Suicide in Old Age

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Suicide in Old AgeMargda Wrn, Professor/Senior psychiatrist

Neuropsychiatric Epidemiology Research Unit

And the AE!AP !enter

Uni"ersity of othen#urg, S$eden


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Declaration of interest

Sahlgrens%a Suicide Studies are funded

#y the S$edish Research !ouncil and&'R(E)

!onflict of interest* None


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Controlled psychological autopsy

studies focusing on older adults

Waern M. Suicidologi 2011


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High suicide rates in old age


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Accelerating rates

in the Asian PacificSouth oreaMen +-

../.00 000Women +-

12/.00 000

Cheong et al. ! Pre" Med Pu# Health2012


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$reatly ele"ated ris% of suicide

follo&ing an atte'ptProspecti"e, population3#ased self3harm cohort 4+0-5 from 6 generalhospitals $as follo$ed for 2 yrs)

Ris% of death #y suicide $as +2times that of the population)

Murphy et al. (rit ! Psych 2012


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History of atte'pted suicide

7ndisputa#le ris% factor in old age suicide)

8o$e"er, proportions "ary $idely in differentsettings 4936: 3 19:5

Ris% estimates "ary

'R; 10 4!hui et al)5

'R; .+ 4


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Death ideation in )*+year+olds

7n a population3#ased sample 4n;615, a latent classanalysis re"ealed distinct groups) 7ndi"iduals $ithrecent death ideation also reported either*

.5 high le"els of depression and an=iety or

95 more distant histories of serious suicidal ideation)

>oth .5 and 95 may signal ele"ated ris% for suicide)

,an Orden et al. A' ! $er Psych 201-


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Depression

?epression $as theonly factor associated$ith suicide in A@@ ofthe psychological

autopsy studies)+32: of elderlysuicides suffer fromdepression)


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Age and diagnosesAge and diagnoses

in mental health service usersin mental health service users

who die by suicidewho die by suicide

Hunt IM et al. Br J Psychiatry, 2006: 188:135-142


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Aniety disorders

(he late3life literature is sparse)

An=iety disorder $as associated $ithincreased ris% in the S$edish study)

Waern et al) Am Psych 9009


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Aniety and suicidality at se"enty

7n a S$edish population3#ased study 4n; +05,an=iety symptom #urden $as associated $ithincreased ris% of suicidal feelings)

(he association $as independent of depression)

onson et al), 7nt Psychogeriatrics 90.9


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Do antidepressants increase suicide ris%in older adults/

Antidepressants do not increasesuicide ris% in older adults 4Belly etal 9006, 8all et al 90065,and there isclinical e"idence that they reduceris% of suicidal #eha"ior in thisage group 4>ara% et al 900+5)


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Attitudes to antidepressant treat'entone year after suicide atte'pt at age0 n3405

>enefits of #eing on an

antidepressant out$eigheddisad"antages)

6es7n et al8 9nt Psychogeriatrics 201*


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Attitudes toantidepressant treat'ent age 05

7 sometimes $orry a#out #ecoming

addicted to antidepressants)C Strongly agree/agree* 6.:

6es7n et al8 9nt Psychogeriatrics8 201*


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Can treat'ent &ith sedati"es increasesuicide ris% in the elderly/

A large cohort study from !anadasho$ed increased ris% associated$ith #enDodiaDepines

(he authors pointed out that this could#e due to confounding #y indication)

,oa%lander et al.8 2004


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6ate life suicid ris% associated

&ith sedati"es:hypnoticsOROR 95% C.I.95% C.I. OROR 95% C.I.95% C.I.

DayDay

sedativessedatives14.114.1 (5.6-35.6)(5.6-35.6) 11.811.8 aa (4.6-30.6)(4.6-30.6)

HypnotisHypnotis 10.810.8 (5.4-!1.5)(5.4-!1.5) 4.!4.! "" (1.6-10.9)(1.6-10.9)

Adjusted for diagnosis of amood or anxiety disorder, bany Axis Idisorder Carlsten ; Waern8 (MC $eriatrics 200o Runeson

Suicide in Old Age

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