Suicidal ideation and the 'wish to die' in dementia patients: the role of depression

Abstract

Objc~ctive: to determine the prevalence of self-reported suicidal ideation and the 'wish to die' in dementia patients, their association with depressive symptoms and the type of dementia. Design: the cohort was formed retrospectively of consecutive referrals between 1985 and 1994 of cognitively impaired patients who met American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, third edition and third edition, revised, criteria for dementia. They were assessed for depression using the 21-item Hamilton Rating Scale for Depression (HRSD) which includes an item on suicide. Settiing: an outpatient multidisciplinary memory disorders clinic in Sydney, Australia. Pati,ents: the sample comprised 221 patients with dementia: 148 with Alzheimer's disease according to NINCDS-ADRDA criteria, 24 with vascular dementia diagnosed by a Hachinski ischaemia scale score of seven or more, plus focal neurological signs, symptoms or computed tomography-visible lesions, and 49 with other dementias. Measures: cognitive impairment was measured by the Mini-Mental State Examination and the Blessed orientationinformation -memory -concentration test and dementia scales, depression by the 21-item HRSD, suicidal ideation and the 'wish to die' as defined by the suicide item on the HRSD, functional capacity by the activities of daily living scale and the instrumental activities of daily living scale. Caregiver psychological morbidity was assessed with the General Health Questionnaire. Results: 12 patients (5.4%) felt life was not worth living, seven (3.2%) 'wished to die' or had thoughts of death, two (0.9%) had suicidal ideation or gestures and none had made any suicide attempts. The nine patients who 'wished to die' or had suicidal ideation scored 12 or more on the HRSD. Of these, six were clinically depressed. Suicidal ideation and the 'wish to die' were significantly correlated with the presence of depressive symptoms as measured by the HRSD (suicide item excluded), but only in those with Alzheimer's disease. There were no significant differences in HRSD scores between the dementia groups. Suicidal ideation was unrelated to the presence of insight into loss of memory. Conclusions: suicidal ideation and/or the 'wish to die' is self-reported in 4% of dementia patients attending a memory disorders clinic and is associated with comorbid depressive symptoms, particularly in Alzheimer's disease.

The link between depressive symptoms, negative cognitive bias and memory complaints in older adults

“…Consistent with previous research, depressive symptoms and negative cognitive bias were strongly correlated in older adults (Alford et al, 1995;Andrews & Brown, 1995;Beevers & Miller, 2004;Draper et al, 1998;Forsell et al, 1997;Jorm et al, 1995;Jungwirth et al, 2004;La Rue et al, 1996;Pearman & Storandt, 2004;Scocco et al, 2001). Extensive research has found strong associations between depressive symptoms and hopelessness (Alford et al, 1995;Beevers & Miller, 2004), death thoughts (Draper et al, 1998;Forsell et al, 1997;Jorm et al, 1995;Scocco et al, 2001) and low self-esteem (Andrews & Brown, 1995;Brown et al, 1986;) both individually and as part of Beck's negative cognitive triad.…”

“…Extensive research has found strong associations between depressive symptoms and hopelessness (Alford et al, 1995;Beevers & Miller, 2004), death thoughts (Draper et al, 1998;Forsell et al, 1997;Jorm et al, 1995;Scocco et al, 2001) and low self-esteem (Andrews & Brown, 1995;Brown et al, 1986;) both individually and as part of Beck's negative cognitive triad. Hopelessness is intimately linked to late-life depressive symptoms (Adams, Matto, & Sanders, 2004).…”

“…Previous research has found depressive symptoms to be associated with self-perceived memory loss (La Rue et al, 1996), hopelessness (Alford, Lester, Patel, Buchanan, & Giunta, 1995;Beevers & Miller, 2004), death thoughts (Draper, MacCuspie-Moore, & Brodaty, 1998;Forsell, Jorm, & Winblad, 1997;Jorm et al, 1995;Scocco, Meneghel, Caon, Dello Buono, & De Leo, 2001) and low self-esteem (Andrews & Brown, 1995;Brown, Andrews, Harris, Adler, & Bridge, 1986;Brown, Bifulco, & Andrews, 1990a;Brown, Bifulco, Veiel, & Andrews, 1990b). Beck's theory of depression described depressed persons as having distorted negative perceptions of themselves, their world and their future (Beck, Rush, Shaw, & Emery, 1979;Blackburn & Eunson, 1989).…”

Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

“…24,26,27 Nevertheless, suicidal behavior in demented persons might entirely be explained by the presence of depressive disorders. 6,18 It yet remains to be confirmed whether depressive disorders act as a mediator for suicide in persons with dementia. As in the general population, chronic and other somatic diseases are expected to be associated with an elevated risk of suicide among demented persons.…”

“…12,18 Specific types of dementia, such as Huntington and Alzheimer diseases, are mentioned by case reports as potential predictors for suicidal behavior. 7,9,[18][19][20] Furthermore, early stages of dementia, 6,10,20 intact awareness of disease and its course, 6,[8][9][10]21 and accessibility to means 6,8 might increase the risk of suicide.Comorbid mental disorders, particularly mood disorders, are frequently listed as contributing to suicide in dementia patients. 6,9,10,19,22 Having dementia is found to increase the probability of developing depression, 23,24 Although depressive symptoms are found to predict cognitive decline, 25 there are diverging results on whether depression increases the probability of developing dementia.…”