Suicidal behavior in late life: population and patient perspectives

Abstract

Older adults have high rates of suicide, and the strong role of depression is often emphasized in studies on suicidal behaviour in this age group. The literature regarding other factors is rather sparse. This thesis utilizes data from three population-based studies and one clinical study with the aim of increasing knowledge about factors associated with suicidal behavior in late life. Study I is based on data from EURODEP, a multicenter study involving 15,890 adults (9,429 women, 6461 men) aged 64-104 years. In Study II, all 97-year-olds living in Gothenburg were invited to take part and 269 (197 women, 72 men) without dementia participated. The Prospective Population Study on Women, initiated in 1968, provided data for study III; 800 middle-aged women were examined in 1968 and followed over a 42-year period. In Study IV a hospital cohort of 80 individuals (42 women, 38 men) aged 70-91 were interviewed after a suicide attempt. Findings from study I showed that both intermediate and high functional disability was associated with death wishes in both sexes. Results remained after adding depressive symptoms to the model. Among the 97-year-olds in study II, 11.5 % reported suicidal feelings in accordance with the Paykel questions and the majority (77.4 %) of these fulfilled criteria for neither major nor minor depression. Sleep problems and deficient social contacts were associated with suicidal feelings; relationships were independent of depression. One fourth of the women who participated in study III had experienced suicidal thoughts at some point during their life and 8 % had made at least one suicide attempt. Onset of suicidal behavior occurred after age 40 in half the women. Women who reported five or more early childhood adversities were significantly younger when they had their first-episode of suicidal thoughts. In study IV a strong association between major depression and low Sense of Coherence (SOC) was observed. Low SOC was associated with deficient social contacts and having moved in the past five years, and these relationships remained also after adjustment for depression. While early detection and treatment of depression is imperative, interventions to reduce suicidal behavior in later life may also need to target functional disability, pain and sleep problems, and limited social networks.