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Suicide in patients suffering from late-life anxiety disorders; a comparison with younger patients

Published online by Cambridge University Press:  11 February 2015

R. C. Oude Voshaar ,
D. C. van der Veen ,
N. Kapur ,
I. Hunt ,
A. Williams  and
N. A. Pachana
R. C. Oude Voshaar*
Affiliation:
Department of Psychiatry and Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
D. C. van der Veen
Affiliation:
Department of Psychiatry and Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
N. Kapur
Affiliation:
Centre for Suicide Prevention, University of Manchester, Manchester, UK
I. Hunt
Affiliation:
Centre for Suicide Prevention, University of Manchester, Manchester, UK
A. Williams
Affiliation:
Centre for Suicide Prevention, University of Manchester, Manchester, UK
N. A. Pachana
Affiliation:
School of Psychology, The University of Queensland, Brisbane, Australia
*
Correspondence should be addressed to: Richard C. Oude Voshaar, University Medical Center Groningen, Department of Psychiatry (CC44), Post office box 30.001, 9700 RB Groningen, the Netherlands. Phone: +31-50-3612367. Email: r.c.oude.voshaar@umcg.nl.
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Abstract

Background:

Anxiety disorders are assumed to increase suicide risk, although confounding by comorbid psychiatric disorders may be one explanation. This study describes the characteristics of older patients with an anxiety disorder who died by suicide in comparison to younger patients.

Method:

A 15-year national clinical survey of all suicides in the UK (n = 25,128). Among the 4,481 older patients who died by suicide (≥ 60 years), 209 (4.7%) suffered from a primary anxiety disorder, and 533 (11.9%) from a comorbid anxiety disorder. Characteristics of older (n = 209) and younger (n = 773) patients with a primary anxiety disorder were compared by logistic regression adjusted for sex and living arrangement.

Results:

Compared to younger patients, older patients with a primary anxiety disorder were more often males and more often lived alone. Although 60% of older patients had a history of psychiatric admissions and 50% of deliberate self-harm, a history of self-harm, violence, and substance misuse was significantly less frequent compared to younger patients, whereas physical health problems and comorbid depressive illness were more common. Older patients were prescribed significantly more psychotropic drugs and received less psychotherapy compared to younger patients.

Conclusion:

Anxiety disorders are involved in one of every six older patients who died by suicide. Characteristics among patients who died by suicide show severe psychopathology, with a more prominent role for physical decline and social isolation compared to their younger counterparts. Moreover, treatment was less optimal in the elderly, suggesting ageism. These results shed light on the phenomenon of suicide in late-life anxiety disorder and suggest areas where prevention efforts might be focused.

Keywords

anxiety disordersagedaged80 years and overelderlysuicide
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 7: Late Life Anxiety , July 2015 , pp. 1197 - 1205
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Allgulander, C. (1994). Suicide and mortality in anxious neurosis and depressive neurosis. Archives of General Psychiatry, 51, 708–712.CrossRefGoogle ScholarPubMed
Allgulander, C. and Lavori, P. W. (1993). Causes of death among 936 elderly patients with “pure” anxiety neurosis in Stockholm county, Sweden, and in patients with depressive neurosis or both diagnoses. Comprehensive Psychiatry, 5, 299–302.CrossRefGoogle Scholar
Appleby, L. et al. (1999). Suicide within 12 months of contact with mental health services: national clinical survey. BMJ, 318, 1235–1239.CrossRefGoogle ScholarPubMed
Appleby, L., Shaw, J., Sherrat, J., Amos, T., Robinson, J. and McDonnell, R. (2001). Safety first: Five-year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London 2001: Department of Health.Google Scholar
Beekman, A. F. T. et al. (1998). Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Benyamini, Y., Leventhal, H. and Leventhal, E. A. (2004). Self-rated oral health as an independent predictor of self-rated general health, self-esteem and life satisfaction. Social Science & Medicine, 59, 1109–1116.CrossRefGoogle ScholarPubMed
Bolton, J. M., Cox, B. J., Afifi, T. O., Enns, M. W., Bienvenu, O. J. and Sareen, J. (2008). Anxiety disorders and the risk for suicide attempts: findings from the Baltimore epidemiologic catchment are follow-up study. Depression and Anxiety, 25, 477–481.CrossRefGoogle ScholarPubMed
Chiu, H. F. K. et al. (2004). Elderly suicide in Hong Kong – a case-controlled psychological autopsy study. Acta Psychiatrica Scandinavica, 109, 299–305.CrossRefGoogle Scholar
Conwell, Y., Duberstein, P. R., Cox, C., Herrmann, J. H., Forbes, N. T. and Caine, E. D. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. American Journal of Psychiatry, 153, 1001–1008.Google ScholarPubMed
Fässberg, M. M. et al. (2012). A systematic review of social factors and suicidal behavior in older adulthood. The International Journal of Environmental Research and Public Health, 9, 722–745.CrossRefGoogle ScholarPubMed
Grenier, S. et al. (2011). The impact of DSM-IV symptom and clinical significance criteria on the prevalence estimates of subthreshold and threshold anxiety in the older adult population. American Journal of Geriatric Psychiatry, 19, 316–326.CrossRefGoogle ScholarPubMed
Hawton, K. and Van Heeringen, K. (2009). Suicide. Lancet, 373, 1372–1381.CrossRefGoogle ScholarPubMed
Hunt, I. M. et al. (2006). Suicides within 12 months of contact with mental health services in different age and diagnostic groups: a national clinical survey. British Journal of Psychiatry, 188, 135–142.CrossRefGoogle ScholarPubMed
Kanwar, A. et al. (2013). The association between anxiety disorders and suicidal behaviors: a systematic review and meta-analysis. Depression and Anxiety, 30, 917–929.Google ScholarPubMed
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merinkangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602.CrossRefGoogle ScholarPubMed
Lindsley, K. R., Schapira, K. and Kelly, T. P. (2001). Open verdict v. suicide – Importance to research. British Journal of Psychiatry, 178, 465–468.CrossRefGoogle Scholar
Meehan, J. et al. (2006). Suicide in mental health in-patients and within 3 months of discharge: national clinical survey. British Journal of Psychiatry, 188, 129–134.CrossRefGoogle ScholarPubMed
Nepon, J., Belik, S. L., Bolton, J. and Sareen, J. (2010). The relationship between anxiety disorders and suicide attempts: findings from the national epidemiologic survey on alcohol and related conditions. Depression and Anxiety, 27, 791–798.CrossRefGoogle ScholarPubMed
Nock, M. K. et al. (2009). Cross-national analysis of the associations among mental disorders and suicidal behaviour: findings from the WHO World Mental Health Surveys. PLoS Medicine, 6, e1000123.CrossRefGoogle ScholarPubMed
Orbach, I., Stein, D., Shani-Sela, M. and Har-Even, D. (2001). Body attitudes and body experiences in suicidal adolescents. Suicide and Life-Threatening Behavior, 31, 237–249.CrossRefGoogle ScholarPubMed
Oude Voshaar, R. C. (2013). Lack of interventions for anxiety disorders in later life. British Journal of Psychiatry, 203, 8–9.CrossRefGoogle Scholar
Sareen, J., Houlohan, T., Cox, B. J. and Asmundson, G. J. G. (2005). Anxiety disorders associated with suicidal ideation and suicide attempts in the national comorbidity survey. The Journal of Nervous and Mental Disease, 193, 450–454.CrossRefGoogle ScholarPubMed
Spinewine, A. et al. (2007). Appropriate prescribing in elderly people: how well can it be measured and optimised?. The Lancet, 370, 173–184.CrossRefGoogle ScholarPubMed
Tamam, L., Bican, M. and Keskin, N. (2014). Impulse control disorders in elderly patients. Comprehensive Psychiatry, 55, 1022–1028.CrossRefGoogle ScholarPubMed
Thibodeau, M. A., Welch, P. G., Sareen, J. and Asmundson, G. J. G. (2013). Anxiety disorders are independently associated with suicide ideation and attempts: propensity score matching in two epidemiological samples. Depression and Anxiety, 30, 947–954.CrossRefGoogle ScholarPubMed
Waern, M., Rubenowitz, E., Runeson, B., Skoog, I., Wilhelmson, K. and Allebeck, P. (2002). Burden of illness and suicide in elderly people: case-control study. BMJ, 324, 1355.CrossRefGoogle ScholarPubMed
Waern, M. et al. (2002). Mental disorders in elderly suicides: a case-control study. American Journal of Psychiatry, 159, 450–455.CrossRefGoogle ScholarPubMed
Wiktorsson, S., Runeson, B., Skoog, I., Ostling, S. and Waern, M. (2010). Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group. American Journal of Geriatric Psychiatry, 18, 57–67.CrossRefGoogle Scholar
Windfuhr, K. and Kapur, N. (2011). Suicide and mental illness: a clinical review of 15 years findings from the UK national confidential inquiry into suicide. British Medical Bulletin, 100, 101–121.CrossRefGoogle ScholarPubMed
World Health Organization (2015). Available at: http://www.who.int/classifications/icd/en; last accessed 24 February 2015.Google Scholar