Do suicide characteristics differ by age in older people?

Suicide Risk Factors among Polish Adults Aged 65 or Older in 2000-2018 Compared with Selected Countries Worldwide

The aim of this study was to determine the tendencies of change in suicide frequency among Polish adults aged 65 or older, recognize the importance of available socio-demographic data (age, sex, marital status, and education attainment level) and provide an in-depth psychological understanding of the obtained results. We analysed the influence of education and marital status on suicide risk in the Polish adult population aged 65 or older, which has not been previously presented in publications related to the Central Statistical Office or any other research. Our results indicated that male adults aged 65 or older that were single or divorced and with a lower education had a higher risk of death by suicide. In female adults aged 65 or older, those with higher education and who were divorced or married had a higher risk of fatal suicide behaviour meanwhile, single women and widows had a lower risk. The dominant method of suicide among Polish older adults was suicide by hanging, regardless of sex; female older adults were more likely to die by suicide by poisoning or jumping from a height, and male older adults were more likely to die by shooting with a firearm. Although data from recent years highlights a downward trend for suicide rates in Polish older adults, the problem cannot be considered solved.

Time Trends and Predictions of Suicide Mortality for People Aged 70 Years and Over From 1990 to 2030 Based on the Global Burden of Disease Study 2017

Background: High suicide rate in the elderly is an important global public health problem but has not received the attention it deserves. This study aimed to examine time trends of suicide mortality for people aged 70 years and over by sex, age, and location from 1990 to 2017, and to provide predictions up to 2030. Methods: Using data from the Global Burden of Disease study 2017, we presented elderly suicide mortality changes and compared the patterns for the elderly with that for all ages. We estimated associations between socio-demographic index (SDI) and suicide mortality rates using a restricted cubic spline smoother, and predicted suicide mortality rates up to 2030. Results: In 2017, 118,813 people aged 70 years and over died from suicide, indicating a mortality rate of 27.5 per 100,000, with the highest rates in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Sub-Saharan Africa, and for countries and territories, the highest were in South Korea, Zimbabwe, Lesotho, Mozambique, and Senegal. Between 1990 and 2017, suicide mortality rate for the elderly aged 70 years and over decreased globally (percentage change -29.1%), and the largest decreases occurred in East Asia, Southern Latin America, and Western Europe. Nationally, the largest decrease was found in Chile, followed by Czech Republic, Hungary, Turkey, and Philippines. For most countries, the elderly mortality rate was higher than the age-standardized rate, with the largest percentage differences in China and countries in Sub-Saharan Africa. The elderly suicide mortality rate decreased as SDI increased, except for a slight rebound at mid to high SDI. According to projections, 10 out of 195 countries were expected to meet the SDGs indicator of a third reduction by 2030. Conclusions: Variability in suicide mortality rates for the elderly aged 70 years and over by sex, age, region, country, and SDI can guide preventive policies, but causes of the variability need further study. Comprehensive strategies should be adopted to reduce suicide rates and close the gap to the 2030 SDGs.

Suicide in the elderly: approach to social determinants of health in the Dahlgren and Whitehead model

OBJECTIVE

Identify in literature the social determinants of health related to suicide in the elderly, according to the model proposed by Dahlgren and Whitehead.

METHOD

Integrative review of articles indexed in the databases BDENF, CINAHL, LILACS, and MEDLINE, with the following main descriptors: aged, suicide, social determinants of health, and risk factors. Primary studies were included which addressed social determinants of health and suicide in the elderly.

RESULTS

From the 19 articles analyzed, three categories emerged: proximal social determinants of health (male gender, mental disorders, physical illnesses, white race, 70-74 years old); intermediate social determinants of health (substance abuse, use of alcohol or psychotropic drugs, marital status, marital, social, and family problems, violence, previous suicide attempt, history of admission to psychiatric service); and distal social determinants of health (schooling, economic issues, sanitation, stressful events).

CONCLUSION

Proximal determinants have more effects on suicide. Intermediate determinants are composed mainly of changeable factors. Distal determinants showed lesser associations.

No country for older men: ageing male suicide in New Zealand

OBJECTIVE

Suicide rates increase in late life. There is, however, a gap in understanding suicide in the very old. We aimed to underscore the evidence for high rates of death by suicide in the oldest-old men (age 85+) in New Zealand and to provide a conjectural discussion about factors driving these rates.

METHOD

Provisional suicide data were obtained from the New Zealand Coronial Services website for the period 2011-2019. Yearly suicide rates for those aged 85+ were plotted over time. Mean suicide rates were calculated for three youth and young adult male cohorts, identified by the Coroner as having very high rates, and compared with the 85+ age cohort.

RESULTS

Between 2011 and 2019, rates of death by suicide of older males remained consistently high never overlapping female suicide rates. Mean suicide deaths/100,000 population for all four age cohorts were comparable; 15-19 years: 23.5; 20-24 years: 29.0; 25-29 years: 27.0; 85+ years: 27.9.

CONCLUSIONS

Deaths by suicide are very high for older males. In addition to established risk factors, psychosocial adversity as reflected by loneliness, poverty and shift to residential care may be major reasons for the high suicide rates. Research to inform about this vulnerable population and prevention are urgently needed.

Characteristics, causality, and suicidal behavior: a qualitative study of family members with suicide history in Wonogiri, Indonesia

Objective

This study explored the characteristics, causality, and suicidal behavior among family members with suicide history in Wonogiri, Central Java, Indonesia.

Methods

Qualitative semistructured interviews were conducted with 15 family members who had made suicide attempts. The interviews directly explored the relationships among characteristics, causality, and suicidal behavior. The research data were analyzed using the Miles and Huberman approach.

Results

The results indicate that there are relationships among characteristics, causality, and suicidal behaviors. The characteristics contributing to suicide attempts were male gender, age (adolescence and old age), lack of religious activities, introvert nature, low economic status, chronic diseases, unemployment, and a history of family members with suicide attempts. The causality of suicide was joblessness, economic crisis, unemployment, family conditions, personality disorder, depression, sickness, and suicide ideation.

Conclusions

The findings highlight the relationships among characteristics, causality, and suicidal behaviors. Suicide occurs when individuals have some problems that they cannot solve because of the lack of family support. The causal factors were related to one another, which caused the suicidal behavior. One of the most effective suicide prevention strategies is educating the community on how to identify suicidal signs and increase social supports.

Personality of late- and early-onset elderly suicide attempters

OBJECTIVES

While suicidal behavior often manifests in adolescence and early adulthood, some people first attempt suicide in late life, often with remarkable lethal intent and determination. Given these individuals' more adaptive functioning earlier in life, they may possess traits that hinder adjustment to aging, such as high conscientiousness, rather than impulsive-aggressive traits associated with suicidal behavior in younger adults.

METHODS

A cross-sectional case-control study was conducted in older adults aged ≥50 (mean: 65), divided into early- and late-onset attempters (age at first attempt ≤ or >50, mean: 31 vs 61), suicide ideators as well as non-suicidal depressed and healthy controls. Personality was assessed in terms of the five-factor model (FFM, n = 200) and five DSM personality disorders analyzed on the trait level as continuous scores (PDs, n = 160). Given our starting hypothesis about late-onset attempters, the FFM dimension conscientiousness was further tested on the subcomponent level.

RESULTS

All clinical groups displayed more maladaptive profiles than healthy subjects. Compared to depressed controls, higher neuroticism, and borderline traits characterized both suicide ideators and early-onset attempters, while only early-onset attempters further displayed lower extraversion and higher antisocial traits. Late-onset attempters were similar to depressed controls on most measures, but scored higher than them on orderliness, a conscientiousness subcomponent.

CONCLUSIONS

While neuroticism, introversion, and cluster B traits are prominent in early-onset suicidal behavior, late-onset cases generally lack these features. In contrast, higher levels of orderliness in late-onset suicidal behavior are compatible with the age-selective maladjustment hypothesis. Key points Personality of elderly attempters differed between those with early- and late-onset first attempts. Early-onset attempters possessed personality traits generally found in younger suicidal populations (high neuroticism, low extraversion, antisocial, and borderline PD traits), supporting that constitutional suicide risk factors persist into late life in some individuals. Late-onset suicide attempters had higher levels of orderliness than non-suicidal depressed participants, suggesting that this generally adaptive trait may facilitate suicidal behavior in a subset of depressed elderly.