Should research focus specifically on elderly suicide rates in cross-national ecological studies designed to identify distil risk factors?

Suicide rates increase with aging in many countries. In a recent study of 62 developed and developing countries, suicide rates increased with age for males and females in 25 and 27 countries respectively, and in both sexes in 17 countries (Shah, 2007). Suicide rates increased with age in 47 of the 49 medium- and high-income countries (Keimo, 2004). Comprehensive understanding of the substantial worldwide variation in population patterns of suicide may be critical for developing prevention programs (Knox et al., 2004). Much is known about individual level proximal risk factors and preventative strategies can be targeted at identified high risk groups (Shah and De, 1998). Also, proximal risk factors for elderly suicide victims are generally different from those for younger suicide victims (Shah and De, 1998). However, distil risk factors may be similar for elderly and younger suicide victims. Such distil risk factors include societal socioeconomic status (Kennedy et al., 1999; Shah et al., 2008), societal income inequality (Kowalski et al., 1987; Shah et al., 2008), education (Kowalski et al., 1987; Agbayewa et al., 1998), degree of urbanization (Stack, 1993), degree of social integration (Durkheim, 1992) and provision of health and mental health service provision (Shah and Bhat, 2008). In general, preventative measures targeting distil risk factors require development of public health strategies at a societal level. Should research focus specifically on elderly suicide rates in cross-national ecological studies designed to identify distil risk factors?

Data on general population suicide rates for males and females and elderly suicide rates for males and females in the age-bands 65–74 years and 75+ years was ascertained from the World Health Organization (WHO) website (http://www.who.int/whois/database/mort/table1.cfm). Data on the elderly (65+ years) population size and the total population size were ascertained from the same website. This allowed calculation of the proportion of elderly in the total population. Full data sets were available for 67 countries. Partial correlation coefficients were calculated for the relationship between general population suicide rates and elderly suicide rates by controlling for the proportion of elderly in the general population. Male general population suicide rates were correlated with elderly suicide rates in males aged 65–74 years (r = +0.86, p < 0.00001) and males aged 75+ years (r = +0.61, p < 0.00001). Female general population suicide rates were correlated with elderly suicide rates in females aged 65–74 years (r = +0.78, p < 0.00001) and females aged 75+ years (r = +0.79, p < 0.00001).

The highly significant and strong correlation between general population suicide rates and elderly suicide rates may support an argument in favor of focusing efforts for identifying distil risk factors on general population suicide rates. There are several reasons for this. First, the distil risk factors listed above are similar for general population suicide rates and elderly suicide rates. Second, preventative measures targeting distil risk factors require development of public health strategies at a societal level and should be similar for both groups. Third, if there is a differential focus on the development of different public health preventative strategies for elderly and general population suicides then there is a real risk that the elderly will be marginalized and not be able to compete for scarce funding. This is supported by evidence that special mental health programs for the elderly generally occur in countries that have well developed mental health services for the general population (Shah, 2008). Thus, focusing on general population suicide rates and public health preventative strategies for the entire population may be more likely to be beneficial to the elderly. We would like to challenge an alternative view.