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Suicide risk of old adults with special reference to aging

Published online by Cambridge University Press:  18 December 2017

Tomoyuki Kawada Open the ORCID record for Tomoyuki Kawada [Opens in a new window]
Tomoyuki Kawada*
Affiliation:
Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
*
Correspondence should be addressed to: Tomoyuki Kawada, Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan. Phone: +81-3-3822-2131, Fax: +81-3-5685-3065. Email: kawada@nms.ac.jp.
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Extract

Koo et al. (2017) compared differences in sociodemographic variables, recent life events, and mental and physical illnesses between three age groups (65–74 years, 75–84 years, and 85 years and over) who died by suicide. Psychiatric problems, suicidal behavior, legal and financial stressors, and relationship problems decreased with age. In contrast, physical conditions and bereavement increased with age. Suicide rates were increasing with age for males, but not for females. In addition, significant differences in the prevalence of potential risk factors within the three different age groups existed. I have some concerns about their study.

Type
Letter to the Editor
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 603
Copyright
Copyright © International Psychogeriatric Association 2017 

Koo et al. (Reference Koo, Kõlves and De Leo2017) compared differences in sociodemographic variables, recent life events, and mental and physical illnesses between three age groups (65–74 years, 75–84 years, and 85 years and over) who died by suicide. Psychiatric problems, suicidal behavior, legal and financial stressors, and relationship problems decreased with age. In contrast, physical conditions and bereavement increased with age. Suicide rates were increasing with age for males, but not for females. In addition, significant differences in the prevalence of potential risk factors within the three different age groups existed. I have some concerns about their study.

First, Yeh et al. (Reference Yeh, Ng and Wu2017) conducted a conditional logistic regression analysis to specify risk factors of suicide in the older people. They classified subjects into the same categories of age with those by Koo et al., and crude suicide mortality rates in the young-old, middle-old, and oldest old were 30.57, 35.88, and 43.46 per 100,000 people. In addition, crude suicide mortality rates in male and female were 46.52 and 22.32 per 100,000 people. They adopted propensity score matching for a one-to-one ratio on gender, age, and residence between suicide people and control. Statistical methods of two reports differ, and risk assessment on suicide in older adults should be conducted by setting appropriate controls and by multivariate analysis, although I accept the need of aging effect in older adults.

Second, Diehl-Schmid et al. (Reference Diehl-Schmid2017) summarized risk factors of suicidal intention and behavior in dementia, and patient's cognitive impairment profile, behavioral disturbances, social isolation, and psychiatric comorbidities, such as depression, should be evaluated for predicting suicide intention. There are some different factors in relation to suicide intention, attempt, and completion (Joo et al., Reference Joo2016; Simon et al., Reference Simon2016). In addition, there is a difficulty of identifying risk factors for suicide in patients with dementia. Further study is needed to know factors in older adults, who died by suicide, with stratifying by age.

Conflicts of interest

Not applicable.

References

Diehl-Schmid, J. et al. (2017). Suicide and assisted dying in dementia: what we know and what we need to know. A narrative literature review. International Psychogeriatrics, 29, 1247–1259. doi: 10.1017/S1041610217000679.CrossRefGoogle Scholar
Joo, S. H. et al. (2016). Factors associated with suicide completion: a comparison between suicide attempters and completers. Asia-Pacific Psychiatry, 8, 80–86. doi: 10.1111/appy.12216.Google Scholar
Koo, Y. W., Kõlves, K. and De Leo, D. (2017). Suicide in older adults: differences between the young-old, middle-old, and oldest old. International Psychogeriatrics, 29, 1297–1306. doi: 10.1017/S1041610217000618.Google Scholar
Simon, G. E. et al. (2016). Risk of suicide attempt and suicide death following completion of the patient health questionnaire depression module in community practice. The Journal of Clinical Psychiatry, 77, 221–227. doi: 10.4088/JCP.15m09776.CrossRefGoogle ScholarPubMed
Yeh, S. T., Ng, Y. Y. and Wu, S. C. (2017). Risk of suicide according to the level of psychiatric contact in the older people: analysis of national health insurance databases in Taiwan. Comprehensive Psychiatry, 74, 189–195. doi: 10.1016/j.comppsych.2017.01.016.Google Scholar