Advertisement

Suicidal Behaviour in Older Adults

  • Diego De LeoEmail author
  • Urska Arnautovska
Chapter

Abstract

Suicide rates among older adults are the highest in nearly every part of the world. Also in late life, suicide is a multifactorial problem with several interrelated factors that vary with age, gender and culture. Depression is one of the main risk factors for suicide in older adults; however, cultural variations do exist that change the hierarchy of importance of risk factors. In the oldest olds, men appear to be more vulnerable than women to adverse life circumstances. Thus, suicide prevention in older adults should pay particular attention to the many socio-environmental conditions that may be relevant in this age, especially social isolation, loneliness, financial insecurity and physical illnesses. Early detection and treatment of affective disorders are key interventions to reduce the risk of suicide in this late part of life. Ageistic perspectives are still very present also among health professionals and should be counteracted with great determination. Promoting a culture of adaptation to the changes imposed by the advancing of age should form the essential part of a process central to suicide prevention.

Keywords

Suicide Suicidal behaviour Older adults Risk factors Protective factors Treatment of suicidality 

Notes

Acknowledgments

Thanks are due to colleagues that have helped in growing our interest towards the theme of suicide in old age, particularly Prof José’ Bertolote, Dr. Karolina Krysinska and Prof Brian Draper.

References

  1. 1.
    Bertolote J, De Leo D. Global suicide mortality rates – a light at the end of the tunnel? Crisis. 2012;33:249–53.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    WHO. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014.Google Scholar
  3. 3.
    Shah A, Zarate-Escudero S, Bhat R, De Leo D, Erlangsen A. Suicide in centenarians: the international landscape. Int Psychogeriatr. 2014;26:1703–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    De Leo D, Scocco P. Treatment and prevention of suicidal behaviour in the elderly. In: Hawton K, van Heeringen K, editors. The international handbook of suicide and attempted suicide. Chichester: Wiley; 2000. p. 555–−570.CrossRefGoogle Scholar
  5. 5.
    De Leo D, Padoani W, Scocco P, et al. Attempted and completed suicide in older subjects: results from the WHO/EURO multicentre study of suicidal behaviour. Int J Geriatr Psychiatry. 2001;16:300–10.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    McIntosh JL, Santos JF, Hubbard RW, et al. Elderly suicide research, theory and treatment. Washington, DC: American Psychological Association; 1994.CrossRefGoogle Scholar
  7. 7.
    Shaffer D, Jacobson C. Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. Arlington: American Psychiatric Association; 2009. Retrieved from http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20DSM-5%20NSSI%20Proposal.pdf.Google Scholar
  8. 8.
    Shah A, Bhat R, Mac Kenzie S, et al. Elderly suicide rates: cross/national comparison of trends over a 10-year period. Int Psychogeriatr. 2008;20:673–86.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Karch D. Sex differences in suicide incident characteristics and circumstances among older adults: surveillance data from the National Violent Death Reporting System – 17 US states, 2007-2009. Int J Environ Res Public Health. 2011;8:3479–96.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kolves K, Potts B, De Leo D. Ten year of suicide mortality in Australia: socio-economic and psychiatric factors in Queensland. J Forensic Legal Med. 2015;36:136–43.CrossRefGoogle Scholar
  11. 11.
    Schriivers DL, Bollen J, Sabbe BG. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord. 2012;138:19–26.CrossRefGoogle Scholar
  12. 12.
    De Leo D, Cerin E, Spathonis K, Burgis S. Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour. J Affect Disord. 2005;86:215–25.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    De Leo D. Can we rely on suicide mortality data? Crisis. 2015;36:1–3.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Williams RF, Doessel DP, Sveticic J, De Leo D. Accuracy of official suicide mortality data in Queensland. Aust N Z J Psychiatry. 2010;44:815–22.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    De Leo D, Arnautovska U. Prevention and treatment of suicidality in older adults. In: O’Connor R, Pirkis J, editors. International handbook of suicide prevention. Research, policy and practice. Chichester: Wiley-Blackwell; 2016.Google Scholar
  16. 16.
    Rabheru K. Special issues in the management of depression in older patients. Can J Psychiatr. 2004;49:41–50.Google Scholar
  17. 17.
    De Leo D, Diekstra RFW. Depression and suicide in late life. Goettingen: Hogrefe & Huber; 1990.Google Scholar
  18. 18.
    Maj M. When does depression become a mental disorder? Br J Psychiatry. 2011;199:85–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Shah A, Buckley L. The current status of methods used by the elderly for suicides in England and Wales. J Inj Violence Res. 2011;3:68–73.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Chia B-H, Chia A, Ng W-Y, Tai B-C. Suicide methods in Singapore (2000–2004): type and associations. Suicide Life Threat Behav. 2011;41:574–83.CrossRefPubMedGoogle Scholar
  21. 21.
    Dombrovski AY, Szanto K, Duberstein P, Conner KR, Houck PR, Conwell Y. Sex differences in correlates of suicide attempt lethality in late life. Am J Geriatr Psychiatr. 2008;16:905–13.CrossRefGoogle Scholar
  22. 22.
    De Leo D, Draper B, Krysinska K. Suicidal elderly people in clinical and community settings. In: Wasserman D, Wasserman C, editors. Oxford textbook of suicidology and suicide prevention. New York: Oxford University Press; 2009. p. 703–19.Google Scholar
  23. 23.
    Conwell Y, Thomson C. Suicidal behaviour in elders. Psychiatr Clin North Am. 2008;31:333–56.CrossRefPubMedGoogle Scholar
  24. 24.
    Shah AK, De T. Suicide and the elderly. Int J Psychiatry Clin Pract. 1998;2:3–17.CrossRefPubMedGoogle Scholar
  25. 25.
    Conwell Y. Suicide later in life. Challenges and priorities for prevention. Am J Prev Med. 2014;47:S244–50.CrossRefPubMedGoogle Scholar
  26. 26.
    Blazer DG. Depression in late life: review and commentary. J Gerontol Series A. 2003;58:249–65.CrossRefGoogle Scholar
  27. 27.
    Reynolds CF III, Kupfer DJ. Depression and aging: a look to the future. Psychiatr Serv. 1999;50:1167–72.CrossRefPubMedGoogle Scholar
  28. 28.
    De Leo D, Draper B, Snowdon J, Kolves K. Suicides in older adults: a case-control psychological autopsy study in Australia. J Psychiatr Res. 2013;47:980–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Montano CB. Primary care issues related to the treatment of depression in elderly patients. J Clin Psychiatry. 1999;60:45–51.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Diefenbach GJ, Woolley SB, Goethe JV. The association between self-reported anxiety-symptoms and suicidality. J Nerv Ment Dis. 2009;197:92–9.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fawcett J. Severe anxiety and agitation as treatment modifiable risk factors for suicide. In: Wasserman D, Wasserman C, editors. Oxford textbook of suicidology and suicide prevention. New York: Oxford University Press; 2009. p. 407–11.Google Scholar
  32. 32.
    De Leo D. Suicide in a general hospital: the case of the elderly. Crisis. 1997;18:5–7.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Krysinska K, Heller TS, De Leo D. Suicide and deliberate self-harm in personality disorders. Curr Opin Psychiatry. 2006;18:95–101.CrossRefGoogle Scholar
  34. 34.
    Kolves K, Varnik A, Tooding LM, et al. The role of alcohol in suicide: a case-control psychological autopsy study. Psychol Med. 2006;36:923–30.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Harwood D, Jacoby R. Suicidal behaviour among the elderly. In: Hawton K, van Heeringen K, editors. The international handbook of suicide and attempted suicide. Chichester: Wiley; 2000. p. 275–−292.CrossRefGoogle Scholar
  36. 36.
    Neulinger K, De Leo D. Suicide in elderly and youth population: how do they differ? In: De Leo D, editor. Suicide and euthanasia in older adults. Göttingen: Hogrefe & Huber Publishers; 2001. p. 137–54.Google Scholar
  37. 37.
    Draper B, Kõlves K, De Leo D, Snowdon J. A controlled study of suicide in middle-aged and older people: personality traits, age, and psychiatric disorders. Suicide Life Threat Behav. 2014;44:130–8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Schneider B, Maurer K, Frolich L. Dementia and suicide. Fortschr Neurol Psychiatr. 2001;69:164–73.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Haw C, Harwood D, Hawton K. Dementia and suicidal behaviour: a review of the literature. Int Psychogeriatr. 2009;21:440–53.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Capurso A, Capurso C, Solfrizzi V, et al. Depression in old age: a diagnostic and therapeutic challenge. Recenti Prog Med. 2007;98:43–52.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Erlangsen A, Jeune B, Bille-Brahe U, Vaupel J. Loss of a partner and suicide risk among oldest old: a population-based register study. Age Ageing. 2004;33:378–83.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Turvey CL, Conwell Y, Jones MP, et al. Risk factors for late-life suicide: a prospective, community-based study. Am J Geriatr Psychiatr. 2002;10:398–407.CrossRefGoogle Scholar
  43. 43.
    Rubenowitz E, Waern M, Wilhelmson K, et al. Life events and psychosocial factors in elderly suicides – a case-control study. Psychol Med. 2001;31:1193–202.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    De Leo D, Padoani W, Lonnqvist J, et al. Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study. J Affect Disord. 2002;72:291–5.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    De Leo D, Cimitan A, Dyregrov K, Grad O, Andriessen K. Bereavement after traumatic death: helping the survivors. Göttingen: Hogrefe; 2013.Google Scholar
  46. 46.
    Navarro C, Ayala L, Labeaga JM. Housing deprivation and health status: evidence from Spain. Empir Econ. 2010;38:555–82.CrossRefGoogle Scholar
  47. 47.
    Burrows S, Laflamme L. Living circumstances of suicide mortality in a south African City: an ecological study of differences across race groups and sexes. Suicide Life Threat Behav. 2005;35:592–603.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Law CK, Kolves K, De Leo D. Influences of population-level factors on suicides in older adults: a national ecological study from Australia. Int J Geriatr Psychiatry. 2016;31:384–91.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Baum F. The new public health. 3rd ed. Melbourne: Oxford University Press; 2008.Google Scholar
  50. 50.
    Loebel JP, Loebel JS, Dager SR, et al. Anticipation of nursing home placement may be a precipitant of suicide among the elderly. J Am Geriatr Soc. 1991;91:407–15.CrossRefGoogle Scholar
  51. 51.
    Torresani S, Toffol E, Scocco P, Fanolla A. Suicide in elderly South Tyroleans in various residential settings at the time of death: a psychological autopsy study. Psychogeriatrics. 2014;14:101–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    O’Dwyer S, De Leo D. Older adults and suicide. In: Wasserman D, editor. Suicide: an unnecessary death. 2nd ed. Cambridge: Cambridge University Press; 2016. p. 215–27.Google Scholar
  53. 53.
    Bell CC, McBride DF. Commentary: homicide-suicide in older adults—cultural and contextual perspectives. J Am Acad Psychiatry Law. 2010;38:312–7.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Malphurs JE, Cohen D. A statewide case-control study of spousal homicide-suicide in older persons. Am J Geriatr Psychiatr. 2005;13:211–7.Google Scholar
  55. 55.
    Bourget D, Gagne P, Whitehurst L. Domestic homicide and homicide-suicide: the older offender. J Am Acad Psychiatry Law. 2010;38:305–11.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Salari S. Patterns of intimate partner homicide suicide in later life: strategies for prevention. Clin Interv Aging. 2007;2:441–52.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Conwell Y, Duberstein PR, Cox C, et al. Risk factors for suicide in later life. Biol Psychiatry. 2002;52:193–204.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    De Leo D, Hickey P, Meneghel G, et al. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999;40:339–44.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Waern M, Rubenowitz E, Runeson B, et al. Burden of illness and suicide in elderly people: case-control study. Br Med J. 2002;324:1355.CrossRefGoogle Scholar
  60. 60.
    Karvonen K, Hakko H, Koponen H, Meyer-Rochow VB, Rasanen P. Suicides among older persons in Finland and time since hospitalization discharge. Psychiatr Serv. 2009;60:390–3.CrossRefPubMedGoogle Scholar
  61. 61.
    Erlangsen A, Vach W, Jeune B. The effect of hospitalization with medical illnesses on the suicide risk in the oldest old: a population-based register study. J Am Geriatr Soc. 2005;53:771–6.CrossRefPubMedGoogle Scholar
  62. 62.
    Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Medical illness and the risk of suicide in the elderly. Arch Intern Med. 2004;164:1179–84.CrossRefPubMedGoogle Scholar
  63. 63.
    Voaklander DC, Rowe BH, Dryden DM, Pahal J, Saar P, Kelly KD. Medical illness, medication use and suicide in seniors: a population-based case-control study. J Epidemiol Community Health. 2008;62:138–46.CrossRefPubMedGoogle Scholar
  64. 64.
    Conwell Y, Duberstein PR, Hirsch JK, et al. Health status and suicide in the second half of life. Int J Geriatr Psychiatry. 2009;6:147–8.Google Scholar
  65. 65.
    Kaplan MS, McFarland BH, Huguet N, et al. Physical illness, functional limitations, and suicide risk: a population-based study. Am J Orthopsychiatry. 2007;77:56–60.CrossRefPubMedGoogle Scholar
  66. 66.
    Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:369–89.CrossRefGoogle Scholar
  67. 67.
    Durkheim E. Suicide: a study in sociology. Illinois: Free Press; 1951. (First published in 1897).Google Scholar
  68. 68.
    De Leo D. Struggling against suicide. Crisis. 2002;23:23–31.CrossRefPubMedGoogle Scholar
  69. 69.
    Harwood DMJ, Hawton K, Hope T, et al. Suicide in older people: mode of death, demographic factors, and medical contact before death. Int J Geriatr Psychiatry. 2000;15:736–43.CrossRefPubMedGoogle Scholar
  70. 70.
    De Leo D. Cultural issues in suicide and old age. Crisis. 1999;20:53–5.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Fleischmann A, De Leo D. The World Health Organization’s report on suicide: a fundamental step in worldwide suicide prevention. Crisis. 2014;35:289–91.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    De Leo D, Draper BM, Snowdon J, et al. Contacts with health professionals before suicide: missed opportunities for prevention? Compr Psychiatry. 2013;54:1117–23.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Uncapher H, Arean PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc. 2000;48:188–92.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Conwell Y, Duberstein PR, Cox C, et al. Age differences in behaviours leading to completed suicide. Am J Geriatr Psychiatr. 1998;6:122–6.CrossRefGoogle Scholar
  75. 75.
    Dombrovski AY, Szanto K. Prevention of suicide in the elderly. Ann Long-Term Care. 2005;13:52–32.Google Scholar
  76. 76.
    Waern M, Beskow J, Runeson B, et al. Suicidal feelings in the last year of life in elderly people who commit suicide. Br Med J. 1999;354:917–8.Google Scholar
  77. 77.
    Hawton K, Harriss L. Deliberate self-harm in people aged 60 and over: characteristics and outcome of a 20-year cohort. Int J Geriatr Psychiatry. 2006;21:572–81.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Bertolote J, Fleischmann A. A global perspective on the magnitude of suicide mortality. In: Wasserman D, Wasserman C, editors. Oxford textbook of suicidology and suicide prevention. New York: Oxford University press; 2009. p. 91–8.Google Scholar
  79. 79.
    Hawton K, Harriss L. The changing gender ratio in occurrence of deliberate self-harm across the lifecycle. Crisis. 2008;29:4–10.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Accortt EE, Freeman MP, Allen JJ. Women and major depressive disorder: clinical perspectives on causal pathways. J Women’s Health. 2008;17:1583–90.CrossRefGoogle Scholar
  81. 81.
    Canetto SS. Elderly women and suicidal behavior. In: Canetto SS, Lester D, editors. Women and suicidal behaviour. New York: Springer; 1995.Google Scholar
  82. 82.
    Cochran SV, Rabinowitz FE. Gender-sensitive recommendations for assessment and treatment of depression in men. Prof Psychol. 2003;2:132–40.CrossRefGoogle Scholar
  83. 83.
    Galdas PM, Cheater F, Marshall P. Men and help-seeking behaviour: literature review. J Adv Nurs. 2005;49:616–23.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Vörös V, Osváth P, Fekete S. Gender differences in suicidal behaviour. Neuropsychopharmacol Hung. 2004;6:65–71.PubMedPubMedCentralGoogle Scholar
  85. 85.
    Bruce ML, Ten Have TR, Reynolds CF III, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. J Am Med Assoc. 2004;291:1081–91.CrossRefGoogle Scholar
  86. 86.
    Unützer J, Tang L, Oishi S, et al. Reducing suicidal ideation in depressed older primary care patients. Am Geriatr Soc. 2006;54:1550–6.CrossRefGoogle Scholar
  87. 87.
    Lapierre S, Erlangsen A, Waern M, et al. A systematic review of elderly suicide prevention programs. Crisis. 2011;32:88–98.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Erlangsen A, Nordentoft M, Conwell Y, et al. Key considerations for preventing suicide in older adults. Crisis. 2011;32:106–9.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Oyama H, Watanabe N, Ono Y, et al. Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry Clin Neurosci. 2005;59:337–44.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. J Am Med Assoc. 2005;294:2064–−2074.CrossRefGoogle Scholar
  91. 91.
    De Leo D, Carollo G, Dello Buono M. Lower suicide rates associated with a Tele-help/Tele-check service for the elderly at home. Am J Psychiatr. 1995;152:632–4.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    De Leo D, Dello Buono M, Dwyer J. Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. Br J Psychiatry. 2002;181:226–9.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Florio ER, Hendryx M, Jensen JE, et al. A comparison of suicidal and nonsuicidal elders referred to a community mental health program. Suicide Life Threat Behav. 1997;27:182–93.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Krause N. Church-based social support and mortality. J Gerontol. 2006;61B:140–6.CrossRefGoogle Scholar
  95. 95.
    Draper, B. & Low, L. (2004). What is the effectiveness of old-age mental health services? Retrieved March 24, 2015, from WHO Regional Office for Europe Web site: http://www.euro.who.int/document/E83685.pdf.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Australian Institute for Suicide Research and Prevention, Griffith UniversityMount GravattAustralia
  2. 2.Slovene Centre for Suicide ResearchUniversity of PrimorskaKoperSlovenia
  3. 3.School of Applied Psychology and Mental Health Institute Queensland, Griffith UniversityMount GravattAustralia

Personalised recommendations