Jiang et al, 2001) and increased suicide rates (Conwell et al, 2002). Despite its associated morbidity and mortality, there are few published antidepressant placebo-controlled trials in the elderly.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

Taylor

Doraiswamy

2004

Neuropsychopharmacol

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Depression in the elderly is a major public health problem as untreated depression adversely impacts comorbid illnesses. It is important to develop safe and effective antidepressant therapies for older individuals. We performed a systematic review of all published randomized, placebo-controlled antidepressant medication trials in populations over age 55 years. Papers were obtained via MEDLINE (1966( -August 2003 and PSYCINFO (1872-August 2003. Unpublished trials, trials examining nonpharmacologic interventions, and papers reporting post hoc analyses were not included in this review unless they provided new insights. A total of 18 placebo-controlled trials examining acute efficacy met our criteria. The combined sample size in these studies was 2252. The mean sample size was 51 (range 20-728) and mean trial duration was 7 weeks. A total of 12 trials examined tricyclic antidepressants (TCAs), five trials examined selective serotonin reuptake inhibitors (SSRIs), two trials examined bupropion, and one trial examined mirtazapine. There were no published trials of venlafaxine or nefazodone. In all, 71.5% of trials reported significantly greater efficacy with drug than placebo. In conclusions, there is a paucity of published controlled antidepressant trials in the elderly. Most published studies examine small sample sizes and do not include common comorbid conditions. Efficacy studies examining relapse prevention are lacking. Large placebo response rates, lack of controlled head to head comparisons, and other methodological design differences make crosstrial comparisons difficult. Large simple studies are urgently needed to address the unmet needs for data on safety and efficacy of antidepressants in this population.

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Risk factors for suicide in later life

Cited by 620 publications

References 58 publications

Alcohol Consumption as a Risk Factor for Suicidal Behavior: A Systematic Review of Associations at the Individual and at the Population Level

Alcohol Consumption as a Risk Factor for Suicidal Behavior: A Systematic Review of Associations at the Individual and at the Population Level

Daily Oral Ketamine for the Treatment of Depression and Anxiety in Patients Receiving Hospice Care: A 28-Day Open-Label Proof-of-Concept Trial

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

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