Suicidality and depression in older adults: Prevalence, predictors, and outcomes

Abstract

Older adults have the highest risk of suicide of all age groups. Depression is a major risk factor for suicide in late life, but is also associated with lower quality of life, somatic disorders, and premature death. The aim of the thesis was to deepen the understanding of suicidality and depression in the oldest segment of the population. In Paper I we showed that there was a substantial decrease in suicidal ideation in 85-year-olds between 1986 and 2008, but no change between 2008 and 2015. Suicidal ideation in these cohorts was associated with depressive symptoms, feelings of loneliness and residing in a long-term care facility. In Paper II we found that there was a decrease in depression in 85-year-olds, from 1986 to 2008, and further (in minor but not major depression) from 2008 to 2015. Changes in known risk factors for depression did not explain the decrease. Proportions using antidepressant medication more than doubled from 1986 to 2008 but remained stable from 2008 to 2015. In Paper III we found that a wish to die was associated with all-cause mortality more strongly than both life-weariness and active suicidal ideation. The association remained after adjusting for both somatic and mental disorders and psychosocial factors. In Paper IV we mapped healthcare contacts of older adults (75+) who self-harmed. During the year before self-harm, most contacts were in primary care. There was a sharp increase in contacts with specialized care, and an increase in antidepressant prescriptions, in the months after self-harm. Psychotherapy was rare both before and after self-harm. The conclusion of this thesis is that there has been a positive development for the oldest age group in Sweden during the past decades regarding depression and suicidality. However, there are still areas with potential for improvement.