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Trends in suicide rates of the elderly in Austria, 1970-2004: an analysis of changes in terms of age groups, suicide methods and gender
- Authors:
- KAPUSTA Netsor D., ETZERSDORFER Elmar, SONNECK Germot
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(5), May 2007, pp.438-444.
- Publisher:
- Wiley
Suicides of the elderly (persons aged 65 and older) make up a large proportion of total suicides. Since suicide rates of the elderly are highest in western populations, addressing them as a risk group in prevention plans has been recommended. In order to assess possible approaches to prevention strategies, this study examines high-risk groups of the elderly. The authors examined official statistics on suicides that occurred in Austria between 1970-2004 (18,101 Suicides of the elderly). The authors analyzed time trends and differences in suicide methods as well as in age groups and both genders of the elderly. Three major high-risk groups were identified: elderly male suicides by firearms; elderly female suicides by poisoning, which occur more often with increasing age; and suicides of both genders by jumping from heights. Besides conducting treatment of psychiatric disorders of the elderly, restricting the means to commit suicide may help to prevent it among the elderly. Such specific prevention strategies should be implemented in national suicide prevention plans for the high-risk groups identified in this study.
Comparison of suicide in people aged 65-74 and 75+ by gender in England and Wales and the major Western countries 1979-1999
- Authors:
- PRICHARD Colin, HANSEN Lars
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.17-25.
- Publisher:
- Wiley
The factors most strongly associated with suicide are age and gender - more men than women, and, more people over 65 kill themselves. As a number of Governments have targets to reduce suicide levels we compare elderly suicide rates over a 20-year period in England and Wales. And the major Western countries focusing upon age and gender. Male GSPR: 65-74 suicide ratios fell significantly in six countries and in three for the 75+. Female GSPR: 65-74 suicide ratios fell in every country except Spain. Proportionately, there were more suicides in the over 65s in countries with an extended family tradition, Spain, Italy, Germany, France and Japan, than in the five secular countries. England and Wales male 65-74 suicide fell significantly more than Canada, France, Germany, Italy, Japan, Spain, Netherlands and the USA, and did significantly better than the other countries for all female senior citizen suicides. Suicide of the over-65s has improved in seven countries, especially in England and Wales, who had the greatest proportional reduction, which reflects well upon the psycho-geriatric and community services. However, in all countries, male 65-74 rates did not match the female out so extra efforts are needed to improve male rates.
Is there a relationship between elderly suicide rates and smoking? A cross-national study
- Author:
- SHAH Ajit
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.308-312.
- Publisher:
- Wiley
An independent relationship between smoking cigarettes and completed suicides has been reported in several cohort and case-control studies of younger subjects, but this relationship has rarely been examined in the elderly. The relationship between the prevalence of smoking in males and females and suicide rates in males and females in the age-bands 65-74 years and 75 + years was examined using national-level aggregate data from the World Health Organisation and the United Nations Development Programme websites. In addition to univariate analysis, multivariate analysis were conducted to ascertain an independent relationship between the prevalence of smoking and elderly suicide rates. The main findings were: (i) on univariate analysis, the prevalence of smoking in males was positively correlated with suicide rates in males aged 65-74 years and males aged 75 + years, but this relationship was absent in females and (ii) on multivariate analysis there was no independent relationship between the prevalence of smoking in males and suicide rates in males in both the elderly age-bands. There is a case for examination of the relationship between smoking and elderly suicides in individual-level cohort or case-control studies because of the potential methodological difficulties in cross-national studies using national- level aggregate data, paucity of cohort or case-control studies at an individual-level in the elderly, and the observation of an independent relationship between smoking and completed suicides in individual-level cohort and case-control studies in younger age groups.
Suicides in Hong Kong, Taiwan and Beijing
- Author:
- YIP Paul S.F.
- Journal article citation:
- British Journal of Psychiatry, 169, October 1996, pp.495-550.
- Publisher:
- Cambridge University Press
Examines the differences and similarities of suicide in Hong Kong, Beijing and Taiwan, the populations of which are all ethnically Chinese and share some characteristics of culture but which have very different social and political environments. Results found that despite the remarkable economic growth in all three places during the study period, the differences in suicide trends suggest that the social and political environments may be more important than the economic environment in suicide.
Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study
- Authors:
- MURPHY Elizabeth, et al
- Journal article citation:
- British Journal of Psychiatry, 200(5), May 2012, pp.399-404.
- Publisher:
- Cambridge University Press
Self harm is an important risk factor for suicide, and the risk is said to increase markedly with age. The aim of this study was to calculate self-harm rates, risk factors for repetition and rates of suicide following self-harm in adults aged 60 years and over. A large prospective, population-based study was conducted among patients presenting with self harm to six general hospitals in three cities in England between 2000 and 2007. In total 1177 older adults presented with self-harm and 12.8% repeated self-harm within 12 months. The median age was 68 years and 56% of the cohort was female. Independent risk factors for repetition were previous self-harm, previous psychiatric treatment and age 60–74 years. Following self-harm, 1.5% died by suicide within 12 months. The risk of suicide was 67 times that of older adults in the general population. Men aged 75 years and above had the highest suicide rates. It is concluded that older adults presenting to hospital with self-harm are a high-risk group for subsequent suicide, particularly older men.
Trends in suicide by drowning in the elderly in England and Wales 1979-2001
- Author:
- SALIB Emad
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.175-181.
- Publisher:
- Wiley
Suicide by drowning increases with age but its rates vary between countries and among communities. Drowning suicide rates in some of the available studies may have been over reported or under reported because of misclassification. This study presents data on the time trends, age/sex mortality rates from death by drowning in the elderly in England and Wales between 1979 and 2001. All coroners' verdicts in death by drowning; suicide, deaths undetermined whether accidentally or purposely inflicted were examined. Counts of suicide due to drowning and submersion [ICD 9 codes; E954] and undetermined injury deaths [E984] (WHO, 1977), reported in England and Wales between 1979 and 2001 were obtained from National Statistics (ONS). There has been a gradual reduction in suicide by drowning in men and women by more than a third the observed count in 1979 (p < 0.01). However, this decline was less evident in the elderly particularly those over the age of 75. Elderly drownings appear to attract more verdicts of suicide compared to younger age groups (Odds Ratio 4.3 95% CI 2.3-8.3). Women, particularly elderly, are more likely to have a suicide verdict returned in drowning compared to men (Odds Ratio 1.5 95% CI 1.1-1.6). The high rate of open verdicts in elderly drowning over the study period and compared to any other method of fatal self harm in England and Wales confirms the difficulties in reaching a firm conclusion in drowning death. Therefore combining suicide and all undetermined deaths in drowning as a matter of course, in nationally collected statistics, may result in grossly exaggerated rates and misleading trends in suicidal drowning. Suicide by drowning is probably not amenable to prevention and although the elderly are often thought to benefit more from suicide prevention than younger adults, the study findings seem to suggest that this is not likely to be the case in drowning.
Outcomes of community-based screening for depression and suicide prevention among Japanese elders
- Authors:
- OYAMA Hirofumi, et al
- Journal article citation:
- Gerontologist, 46(6), December 2006, pp.821-826.
- Publisher:
- Oxford University Press
This study evaluates outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older. The study used a quasi-experimental design with intervention and referent municipalities. The program included a 7-year implementation of depression screening with follow-up by general practitioners and a 10-year implementation of public education conducted in Yasuzuka (population 4,940; elderly suicide rate for women, 275/100,000; for men, 323/100,000). Changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR) were estimated. The results found risk for women in the intervention area was reduced by 64%, whereas there was no significant change in the risk for men in the intervention area and either men or women in the referent municipalities. A ratio of the IRR for women aged 65 to 74 in the intervention area to that in its prefecture was estimated at 0.23, showing that the risk reduction was greater than the secular trend. It is concluded that the management of depression by use of community resources involving public health and primary care physicians is effective in the prevention of suicide for elderly women but uncertain for men.
Gender in elderly suicide: analysis of coroners inquests of 200 cases of elderly suicide in Cheshire 1989-2001
- Authors:
- SALIB Emad, GREEN Laura
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1082-1087.
- Publisher:
- Wiley
The aim of this study is to review gender differences in elderly suicide in relation to specific social aspects of the suicidal process and health care contact before death. Such information may have practical value in identifying and targeting vulnerable elderly in whom suicide may be potentially preventable. Data were extracted from the records of coroner's inquests into all reported suicide of persons aged 60 and over, in Cheshire over a period of 13 years 1989-2001. The Coroner's office covers the whole county of Cheshire (population 1 000 000). Men were less likely to have been known to psychiatric services (Odds Ratio [OR] 0.4 95% 0.2-0.6) and with less frequently reported history of previous attempted suicide compared to women (OR 0.5 95% Confidence Intervals [CI] 0.2-1). All deceased from ethnic minorities were men, none of whom had been known to psychiatric services. There was no significant difference between women and men in relation to, physical or psychiatric morbidity, GP contact prior to suicide, intimation of intent or living alone. Of suicide victims not known to services a surprisingly high proportion of 38% and 16% were found to have psychiatric morbidity in men and women respectively.
Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy
- Authors:
- DE LEO Diego, BUONO Marirosa Dello, DWYER Jonathan
- Journal article citation:
- British Journal of Psychiatry, 181, September 2002, pp.226-229.
- Publisher:
- Cambridge University Press
This study examines the long-term effects of a telephone helpline and emergency response service on suicide in an elderly population of northern Italy. The service provided twice-weekly support and needs assessment telephone calls and a 24 hour emergency alarm service. Data from 1988 to 1998 allowed comparison of service users with a comparable general population group of the Veneto region in Italy. Results found significantly fewer suicides among elderly service users than expected despite an assumed overrepresentation of persons at increased risk. The service worked particularly well for older women.
High-risk management guidelines for elderly suicidal patients in primary care settings
- Authors:
- BROWN Gregory K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(6), June 2001, pp.593-601.
- Publisher:
- Wiley
Older adults, especially older white men, are more likely to commit suicide than other age-groups. The assessment and management of suicide ideation and behaviour for the elderly is especially relevant for primary care physicians because many patients visit their physician shortly before committing suicide. In 1993, the Agency for Health Care Policy and Research (AHCPR) in the United States released clinical practice guidelines for the treatment of depression in primary care settings. The AHCPR guidelines offered some assistance with respect to detecting and treating patients who are suicidal. However, these guidelines lacked detailed and specific instructions for managing high-risk patients within the context of intervention research. The current set of guidelines builds upon this previous work by describing (1) a general approach for interacting with suicidal patients; (2) structured assessments for determining the degree of risk for suicide; (3) crisis intervention strategies; and (4) ongoing management procedures for working with suicidal patients in primary care settings.