Risk of Suicide After Dementia Diagnosis

Abstract

ImportancePatients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.ObjectivesTo examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.Design, Setting, and ParticipantsThis was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.ExposuresPatients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.Main Outcomes and MeasuresOdds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.ResultsFrom the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia.Conclusions and RelevanceDiagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-2021

“…Research investigating ethnic differences in the risk of suicide has produced inconsistent results [21]. Few studies from the UK have examined differences in the risk of suicide by ethnicity, although recent research found that White and Mixed ethnic groups had a higher suicide risk than Asian and Black ethnic groups [22]. Our results support these findings with suicide rate being highest in the White group compared to other ethnicities.…”

Argyrophilic grain disease is common in older adults and may be a risk factor for suicide: a study of Japanese forensic autopsy cases

“…On the other hand, although it remains unclear why the overlapping AD-related tau pathology decreased the risk of suicide in the present study, we speculate that the ability to attempt suicide and/or complete suicide is diminished as cognitive impairment progresses owing to the deterioration of AD pathology. A recent clinical study reported that subjects younger than 65 years in the earlier stages of dementia had a 6.69-times (95% CI 1.49–30.12) higher suicide risk compared with subject without dementia [ 67 ]. Further investigations of neuropsychiatric symptoms, including those in the earlier stages of dementia, and their association with suicidal behavior in elderly subjects with autopsy-proven neurodegenerative disease are essential.…”

Young‐onset dementia diagnosis, management and care: a narrative review

“…People with YOD regularly report loss of identity and role changes, feelings of hopelessness and powerlessness, and social exclusion 54,55 . Recent research has found that people with YOD aged 45 to 64 years are 2.8 times more likely to die by suicide than people without dementia in the same age range 56 . Although this likely represents a small number of suicide deaths overall, the risk for death by suicide declines with time from diagnosis.…”