According to information in the article, suicide is the 11th leading cause of death in the United States and is especially common among the elderly. Elderly people in many countries kill themselves at a rate higher than any other segment of the population. Medical illnesses may predispose to suicide, but few studies have examined the association between suicide and specific illnesses, the article states.
David N. Juurlink, M.D., Ph.D., of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, and colleagues examined the relationship between treatment for several illnesses and the risk of suicide in elderly patients.
The researchers examined the prescription records of all Ontario residents 66 years and older who committed suicide between January 1, 1992 and December 31, 2000. For each resident who committed suicide, the researchers also looked at the prescription records of four living controls matched for age, sex, residential area, and income to determine the presence or absence of 17 illnesses potentially related to suicide.
Among the 1,329 elderly persons who committed suicide (1,012 men; 317 women), the most common methods involved firearms (28 percent), hanging (24 percent), and self-poisoning (21 percent). Depression, bipolar disorder (manic-depressive illness) and severe pain were associated with the largest increases in suicide risk. However, several other chronic illnesses including seizure disorder, congestive heart failure, and chronic lung disease, were also associated with an increased risk for suicide.
The researchers also found that treatment for multiple illnesses was strongly related to an increased risk of suicide, and that most of the patients who committed suicide visited a physician in the month before death, about half of them during the preceding week.
"Our findings have important implications for prevention because most elderly patients who commit suicide visit a physician shortly beforehand, and many of them have clinically recognizable features of depression at the time," the authors write. "Physicians, nurses, and other health care professionals should be alert to the possible threat of suicide in elderly patients with chronic illness, particularly in patients with multiple illnesses, symptoms of depression, or other risk factors for suicide."
(Arch Intern Med. 2004;164:1179-1184. Available post-embargo at archinternmed.com)
Editor's Note: This research was supported by a grant from the Ontario Mental Health Foundation. Dr. Juurlink was supported by a New Investigator Award from the Canadian Institutes of Health Research and the Clinician-Scientist Program of the Department of Medicine, University of Toronto. Dr. Redelmeier was supported by a Career Scientist Award from the Ontario Ministry of Health and a Canada Research Chair in Medical Decision Sciences.
Editorial: Preventing Suicide in Elderly Patients
Eve K. Moscicki, Sc.D., M.P.H., of the National Institute of Mental Health, Bethesda, Md., and Eric D. Caine, M.D., of Rochester, N.Y., write, "While suicide may seem to many to be a quintessentially individual problem resulting from intensely personal decisions to end one's life, empirical evidence over the past two decades has shifted this view toward one of suicide as a broader, population-based phenomenon with discernible common patterns that can be used to help define generalized risk and protective factors."
They write that "Juurlink et al find that the likelihood of suicide or nonfatal suicidal behaviors increases with an increasing number of risk factors as well as with specific medical conditions such as depression or severe pain. The findings from this epidemiologic work can now form the basis for a different type of study to examine the mechanisms by which depression and general medical disorders may interact."
The editorialists state that the findings by Juurlink et al point in three different directions for future research: describing the mechanisms that protect individuals with medical disorders, depression and pain who do not kill themselves; understanding how those who killed themselves appeared in their physician's offices and what a physician should look for; and finally, developing preventive and therapeutic interventions to help those identified as at increased risk for suicide.
(Arch Intern Med. 2004;164:1171-1172. Available post-embargo at archinternmed.com)
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .
To contact David Juurlink, M.D., Ph.D., call Julie Argles at 416-480-4780. To contact editorialist Eve K. Moscicki, Sc.D., M.P.H., call the National Institute of Mental Health Press Office at 301-443-4536.
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Archives of Internal Medicine