A multidimensional risk factor model for suicide attempts in later life

Abstract

Background

Elderly suicide is a public health problem worldwide, and the risk factors are multidimensional. Chronic mental health problems, personality traits, stressful life events, comorbid medical conditions, social isolation, unemployment, and poverty are associated with higher risk for suicide in later life. There was a relative paucity of data on the neurobiological markers of elderly suicide.

Objective

This study examines the conjoint roles of cerebrovascular risk factors (CVRFs) and other established biopsychosocial risk factors in older adults who had made a recent suicide attempt.

Design

A cross-sectional, case-controlled study.

Setting

A tertiary care setting in a public sector and a community setting.

Subjects and methods

Cases (N=77) were nondemented Chinese adults aged ≥65 years, enrolled in a regional psychogeriatric service following a suicide attempt; comparison subjects (N=99) were community-dwelling nondemented older adults with no lifetime history of suicide. Measures of sociodemographic profile, life events, suicidal behavior, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I psychopathology, personality traits, functional status, physical health, CVRFs, and executive cognitive functions were administered.

Results

Weighted sum of CVRF score was significantly higher in older women who had made a recent suicide attempt (mean: 10.56; standard deviation [SD]: 5.46) than comparison subjects (mean: 7.24; SD: 4.04) (t=3.52, P=0.001; df=99). Logistic regression showed that CVRF score (Exp[B]: 1.289, P=0.033), DSM-IV depressive disorders (current) (Exp[B]: 348, P<0.001), number of life events in the past 12 weeks (Exp[B]: 10.4; P<0.001), and being married (Exp[B]: 12.2, P<0.048) significantly increased odds for suicide attempt status in older women (Nagelkerke R²: 0.844). Association of CVRF score and suicide attempt status was not observed in older men for whom number of life events in the past 12 weeks (Exp[B]: 9.164; P<0.001), higher neuroticism (Exp[B]: 1.028; P=0.048), and impaired performance on a Modified Card Sorting Test (Exp[B]: 0.646; P=0.032) significantly increased odds for suicide attempt status in a logistic regression model (Nagelkerke R²: 0.611).

Conclusion

Risk factors for cerebrovascular diseases may be associated with higher risk for attempted suicide in older women, but not in older men. Older men and women have distinct risk factor profiles that may inform targeted intervention and prevention strategies.

Keywords:

• chronic medical illness
• cognitive function
• suicide
• later life

Acknowledgments

The authors would like to thank Dr Vivian Leung, former service coordinator of the NTE-ESPP of the Hong Kong Hospital Authority, for kindly facilitating the recruitment of the ESPP clients; Dr Joshua Tsoh for his invaluable comments on the study protocol; Ms Catherine Lee for her dedicated efforts in data collection and networking with the community day centers and residential facilities for older adults; and Ms Shirley Pang and Mr F Lai for their help in data collection. This study was supported by the US National Institute of Health’s Global Health Research Initiative Program for New Investigators Award (5R01TW007256-03; PI: Dr Chan).

Disclosure

The authors have no conflicts of interest to disclose.