Suicide in late life

Sammanfattning: Background: Elderly persons have the highest suicide rates in most industrialized countries. A number of antecedents to suicide late in life have been identified, but the risk associated with these factors is unclear because controlled studies are lacking.Aim: To study the risk for suicide associated with mental and physical illness and social factors in persons 65 years and above. Physician's ability to detect suicidality and the utilization of antidepressants was also studied. Finally, a possible association between the availability of psychoactive drugs and the use of these drugs as a means of suicide was examined.Subjects and Methods: 85 elderly suicide cases (46 men, 39 women) were studied with the "psychological autopsy" method. Papers I-III: Control persons (84 men, 69 women) randomly selected from the tax register were interviewed face-to-face. Past month mental disorders were diagnosed according to DSM-IV. Illness burden was assessed according to the Cumulative Illness Rating Scale - Geriatrics. Life events during the past 24 months were assessed. Paper IV: Suicidal feelings were rated according to Paykel et al. Paper V: Post-mortem analysis of drugs was carried out in 73 of the first 75 consecutive suicides. Paper VI utilizes data from the National Prescription Survey and the Cause of Death Register, Statistics Sweden. Results: Recurrent major depression was a very strong risk factor for suicide, as was substance abuse. Minor depression, dysthymia, single episode major depression and psychotic disorders were also associated with suicide. Neurological disorders, vision impairment and malignant disease were associated with an increased risk of suicide. Serious physical illness, and high overall physical illness burden were risk factors for suicide in men. Family discord, financial problems and feelings of loneliness were psychosocial factors associated with suicide. More than one third of the elderly persons who committed suicide had communicated suicidal feelings to their doctors during this time period. Half of all the study cases were treated for affective illness during their final 6 months of life. In most cases the postmortem blood concentrations of antidepressants were within the normal range. Rates of suicide by drug poisoning decreased in all age groups between the years 1969 and 1996. The reduction was however less pronounced in the elderly. Suicide using benzodiazepines increased among the elderly during most of the study period despite decreasing prescription sales.Conclusions: Recurrent major depression was the mental disorder most strongly associated with suicide. A relatively high rate of antidepressant treatment was observed among the elderly suicides, which probably reflects changing prescription patterns. Many of the suicide decedents had not only depression but also other mental and physical illnesses and interpersonal problems that may have complicated treatment.