A systematic review of physical illness, functional disability, and suicidal behaviour among older adults

Figures & data

Table 1. Population-based studies.

Authors, year, country	Physical factor (measure of physical factor)	Sample^a N and % women Outcome and n	Strength of association
Awata et al., 2005 Japan	Number of physical illnesses (clinical history) Subjective health (self-report) Physical functioning (SF-36) (McHorney, War Jr, Lu, & Sherbourne, 1994) Instrumental activities of living (Rouken–Shiki scale) (Koyano, 1987) Pain (self-report)	Community dwellers 70+. N = 1145 (58% women) Current suicidal ideation n = 52	Two–three physical illnesses: Univariate model: OR = 1.5 (CI^b 0.7–3.5); Multivariate model: OR = 1.6 (CI 0.7–3.8) ≥4 physical illnesses: Univariate model: OR = 2.5 (CI 1.1–5.6); Multivariate model: OR = 1.5 (CI 0.6–3.4) Unhealthy subjective health: Univariate model: OR = 3.3 (CI 1.9–6.0); Multivariate model: OR = 1.3 (CI 0.7–2.5) Impaired physical functioning: Univariate model: OR = 2.2 (CI 1.2–3.8); Multivariate model: OR = 1.0 (CI 0.5–1.8) Impaired instrumental activities of living: Univariate model: OR = 4.3 (CI 2.3–7.9); Multivariate model: OR = 2.0 (CI 1.0–3.9) Pain (mild to severe): Univariate model: OR = 2.9 (CI 1.6–5.2); Multivariate model: OR = 1.9 (CI 1.0–3.5)
Barnow et al., 2004 Germany	Physical health (1 = poor to 5 = very good) Self-rated health (1 = poor to 5 = very good) ADL score (Katz, Downs, Cash, & Grotz, 1970) Requiring help with ADL (Katz et al., 1970)	Representative population-based sample including institutionalized persons 70+. N = 516 (44% women) Wish to die and/or suicidal ideation/suicide attempts n = 54	Physical health: Death wishes/suicidal thoughts/attempts: B = –0.046, S.E. = 0.450, Wald = 0.01, p = NS, Exp (B) = 0.96; Suicidal thoughts/attempts: B = –1.43, S.E. = 1.20, Wald = 1.42, p = NS, Exp (B) = 0.24 Poor self-rated health: Death wishes/suicidal thoughts/attempts: χ2 = 28.9, p = <0.01; Suicidal thoughts/attempts: χ2 = 13.3, p = <0.05 ADL score: Death wishes/suicidal thoughts/attempts: B = –0.910, S.E. = 0.772, Wald = 1.39, p = NS, Exp (B) = 2.49; Suicidal thoughts/attempts:B = 0.320, S.E. = 1.24, Wald = 0.66, p = NS, Exp (B) = 1.38 Requiring help with ADL: Death wishes/suicidal thoughts/attempts: χ2 = 24.1, p = <0.01; Suicidal thoughts/attempts: χ2 = 6.9, p = NS
Chan et al., 2011 Taiwan	Perceived health Disability Heart disease Hypertension Eleven self-reported physical conditions	Community dwellers. N = 3596 (47% women) Past week suicidal ideation n = 218	Fair perceived health: OR = 1.33 (CI 0.58–3.05) Good perceived health: OR = 0.71 (CI 0.27–1.85) Bad perceived health: OR = 3.34 (CI 1.48–7.51) Very bad perceived health: OR = 12.42 (CI 5.19–29.76) Disability: OR = 2.87 (CI 2.00–4.13) Heart disease: Univariate: OR = 2.03 (CI 1.46–2.80); Multivariate: Beta = 0.49, OR = 1.63 (CI 1.06–2.49) Hypertension: OR = 1.36 (CI 0.99–1.85) Asthma: OR = 2.84 (CI 1.76–4.58) Renal disease: OR = 1.45 (CI 0.90–2.33) Diabetes: OR = 1.58 (CI 1.09–2.29) Hyperlipidemia: OR = 0.99 (CI 0.66–1.47) Stroke: OR = 1.28 (CI 0.73–2.24) Headache: OR = 2.47 (CI 1.81–3.39) Joint pain: OR = 2.07 (CI 1.51–2.82) Neck pain: OR = 2.37 (CI 1.71–3.29) Lower back pain: OR = 2.51 (CI 1.94–3.43) Sciatica: OR = 1.94 (CI 1.36–2.77) Osteoporosis: OR = 1.90 (CI 1.38–2.62)
Forsell et al., 1997 Sweden	Physician coded daily living activities and visual problems	Representative population-based sample including institutionalized persons aged 75+. N = 969 (77% women) Past two week suicidal thoughts n = 129	Impaired daily living activities: F = 18.6, df = 3964, p < 0.001 Visual problems: F = 6.9, df = 3963, p < 0.001
Forsell, 2000 Sweden	Disability (Katz et al., 1970)	Representative population-based sample including institutionalized persons aged 75+. N = 964^c Death wishes n = 128 (baseline)	Disability: Baseline: OR = 3.2 (CI 0.9–5.6); Follow-up: OR = 1.8 (CI 0.8–2.8); Persistent and remittent: NS
Fässberg et al., 2013 Sweden	Perceived health (self-report) Motor function score (Gottfries-Bråne-Steen scale (Gottfries, Bråne, Gullberg, & Steen, 1982) Vision impairment (impeding examination) Hearing impairment (impeding examination) Stroke/TIA (self-report/close-informant interview/The Swedish Hospital Discharge register) Aches and pains (Comprehensive Psychopathological Rating Scale) (Åsberg, Montgomery, Perris, Schalling, & Sedvall, 1978)	Representative population-based sample including institutionalized persons aged 97 years. N = 269 (73 % women) Past month suicidal feelings n = 31	Poor perceived health: Suicidal feelings: 23.1 % vs. no suicidal feelings: 12.9%, p = 0.270 Functional disability: Suicidal feelings: 5.0% vs. no suicidal feelings: 3.8% (CI –3.23–0.80), p = 0.236 Vision impairment: Suicidal feelings: 25.8% vs. no suicidal feelings: 29.0%, p = 0.447 Hearing impairment: Suicidal feelings: 33.3% vs. no suicidal feelings: 37.0%, p = 0.431 Stroke/TIA: Suicidal feelings: 22.6% vs. no suicidal feelings: 15.5%, p = 0.224 Aches and pains: OR = 2.17 (CI 0.89–5.16)
Fässberg et al., 2014 Multisite, Europe	Number of chronic conditions Functional disability (trichotomized at site)	Representative population-based sample including institutionalized persons. N = 15,890 (59% women) Death wishes n = 976	One chronic condition: Multivariate model: OR = 1.324 (CI 1.051–1.669); Multivariate model (including depression symptom score): OR = 1.210 (CI 0.957–1.530) Two or more chronic conditions: Multivariate model: OR = 1.795 (CI 1.374–2.343); Multivariate model (including depression symptom score): OR = 1.459 (CI 1.110–1.917) Intermediate functional disability: Multivariate model: OR 1.89 (CI 1.42–2.52); Multivariate model (including depression symptom score): OR = 1.60 (CI 1.19–2.14) High functional disability: Multivariate model: OR = 3.22 (CI 2.34–4.42); Multivariate model (including depression symptom score): OR = 2.43 (CI 1.76–3.36)
Jeon et al., 2007 Korea	Number of physical illnesses (clinical history) Perceived health (self-rated)	Community dwellers. N = 930 (60% women) Past year suicidal ideation n = 258	1–2 physical illnesses: Men: OR = 3.27 (CI 1.09–9.78); Women: OR = 1.21 (CI 0.51-2.88) 3+ physical illnesses: Men: OR = 5.01 (CI 1.55–16.11); Women: OR = 2.06 (0.86–4.91) Unhealthy perceived health: Men: OR = 2.19 (CI 0.98–4.87); Women: OR = 2.12 (CI 1.09–4.14)
Jorm et al., 1995 Australia	Self-rated health Disability (in any of eight specified functions) Vision impairment (rated by interviewer) Hearing impairment (rated by interviewer) Pain (self-report fairly frequently constantly)	Representative population-based sample including institutionalized persons aged 70+. N = 923 (48% women) Past two weeks wish to die n = 21	Poor self-rated health: Model 1: OR = 12.7 (CI 4.7–34.3); Model 2: OR = 4.1 (CI 1.3–13.2) Disability: Model 1: OR = 5.9 (CI 2.1–16.4); Model 2: OR = 3.8 (CI 1.3–11.2) Vision impairment: Model 1: OR = 14.6 (CI 5.7–37.3); Model 2: OR = 9.4 (CI 3.4–26.0) Hearing impairment: Model 1: OR = 5.6 (CI 2.3–13.9); Model 2: OR = 5.5 (CI 2.1–14.5) Pain: Model 1: OR = 5.2 (CI 2.2–12.5); Model 2: OR = 2.7 (CI 1.1–7.0)
Kang et al., 2014 South Korea	Number of chronic medical illness (list of 11 common) (Lindesay, 1990) Chronic medical illness (severer) Disabled (WHODAS) (Üstün, 2010) Pain (Self-report)	Community dwellers. N = 1204 (62% women) Past month suicidal ideation n = 138	1 chronic medical illness: Prevalence: OR = 2.61 (CI 1.05–6.51); Incidence: OR = 0.70 (CI 0.30–1.60); Persistence: NA 2-3 chronic medical illnesses: Prevalence: OR = 4.15 (CI 1.75–9.83); Incidence: OR = 0.89 (CI 0.42–1.91); Persistence: NA 4+ chronic medical illnesses: Prevalence: OR = 6.75 (CI 2.82–16.19); Incidence: OR = 2.41(CI 1.14–5.11); Persistence: NA Chronic medical illness (severer): Prevalence: OR = 1.01 (CI 0.78–1.30); Incidence: OR = 1.16 (CI 0.87–1.56); Persistence: NA Disabled: Model 1: Prevalence: OR = 4.70 (CI 2.70–8.20); Incidence: OR = 1.29 (CI 0.77–2.16) Persistence: OR = 0.50 (CI 0.13–1.88); Model 2: Prevalence: OR = 2.42 (CI 1.31–4.47); Incidence: NA; Persistence: NA Mild pain: Prevalence: OR = 2.01 (CI 1.24–25); Incidence: OR = 1.82 (CI 1.02–3.25); Persistence: OR = 0.66 (CI 0.22–1.99) Moderate pain: Prevalence: OR = 4.41 (CI 2.79–6.96). Incidence: OR = 2.93 (CI 1.60–5.35); Persistence: OR = 0.72 (CI 0.25–2.02) Severe pain: Prevalence: OR = 1.47 (CI 1.12–1.93); Incidence: OR = 1.41 (CI 1.00–1.99); Persistence: NA
Kim et al., 2014 South Korea	Cholesterol measures Hypertension (self-reported diagnosis of and treatment history) Triglycerides Diabetes (self-reported diagnosis of and treatment history)	Community dwellers. N = 732 (59 % women) Past month suicidal ideation n = 93	Total cholesterol, mean (SD) mg/dl: No SI: 173.6 (33.3); SI: 187.1 (37.6), p <.001 High density lipoprotein cholesterol, mean (SD) mg/dl: No SI: 48.2 (13.6); SI: 46.9 (12.8), p = 0.384 Low density lipoprotein cholesterol, mean (SD) mg/dl: No SI: 95.5 (30.0); SI: 110.0 (32.6), p <.001 Hypertension, N (%): No SI: 200 (31.3); SI: 34 (36.6), p = 0.309 Triglycerides, mean (SD) mg/dl: No SI: 151.8 (82.0); SI: 155.3 (80.3), p = 0.696 Diabetes, N (%): No SI: 68 (10.6); SI: 14 (15.1), p = 0.207
Lapierre et al., 2012 Canada	Kidney/urinary problem	Community dwellers. N = 2777 (59% women) Past year wish to die n = 163	Kidney/urinary problem: Wish to die: 22.7% vs. no wish to die: 15.5%, χ^2 = 5.84, p = 0.05
Lapierre et al., 2015 Canada	Number of chronic diseases Negative perception of own health [participants rated their own health by comparing it to people their own age (1– excellent to 5 – bad)] Visual problem (glaucoma cataract) List of 15 self-reported chronic conditions	Community dwellers N = 2811 (70% women) Past year wish to die n = 145	Higher number of chronic diseases: Wish to die: Mean 4.36 (SD 2.12) vs. no wish to die: mean 3.22 (SD 2.11), p .001 Negative perception of own health: Wish to die: Mean 2.99 (SD 1.05) vs. no wish to die: mean 2.44 (SD 1.01), p .001 Visual problem (glaucoma cataract): Wish to die: 41.4% vs. no wish to die: 31.9%, p = .017; OR = 1.15 (CI 0.81–1.64) Heart problem: Wish to die: 31.0% vs. no wish to die: 27.6%, p = 0.362 Cholesterol: Wish to die: 42.8% vs. no wish to die: 38.6%, p = 0.315 High blood pressure: Wish to die: 53.1% vs. no wish to die: 52.8%, p = 0.936 Respiratory problem: Wish to die: 27.6% vs. no wish to die: 14.0%, p = 0.001; Model 1: OR = 1.85 (CI 1.24–2.75); Model 2: OR = 1.53 (CI 0.99–2.37) Digestive problems: Wish to die: 27.6% vs. no wish to die: 16.4%, p = 0.001; OR = 1.46 (CI 0.98–2.17) Liver problem: Wish to die: 4.8% vs. no wish to die: 2.5%, p = 0.090 Urinary/prostate problem: Wish to die: 21.4 % vs. no wish to die: 12.9 %, p = 0.003; Model 1: OR = 1.76 (CI 1.13–2.74); Model 2: OR = 1.85 (CI 1.14–3.01) Anaemia: Wish to die: 6.2% vs. no wish to die: 5.2%, p = 0.603 Diabetes: Wish to die: 15.2 % vs. no wish to die: 15.5%, p = 0.928 Endocrine problem: Wish to die: 26.9% vs. no wish to die: 19.9%, p = 0.042; OR = 1.27 (CI 0.85–1.89) Skin problem: Wish to die: 20.3% vs. no wish to die: 12.3 %, p = 0.005; OR = 1.46 (CI 0.94–2.25) Migraine/headaches: Wish to die: 13.8% vs. no wish to die: 6.6%, p = .001; OR = 1.57 (CI 0.93–2.64) Arthritis/rheumatism: Wish to die: 57.9% vs. no wish to die: 37.2%, p = 0.001; Model 1: OR = 1.72 (CI 1.19–2.48); Model 2: OR = 1.64 (CI 1.11–2.40) Back problem: Wish to die: 39.3% vs. no wish to die: 22.7%, p = 0.001; OR = 1.34 (CI 0.91–1.96)
Lee et al., 2013 South Korea	Functional limitations (single question)	Community dwellers. N = 1343^c Past year suicidal ideation n = 309	Functional limitations: OR = 2.515 (CI 1.875-3.375)
Park, 2014 Korea	Fair self-rated health Poor/very poor self-rated health Limitations in daily living Three self-reported specific physical conditions	Community dwellers. N = 1743 (58% women) Past year suicidal ideation n = 481	Fair self-rated health: Older adults total: OR = 0.95 (CI 0.65–1.37); Older adults living alone: OR = 1.24 (CI 0.65–2.81); Older adults living with others: OR = 0.85 (CI 0.55–1.32) Poor/very poor self-rated health: Older adults total: OR = 1.23 (CI 0.89–1.72); Older adults living alone: OR = 0.92 (CI 0.41–2.04); Older adults living with others: OR = 1.32 (CI 0.91–1.92) Limitations in daily living: Older adults total: OR = 2.10 (CI 1.58–2.78); Older adults living alone: OR = 3.17 (CI 1.70–5.92); Older adults living with others: OR = 1.89 (CI 1.36–2.63) Ischaemic heart disease: Older adults total: OR = 1.45 (CI 0.82–2.55); Older adults living alone: OR = 0.73 (CI 0.19–2.78); Older adults living with others: OR = 1.67 (CI 0.89–3.14) Stroke: Older adults total: OR = 2.01 (CI 1.21–3.33); Older adults living alone: OR = 4.11 (CI 1.20–14.01); Older adults living with others: OR = 1.73 (CI 0.98–3.09) Cancer: Older adults total: OR = 1.12 (CI 0.68–1.84); Older adults living alone: OR = 0.55 (CI 0.16–1.89); Older adults living with others: OR = 1.17 (CI 0.68–2.02)
Rasic, Belik, Bolton, Chochinov, & Sareen, 2008 Canada	Cancer	Community dwellers aged 75+. N = 3621^c Past year suicidal ideation n = 52	Cancer: Model 1: OR = 1.41 (CI 0.36–5.50); Model 2: OR = 1.79 (CI 0.45–7.16); Model 3: OR = 1.79 (CI 0.49–6.53)
Saias, Beck, Bodard, Guignard, & du Roscoat, 2012 Multisite, Europe	Long-term illness (single question) Material support (requiring assistance with personal hygiene, household or paperwork)	Community dwellers. N = 11,440 (59% women) Past month death ideation n = 1169	Long-term illness: OR = 1.28 (CI 1.07–1.53) Received material support in the last 12 months: OR = 1.12 (CI 0.94–1.33)
Scocco et al., 2001 Italy	Somatic pathology Subjective health (self report) Painful symptoms (D De Leo et al., 1991)	Community dwellers. N = 611 (63% women) Remote suicidal feelings n = 56 Recent suicidal feelings n = 40	At least one somatic pathology: Recent suicidal feelings: 90% vs. no suicidal feelings: 73%, χ^2 = 5.30, 0.023; Remote suicidal feelings: NS Poor subjective health: Remote suicidal feelings: 12% vs. no suicidal feelings: 3%, χ^2 = 16.09, p = <0.001; Logistic regression analysis: OR = 2.4, p = <0.001 Mean number of painful symptoms: Remote suicidal feelings: mean 2.1 vs. no suicidal feelings: mean 1.5, t = 3.01, p = <0.005 Mean number of painful symptoms: Recent suicidal feelings: mean 2.2 vs. no suicidal feelings: mean 1.5, t = 2.37, p = <0.03
Skoog et al., 1996 Sweden	3 or more physical disorders 2 self-reported specific physical conditions	Representative population-based sample including institutionalized persons aged 85 years. N = 345 (70% women) Past month suicidal feelings n = 55	Three or more physical disorders: OR = 2.5 (CI 1.3–4.6) Myocardial infarction: OR = 2.7 (CI 1.2–6.4) Peptic ulcer: OR = 3.0 (CI 1.4–6.2)
Turvey et al., 2002 USA	Total number of chronic illnesses Perceived health Functional impairment Physical impairment (Katz et al., 1970; Nagi, 1976; Rosow & Breslau, 1966) Heart attack Diabetes Four self-reported specific physical conditions	Community dwellers aged 67+. N = 420^c Suicide n = 20	Total number of chronic illnesses: OR = 1.51 (CI 0.97–2.27) Poor perceived health: OR = 3.36 (CI 1.21–10.16) Marked impairment: OR = 0.35 (CI 0.00–2.38) Mild functional impairment: OR = 0.92 (CI 0.32–2.83) Physical impairment (Rosow and Breslow): OR = 1.33 (CI 0.83–2.09) Physical impairment (Katz): OR = 0.38 (CI 0.00–1.18) Physical impairment (Nagi Scale): OR = 1.03 (CI 0.87–1.21) Heart attack: OR = 1.78 (CI 0.55–5.12) Diabetes: OR = 1.24 (CI 0.29–4.02) Stroke: OR = 0.30 (CI 0.00–1.80) Hip fracture: OR = 1.45 (CI 0.03–10.40) Fracture since age 50: OR = 3.39 (CI 1.16–9.40) Cancer: OR = 2.51 (CI 0.74–7.49)
Yamauchi et al., 2014a Japan	Stroke	Dwellers in 12 public health centre areas, data linkage with Regional Stroke Registry and mortality data. N = 7681^c Suicide n = 35	Stroke: Univariable: RR^d = 2.8^e; Multivariable-adjusted: RR = 2.7 (CI 0.8–9.1)
Yamauchi et al., 2014b Japan	Cancer	Dwellers in 12 public health centre areas, data linkage with cancer registry and mortality data. N = 102,843^f,^c Suicide n = 42	Cancer: Unadjusted: RR^d = 1.2^e; Adjusted: RR = 1.2 (CI 0.4–3.8)
Yen et al., 2005 Taiwan	Physical illness	Community dwellers. N = 897 (45% women) Past week suicidal ideation n = 147	Physical illness: SI: 77.6 % vs. no SI: 62.3 %, X^2: 12.66, <0.001; OR = 0.83 (CI 0.51–1.36)

Note: ^aStudy participants are aged 65 and above unless otherwise specified.

^b95 % for all studies.

^c% women not shown.

^dRisk ratio.

^e95 % CI not shown.

^fNumber for all study participants, not only 65+.

Table 2. Register-based studies.

Authors, year, country	Physical factor (data source)	Follow-up	Sample^a N and % women Outcome and n	Strength of association
Ahn et al., 2010 Korea	Cancer (Korea Central Cancer Registry)	1993–2005	Patients aged 80+. Comparison respondents from general population. N = 32,044^b Suicide n = 67	Cancer: SMR = 1.46 (CI^c 1.15–1.85)
Allebeck et al., 1989 Sweden	Cancer (Swedish Cancer-Environment Register)	1961–1979	Cancer patients aged 70+. Comparison respondents from general population. N = 424,127^d^, ^b Suicide n = 398	Cancer: Men: 70–79: SMR = 1.9 (CI 1.7–2.2); 80+: SMR = 1.7 (CI 1.4–2.0); Women: 70–79: SMR = 2.0 (CI 1.6–2.5); 80+: SMR = 1.5 (CI 0.9–2.3)
Allebeck & Bolund, 1991 Sweden	Cancer (Stockholm County In-patient Care Register)	1975–1985	Cancer patients 70+. Comparison respondents from general population. N = 59,845^d^, ^b Suicide attempt n = 58	Cancer: Men: 70–79: SMR = 1.0 (CI 0.6–1.6); 80–89: SMR = 2.7 (CI 1.6–4.5); Women: 70–79: SMR = 1.5 (CI 0.9–2.4); 80–89: SMR = 1.3 (CI 0.6–2.6)
Allebeck & Bolund, 1991 Sweden	Cancer (Stockholm County In-patient Care Register)	1975–1985	Cancer patients 70+. Comparison respondents from general population. N = 59,845^d^, ^b Suicide n = 70	Cancer: Men: 70–79: SMR = 2.5 (CI 1.7–3.6); 80–89: SMR = 2.6 (CI 1.5–4.3); Women: 70–79: SMR = 4.5 (CI 2.8–6.7); 80–89: SMR = 1.3 (CI 0.3–3.8)
Björkenstam, Edberg, Ayoubi, & Rosen, 2005 Sweden	Cancer (Malignant) (Swedish Cancer Registry)	1965–1999	Cancer patients 75+. Comparison respondents from general population. N = 1,031,919^d^, ^b Suicide n = 2112^d	Cancer (Malignant): Findings for 1965–1979: Men: 75–89: Re = 2.4 (CI 2.0–2.9); 90+: R = 2.0 (CI 0.4–5.9); Women: 75–89: R = 2.4 (CI 1.5–3.5); 90+: –; Findings for 1975–1989: Men: 75-89: R = 2.1 (CI 1.8–2.5); 90+: R = 1.7 (CI 0.5–3.9); Women: 75-89: R = 2.4 (CI 1.8–3.1); 90+: R = 4.3 (CI 1.2–10.9); Findings for 1985–1999: Men: 75–89: R = 2.3 (CI 2.0–2.6); 90+: R = 2.9 (CI 1.7–4.6); Women: 75–89: R = 2.1 (CI 1.6–2.7); 90+: R = 1.4 (CI 0.2–5.2)
Carlsson et al., 2013 Sweden	Prostate cancer (Prostate Cancer Data Base Sweden)	1997–2009	Prostate cancer patients. Comparison respondents from general population. N = 77,539 Suicide n = 160	Prostate cancer: 0–6 months after diagnosis: 65–74: RR^f = 6.9 (CI 2.8–17); 75+: RR = 7.8 (CI 3.7–16); 6-18 months after diagnosis: 65-74: RR = 2.0 (CI 1.1–3.6); 75+: RR = 2.0 (CI 1.2–3.4); >18 months after diagnosis: 65–74: RR = 1.1 (CI 0.82–1.6); 75+: RR = 1.4 (CI 1.0–1.8); Diagnosed at some point: 65–74: RR = 1.5 (CI 1.1–1.9); 75: RR = 1.7 (CI 1.4–2.2)
Crocetti et al., 1998 Italy	Cancer (Tuscany Cancer Registry)	1985–1989	Cancer patients. Comparison respondents from general population. N = 27,123^d^, ^b Suicide n = 31	Cancer: 65–74: SMR = 2.98 (p = <0.001); 75+: SMR = 1.85 (p = <0.05)
Dormer et al., 2008 Australia	Cancer (Western Australian Cancer Registry)	1981–2002	Cancer patients (excl. nonmelanoma skin cancer) aged 70+. Comparison respondents from general population. N = 121,533 ^d^, ^b Suicide n = 59	Cancer: 70–79: SMR = 1.58 (CI 1.13–2.21); 80+: SMR = 1.89 (CI 1.28–2.80)
Erlangsen et al., 2005 Denmark	Hospitalization within past 2 years (National Registry of Patients)	1996–1998	Persons 65+ hospitalized for somatic disorders. Comparison respondents from general population. N = 1,684,205^d^, ^b Suicide n = 661	Hospitalized vs. not hospitalized: Men: 65–79: RR^f = 3.3 (CI 2.7–4.0) vs. RR = 1.0 (CI 0.8–1.3); 80+: RR = 5.1 (CI 3.9–6.5) vs. RR = 2.6 (CI 2.0–3.4); Women: 65–79: RR = 3.4 (CI 2.5–4.5) vs. RR = 1.0 (CI 0.7–1.3); 80+: RR = 3.8 (CI 2.7–5.4) vs. RR = 1.0 (CI 0.6–1.6)
Erlangsen et al., 2015 Denmark	Thirty-four specific physical conditions (National Registry of Patients)	1990–2009	Persons diagnosed with physical disorder at hospital during past 3 years^g. Comparison respondents from general population. N = 1,849,110 (55% women) Suicide n = 4792	Glaucoma: Men: Unadjusted: RR^e = 1.16 (CI 0.67-2.00); Women: Diagnosed within 3 years: Unadjusted: RR = 1.87 (CI 1.13–3.11); Adjusted: RR = 1.86 (CI 1.12–3.10); Multivariate: RR = 1.75 (CI 1.05–2.91) Cataract: Men: Diagnosed within 3 years: Unadjusted: RR = 1.12 (CI 0.94–1.33); Adjusted: RR = 1.55 (CI 1.37–1.75); Multivariate: RR = 1.37 (CI 1.21–1.54); Women: Diagnosed within 3 years: Unadjusted: RR = 1.02 (CI 0.84–1.24); Adjusted: RR = 2.06 (CI 1.77–2.40); Multivariate: RR = 1.64 (CI 1.41–1.91) Hearing loss: Men: Diagnosed within 3 years: Unadjusted: RR = 0.90 (CI 0.77–1.05); Women: Diagnosed within 3 years: Unadjusted: RR = 0.75 (CI 0.60–0.95) Heart diseases: Men: Diagnosed within 3 years: Unadjusted: RR = 1.24 (CI 1.12–1.37); Adjusted: RR = 1.24 (CI 1.12–1.37); Multivariate: RR = 1.19 (CI 1.08–1.32); Women: Diagnosed within 3 years: Unadjusted: RR = 1.24 (CI 1.06–1.44); Adjusted: RR = 1.31 (CI 1.12–1.53) Chronic obstructive pulmonary disease (COPD): Men: Diagnosed within 3 years: Unadjusted: RR = 2.07 (CI 1.77–2.40); Adjusted: RR = 2.09 (CI 1.79–2.43); Multivariate: RR = 1.81 (1.55–2.10); Women: Diagnosed within 3 years: Unadjusted: RR = 2.42 (CI 1.99–2.96); Adjusted: RR = 2.61 (CI 2.14–3.18); Multivariate: RR = 2.00 (CI 1.64–2.45) Enteritis and colitis: Men: Diagnosed within 3 years: Unadjusted: RR = 1.20 (CI 0.72–1.99); Women: Diagnosed within 3 years: Unadjusted: RR = 1.22 (CI 0.67–2.21); Gastrointestinal disorders: Men: Diagnosed within 3 years: Unadjusted: RR = 1.75 (CI 1.49–2.05); Adjusted: RR = 1.71 (CI 1.46–2.01); Multivariate: RR = 1.41 (CI 1.20–1.66); Women: Diagnosed within 3 years: Unadjusted: RR = 2.20 (CI 1.81–2.68); Adjusted: RR = 2.26 (CI 1.86–2.76); Multivariate: RR = 1.67 (CI 1.37–2.04)
				Liver diseases: Men: Diagnosed within 3 years: Unadjusted: RR = 3.27 (CI 2.11–5.08); Adjusted: RR = 3.64 (CI 2.35–5.66); Multivariate: RR = 2.69 (CI 1.73–4.17); Women: Diagnosed within 3 years: Unadjusted: RR = 5.27 (CI 3.43–8.67); Adjusted: RR = 5.45 (CI 3.43–8.67); Multivariate: RR = 4.00 (CI 2.51–6.37); Renal diseases: Men: Diagnosed within 3 years: Unadjusted: RR = 1.44 (CI 1.03–2.02); Adjusted: RR = 1.54 (CI 1.10–2.17); Women: Diagnosed within 3 years: Unadjusted: RR = 1.10 (CI 0.57–2.11) Prostate: Men: Diagnosed within 3 years: Unadjusted: RR = 1.40 (CI 1.23–1.60); Adjusted: RR = 1.35 (CI 1.19–1.54); Multivariate: RR = 1.38 (CI 1.20–1.57) Male genital disorders: Men: Diagnosed within 3 years: Unadjusted: RR = 2.81 (CI 1.46–5.40); Adjusted: RR = 2.88 (CI 1.49–5.53); Multivariate: RR = 2.43 (CI 1.26–4.68) Diabetes: Men: Diagnosed within 3 years: Unadjusted: RR = 1.00 (CI 0.77–1.29); Women: Diagnosed within 3 years: Unadjusted: RR = 0.75 (CI 0.48–1.17) Thyroid diseases: Men: Diagnosed within 3 years: Unadjusted: RR = 0.75 (CI 0.36–1.57); Women: Diagnosed within 3 years: Unadjusted: RR = 1.27 (CI 0.86–1.89) Cerebrovascular diseases and hemiplegia: Men: Diagnosed within 3 years: Unadjusted: RR = 1.61 (CI 1.41–1.84); Adjusted: RR = 1.53 (CI 1.33–1.75); Multivariate: RR = 1.31 (CI 1.15–1.51); Women: Diagnosed within 3 years: Unadjusted: RR = 1.73 (CI 1.43–2.10); Adjusted: RR = 1.77 (CI 1.46–2.15); Multivariate: RR = 1.41 (CI 1.16–1.72) Epilepsy: Men: Diagnosed within 3 years: Unadjusted: RR = 2.34 (CI 1.62–3.37); Adjusted: RR = 2.41 (CI 1.67–3.47); Multivariate: RR = 1.68 (CI 1.17–2.43); Women: Diagnosed within 3 years: Unadjusted: RR = 2.89 (CI 1.69–4.67); Adjusted: RR = 2.94 (CI 1.77–4.89) Parkinson's disease: Men: Diagnosed within 3 years: Unadjusted: RR = 1.92 (CI 1.26–2.92); Adjusted: RR = 1.80 (CI 1.19–2.74); Women: Diagnosed within 3 years: Unadjusted: RR = 2.26 (CI 1.25–4.08); Adjusted: RR = 2.22 (CI 1.23–4.02)
				Polyneuropathy: Men: Diagnosed within 3 years: Unadjusted: RR = 1.16 (CI 0.55–2.43); Women: Diagnosed within 3 years: Unadjusted: RR = 2.22 (CI 0.92–5.34); Adjusted: RR = 2.46 (CI 1.02–5.93) Arthritis: Men: Diagnosed within 3 years: Unadjusted: RR = 1.40 (CI 1.09–1.79); Adjusted: RR = 1.51 (CI 1.18–1.94); Multivariate: RR = 1.38 (CI 1.08–1.77); Women: Diagnosed within 3 years: Unadjusted: RR = 1.34 (CI 0.99–1.80); Adjusted: RR = 1.42 (1.05–1.92) Arthrosis: Men: Diagnosed within 3 years: Unadjusted: RR = 0.88 (CI 0.71–1.08); Women: Diagnosed within 3 years: Unadjusted: RR = 0.85 (CI 0.67–1.08) Osteoporosis: Men: Diagnosed within 3 years: Unadjusted: RR = 2.07 (CI 1.30–3.29); Adjusted: RR = 2.18 (CI 1.37–3.47); Multivariate: RR = 1.75 (CI 1.10–2.78); Women: Diagnosed within 3 years: Unadjusted: RR = 1.96 (CI 1.48–2.58), Adjusted: RR = 2.29 (CI 1.74–3.02; Multivariate: RR = 1.92 (CI 1.46–2.54) Foot fracture: Men: Diagnosed within 3 years: Unadjusted: RR = 1.11 (CI 0.53–2.32); Women: Diagnosed within 3 years: Unadjusted: RR = 1.38 (CI 0.72–2.66) Hand fracture: Men: Diagnosed within 3 years: Unadjusted: RR = 1.32 (CI 0.84–2.07); Women: Diagnosed within 3 years: Unadjusted: RR = 1.01 (CI 0.61–1.68) Hip fracture: Men: Diagnosed within 3 years: Unadjusted: RR = 1.59 (CI 1.24–2.04); Adjusted: RR = 1.31 (CI 1.02–1.68); Women: Diagnosed within 3 years: Unadjusted: RR = 1.45 (CI 1.17–1.80); Adjusted: RR = 1.45 (CI 1.17–1.81) Leg fracture: Men: Diagnosed within 3 years: Unadjusted: RR = 1.67 (CI 1.12–2.47); Adjusted: RR = 1.68 (CI 1.13–2.49); Women: Diagnosed within 3 years: Unadjusted: RR = 1.06 (CI 0.68–1.67) Spinal fracture: Men: Diagnosed within 3 years: Unadjusted: RR = 2.67 (CI 1.96–3.63); Adjusted: RR = 2.49 (CI 1.83–3.38); Multivariate: RR = 1.82 (CI 1.34–2.48); Women: Diagnosed within 3 years: Unadjusted: RR = 2.96 (CI 2.23–3.93); Adjusted: RR = 3.04 (CI 2.29–4.04); Multivariate: RR = 2.12 (CI 1.59–2.83)
				Shoulder/arm fracture: Men: Diagnosed within 3 years: Unadjusted: RR = 1.42 (CI 1.06–1.92); Adjusted; RR = 1.42 (CI 1.06–1.92); Women: Diagnosed within 3 years: Unadjusted: RR = 0.98 (CI 0.77–1.24) Bladder cancer: Men: Diagnosed within 3 years: Unadjusted: RR = 2.26 (CI 1.73–2.96); Adjusted: RR = 2.09 (CI 1.60–2.74); Multivariate: RR = 2.08 (CI 1.59–2.73); Women: Diagnosed within 3 years: Unadjusted: RR = 1.79 (CI 0.85–3.76) Bone cancer: Men: Diagnosed within 3 years: Unadjusted: RR = 1.40 (CI 1.03–1.89); Adjusted: RR = 1.35 (CI 1.00–1.82); Multivariate: RR = 1.36 (CI 1.00–1.84); Women: Diagnosed within 3 years: Unadjusted: RR = 0.97 (CI 0.55–1.72); Brain cancer: Women: Diagnosed within 3 years: Unadjusted: RR = 3.75 (CI 1.21–11.63); Adjusted: RR = 3.72 (CI 1.20–11.55); Multivariate: RR = 3.46 (CI 1.11–10.75) Breast cancer: Women: Diagnosed within 3 years: Unadjusted: Not shown; Adjusted: RR = 1.72 (CI 1.29–2.30); Multivariate: RR = 1.67 (CI 1.25–2.24) Gastrointestinal cancer: Men: Diagnosed within 3 years: Unadjusted: RR = 2.62 (CI 1.92–3.57); Adjusted: RR = 2.54 (CI 1.86–3.47); Multivariate: RR = 2.54 (CI 1.86–3.48); Women: Diagnosed within 3 years: Unadjusted: RR = 1.37 (CI 0.68–2.75) Genital cancer: Men: Diagnosed within 3 years: Unadjusted: RR = 1.57 (CI 1.26–1.95); Adjusted: RR = 1.55 (CI 1.24–1.93); Multivariate: RR = 1.58 (CI 1.26–1.97); Women: Diagnosed within 3 years: Unadjusted: RR = 1.59 (CI 0.99–2.57) Lung cancer: Men: Diagnosed within 3 years: Unadjusted: RR = 2.45 (CI 1.90–3.17); Adjusted; RR = 2.49 (CI 1.92–3.22); Multivariate: RR = 2.30 (CI 1.78–2.98); Women: Diagnosed within 3 years: Unadjusted: RR = 3.67 (CI 2.46–5.50); Adjusted: RR = 3.77 (CI 2.52–5.64); Multivariate: RR = 3.16 (CI 2.11–4.73)
				Lymph node cancer: Men: Diagnosed within 3 years: Unadjusted: RR = 1.81 (CI 1.26–2.62); Adjusted: RR = 1.82 (CI 1.26–2.62); Multivariate: RR = 1.84 (CI 1.28–2.65); Women: Diagnosed within 3 years: Unadjusted: RR = 1.64 (CI 0.90–2.96)
Fall et al., 2009 Sweden	Prostate cancer (Swedish Cancer Registry)	1987–2004	Men diagnosed with prostate cancer within past 1 year. Comparison respondents from general population. N = 168,584^d Suicide n = 99	Prostate cancer: 65–74: RR^f = 2.6 (CI 2.0–3.4); 75+: RR = 2.5 (CI 1.8–3.4)
Fang et al., 2008 Sweden	Amyotrophic lateral sclerosis (ALS) (Inpatient Register)	1965–2004	Patients diagnosed with ALS aged 70+. Comparison respondents from general population. N = 6642^d (44% women) Suicide n = 4	Amyotrophic lateral sclerosis (ALS): SMR = 3.2 (CI 0.9–8.1)
Fang et al., 2010 USA	Prostate cancer (Surveillance, Epidemiology, and End Results Program)	1979–2004	Men diagnosed with prostate cancer within 1-3 months aged 70+. Comparison respondents from general population. N = 185,216 Suicide n = 91	Prostate cancer: 1-3 months after diagnosis: 70–79: SMR = 1.6 (CI 0.9–2.6); 80+: SMR = 2.4 (CI 1.3–4.1); 4-12 months after diagnosis: 70–79: SMR = 1.2 (CI 0.8–1.6); 80+: SMR = 1.2 (CI 0.8–1.8)
Fang et al., 2012 Sweden	Cancer (Swedish Cancer Registry)	1991-2006	Persons diagnosed with cancer. Comparison respondents from general population. N = 3911^b Suicide n = 184	Cancer: 65–74: RR^f = 3.7 (CI 2.9–4.5); 75–84: RR = 2.7 (CI 2.2–3.2)
Juurlink et al., 2004 Canada	Prescription data (proxy for 12 specified conditions)	1992–2000	Persons receiving prescribed drug medications (proxy for disorders) aged 66+. Comparison respondents from general population. N = 6644 (24% women) Suicide n = 1329	Congestive heart failure: Univariate: OR = 1.73 (CI 1.33–2.24) Multivariate: OR = 1.36 (CI 1.00–1.85) Ischemic heart disease: Univariate: OR = 0.92 (CI 0.76–1.12); Multivariate: Not included Chronic lung disease: Univariate: OR = 1.62 (CI 1.37–1.92); Multivariate: OR = 1.30 (CI 1.06–1.58) Hyperacidity syndromes: Univariate: OR = 1.26 (CI 1.09–1.47); Multivariate: OR = 0.81 (CI 0.68–0.97) Urinary incontinence: Univariate: OR = 2.02 (CI 1.29–3.17); Multivariate: OR = 1.11 (CI 0.65–1.89) Diabetes mellitus: Univariate: OR = 1.01 (CI 0.73–1.41); Multivariate: Not included Seizure disorder: Univariate: OR = 2.95 (CI 1.89–4.61); Multivariate: OR = 2.41 (CI 1.42–4.07) Parkinson: Univariate: OR = 1.60 (CI 1.00–2.55); Multivariate: OR = 1.11 (CI 0.65–1.90) Moderate pain: Univariate: OR = 1.91 (CI 1.66–2.20); Multivariate: OR = 1.24 (CI 1.04–1.47) Severe pain: Univariate: OR = 7.52 (CI 4.93–11.46); Multivariate: OR: 4.07 (CI 2.51–6.59) Rheumatoid arthritis: Univariate: OR = 1.00 (CI 0.33–2.99); Multivariate: Not included Breast cancer: Univariate: OR = 1.46 (CI 0.46–4.57); Multivariate: Not included Prostate cancer: Univariate: OR = 1.18 (CI 0.71–1.95); Multivariate: Not included
Kurella et al., 2005 USA	End stage renal disease (Center for Medicare and Medicaid Services, Medical Evidence form)	1995–2000	Patients aged 75+. Comparison respondents from general population. N = 102,424^d (47% women) Suicide n = 264^d	End stage renal disease: Unadjusted: RR^f = 2.25 (CI 1.58–3.22); Multivariate: RR = 1.49 (CI 1.03–2.16)
Larsen et al., 2010 Denmark	Myocardial infarction (Danish Society of Cardiology)	1981–2006	Patients aged 70+. Comparison respondents from general population. N = 49,518^b Suicide n = 5249	Myocardial infarction: Age 70–79: Unadjusted: RRe = 1.24 (CI 1.08–1.42); Adjusted: RR = 1.19 (CI 1.02–1.38); Age 80–89: Unadjusted: RR = 1.24 (CI 1.03–1.49); Adjusted: RR = 1.23 (CI 1.02–1.49)
Miccinesi et al., 2004 Italy	Cancer (Tuscany Cancer Registry)	1985–1999	Cancer patients. Comparison respondents from general population. N = 90,197^d (47% women) Suicide n = 76	Cancer: 65–74: SMR = 180^h; 75+: SMR = 231^h
Miller et al., 2008 USA	Nine specific medical illnesses (Pharmaceutical Assistance Program for the Aged and Disabled)	1994–2002	Persons using Medicare. Comparison respondents part of same program. N = 1408 (18% women) Suicide n = 128	Medical illness (any of 9 specific): Crude: OR = 1.2 (CI 0.8–1.8) Angina pectoris: Crude: OR = 1.3 (CI 0.8–2.0) Congestive heart failure: Crude: OR = 2.0 (CI 1.3–3.3); Multivariate: OR = 1.1 (CI 0.6–1.9) Acute myocardial infarction: Crude: OR = 1.4 (CI 0.8–2.7) Chronic obstructive pulmonary disease (COPD): Crude analysis: OR = 1.7 (CI 1.1–2.5); Multivariate: OR = 1.1 (CI 0.7–1.8) Diabetes: Crude: OR = 0.8 (CI 0.5–1.2) Stroke: Crude analysis: OR = 1.8 (CI 1.2–2.7); Multivariate: OR = 1.2 (CI 0.7–1.9) Osteoarthritis: Crude analysis: OR = 1.2 (CI 0.7–2.1) Spine disorder: Crude analysis: OR = 1.8 (CI 1.1–3.0); Multivariate: OR = 0.9 (CI 0.5–1.6) Malignancy: Crude: OR = 3.3 (CI 1.9–5.7); Multivariate: OR = 2.3 (CI 1.1–4.8)
Misono et al., 2008 USA	Cancer (Surveillance, Epidemiology, and End Results Program)	1973–2002	Cancer patients. Comparison respondents from general population. N = 3,594,750^d (52% women) Suicide n = 3271	Cancer: 65–69: SMR = 2.42 (CI 2.27–2.58); 70–74: SMR = 2.48 (CI 2.33–2.64); 75–79: SMR = 2.28 (CI 2.12–2.46); 80–84: SMR = 2.38 (CI 2.16–2.61); 85+: SMR = 2.51 (CI 2.19–2.86)
Nakash, Barchana, Liphshitz, Keinan-Boker, & Levav, 2013 Israel	Cancer (Israel National Cancer Registry)	1999–2007	Cancer patients ethnic origins. Comparison respondents from general population. N not shown Suicide: n = 10 (Asia-North Africa) (10% women); n = 131 Europe-America (21% women)	Cancer: Asia–North Africa: Men: SIR = 0.59 (CI 0.21–0.98); Women: SIR = 1.36 (CI 0.00–1.04); Europe–America: Men: SIR = 1.88 (CI 1.52–2.24); Women: SIR = 1.36 (CI 0.85–1.86)
Oberaigner et al., 2014 Austria	Cancer (Malignant) (Cancer patients diagnosed in Tyrol, Austria)	1991–2010	Cancer patients aged 70+. Comparison respondents from general population. N = 53,803^d (48% women) Suicide n = 52	Cancer (malignant): Men and women: 70–79: SMR = 1.86 (CI 1.31–2.55); 80+: SMR = 1.62 (CI 0.89–2.72); Men: 70–79: SMR = 1.72 (CI 1.15–2.47); 80+: SMR = 1.99 (CI 1.09–3.34); Women: 70–79: SMR = 2.52 (CI 1.15–4.79); 80+: SMR = 0.00 (CI 0.00–2.31)
Smailyte et al., 2013 Lithuania	Cancer (Lithuanian Cancer Registry)	2001–2009	Cancer patients aged 70+. Comparison respondents from general population. N = 132,459^d (48% women) Suicide: n = 98	Cancer: Men: SMR = 1.44 (CI 1.14–1.79); Women: SMR = 1.27 (CI 0.75–2.00)
Tanaka et al., 1999 Japan	Cancer (Osaka Cancer Registry)	1978–1994	Cancer patients diagnosed in hospital aged 70+. Comparison respondents from general population. N = 23,979^d (45% women) Suicide n = 8	Cancer: O/E = 1.36 (CI 0.59–2.68)
Teasdale & Engberg, 2001 Denmark	Stroke (National Bureau of Health Register of Hospitalizations)	1979–1993	Persons diagnosed with stroke in hospital aged 70+. Comparison respondents from general population. N = 67,070^b Suicide: n = 154	Stroke: Age 70–79: SMR = 1.81 (CI 1.51–2.17); Aged 80+: SMR = 1.30 (CI 0.95–1.79)
Urban et al., 2013 USA	Lung cancer (ICD for Oncology)	1973–2009	Patients diagnosed with lung cancer aged 70+. Comparison respondents from general population. N = 418,202^b Suicide n = 561	Lung cancer: Diagnosed: 70–79: SMR = 5.66 (CI 5.12–6.24); 80+: SMR = 6.18 (CI 5.25–7.23); Diagnosed within last 3 months: 70–79: SMR = 14.8 (CI 12.5–17.4); 80+: SMR = 15.5 (CI 12.4–19.3); Diagnosed more than 3 months ago: 70–79: SMR = 4.2 (CI 3.7–4.8); 80+: SMR = 3.7 (CI 2.9–4.6)
Voaklander et al., 2008 Canada	13 specified physical conditions	1993–2002	Persons aged using health care services from GP or hospital aged 66+. Comparison respondents from general population. N = 3601 (28% women) Suicide n = 602	Cardiac diagnosis: Physician coded: Unadjusted: OR = 0.95 (0.73–1.24); Hospital coded: Unadjusted: OR = 2.67 (CI 2.05–3.46) Hypertension: Physician coded: Unadjusted: OR = 0.85 (CI 0.68–1.06); Hospital coded: Unadjusted: OR = 2.62 (CI 1.88–3.66) Asthma: Physician coded: Unadjusted: OR = 1.53 (CI 0.93–2.49); Hospital coded: Unadjusted: OR = 1.59 (CI 0.51–4.96) Chronic obstructive pulmonary disease (COPD): Physician coded: Unadjusted: OR = 1.30 (CI 0.89–1.89); Hospital coded: Unadjusted: OR = 3.37 (CI 2.26–5.02) Liver disease: Physician coded: Unadjusted: OR = 1.68 (CI 1.11–2.42); Group adjusted: OR = 1.19 (CI 0.73–1.95); Fully adjusted: OR = 0.89 (CI 0.53–1.49); Hospital coded: Unadjusted: OR = 4.32 (CI 2.55–7.01); Group adjusted: OR = 2.56 (CI 1.40–4.67); Fully adjusted: OR = 3.12 (CI 1.70–5.75) Renal disease: Physician coded: Unadjusted: OR = 0.86 (CI 0.33–2.27); Hospital coded: Unadjusted: OR = 1.66 (CI 0.17–15.98) Incontinence: Physician coded: Unadjusted: OR = 1.98 (CI 1.50–2.62); Group adjusted: OR = 1.66 (CI 1.18–2.34); Fully adjusted: OR = 1.76 (CI 1.24–2.49); Hospital coded: Unadjusted: OR = 4.54 (CI 2.28–9.03); Group adjusted: OR = 2.21 (CI 0.92–5.29); Fully adjusted: OR = 1.84 (CI 0.74–4.54) Diabetes: Physician coded: Univariate: OR = 0.69 (CI 0.46–1.03); Hospital coded: Univariate: OR = 2.27 (CI 1.53–3.39) Stroke: Physician coded: Unadjusted: OR = 2.25 (CI 1.42–3.57); Group adjusted: OR = 2.18 (CI 1.25–3.83); Fully adjusted: OR = 2.39 (CI 1.37–4.20); Hospital coded: Unadjusted: OR = 2.15 (CI 1.40–3.39); Group adjusted: OR = 1.01 (CI 0.54–1.88); Fully adjusted: OR = 1.32 (CI 0.71–2.44) Pain: Narcotic pain killers: Prescriptions: Unadjusted: OR = 4.38 (CI 3.22–5.93); Group adjusted: OR = 3.03 (CI 2.12–4.34); Fully adjusted: OR = 2.57 (CI 1.71–3.86) Narcotic pain killers: Mild: OR = 2.10 (CI 1.29–3.42); Strong: OR = 6.30 (CI 2.61–15.20) Osteoarthritis: Physician coded: Unadjusted: OR = 1.34 (CI 0.99–1.74); Hospital coded: Unadjusted: OR = 1.22 (CI 0.61–2.45) Osteoporosis: Physician coded: Unadjusted: OR = 1.69 (CI 0.62–4.66); Hospital coded: Unadjusted: OR = 3.12 (CI 1.56–6.21) Cancer: Physician coded: Unadjusted: OR = 0.99 (CI 0.72–1.35); Group adjusted: OR = 1.19 (CI 0.84–1.69); Fully adjusted: OR = 1.09 (CI 0.76–1.57); Hospital coded: Unadjusted: OR = 3.93 (CI 2.72–5.67); Group adjusted: OR = 3.28 (CI 2.11–5.09); Fully adjusted: OR = 2.15 (CI 1.33–3.49)

Note: ^aStudy participants are aged 65 and above unless otherwise specified.

^b% women not shown.

^c95 % for all studies.

^dAll ages.

^eRate ratio.

^fRelative risk.

^gSee article for results for lifetime diagnoses.

^h95 % CI not specified, but does not include 100.

Table 3. Clinical studies.

Authors, year, country	Physical factor (measure of physical factor	Sample^a N and % women Outcome and n	Strength of association
Hirsch et al., 2007 USA	Burden of illness (CIRS) (Linn, Linn, & Gurel, 1968) Functional status (activity) (Karnofsky & Burchenal, 1949)	Primary care patients. N = 462 (63% women) Suicide ideation n = 37	CIRS: Mean: 7.37 (SD 2.87), bivariate correlation: .14, p = <0.05); Step 1: OR = 0.95 (CI^b 0.79–1.14), Unstandardized B (SE): –0.05 (0.09), Wald score: 0.25; Step 2: OR = 0.95 (CI 0.79–1.15), Unstandardized B (SE): –0.05 (0.10), Wald score: 0.29 Activity: Mean: 8.55 (SD 2.81), bivariate correlation: .14, p = <0.05); Step 1: OR = 1.10 (CI 0.93–1.31), Unstandardized B (SE): 0.09 (0.09), Wald score: 1.28; Step 2: OR = 1.16 (CI 0.97–1.40), Unstandardized B (SE): 0.16 (0.09), Wald score: 2.71
Kim et al., 2006 USA	Three self-reported physical conditions	Primary care patients screened for depression. N = 355 (75% women) Past year wishes to die n = 44	Myocardial infarction: Model 1: OR = 2.61 (CI 1.31–5.19); Model 2: OR = 3.17 (CI 1.52–6.60); Model 3: OR = 2.45 (CI 1.03–5.85); Model 4: OR = 3.32 (CI 1.26–8.75). Urinary incontinence: Model 1: OR = 2.59 (CI 1.31–5.10); Model 2: OR = 2.36 (CI 1.17–4.77); Model 3: OR = 1.88 (CI 0.88–4.17); Model 4: OR = 1.90 (CI 0.81–4.46) Stroke: Model 1: OR = 2.31 (CI 1.12–4.79); Model 2: OR = 2.82 (CI 1.31–6.06); Model 3: 3.08 (CI 1.23–7.71); Model 4: OR = 2.38 (CI 0.90–6.29)
Levy et al., 2011 Israel	Mean total CIRS score (Cumulative Illness Rating Scale) (Linn et al., 1968)	Geriatric hospital admissions. N = 165 (64% women) Suicide attempt n = 78	Mean total CIRS score: Unadjusted: 10.2 ± 3.6 vs. 8 ± 4.3, p = 0.0008; Adjusted: 10.8 vs. 7.5, p = <0.0001
Raue et al., 2007 USA	Medical comorbidity (Charlson Comorbidity Index) (Charlson, Pompei, Ales, & MacKenzie, 1987) Activities of daily living limitations (Lawton ADL scales) (Lawton, Moss, Fulcomer, & Kleban, 1982) Instrumental activities of daily living limitations Vision impairment Pain (SF-36) (Ware & Sherbourne, 1992)	Random sample, new admissions visiting nursing services. N = 539 (65% women) Passive suicidal ideation n = 57 Active suicidal ideation n = 6	Medical comorbidity: Passive SI: mean 3.6 (SD 2.4); Active SI: mean 3.7 (SD 2.7); No SI: mean 2.5 (SD 2.0), p = 0.001 (significant difference between passive SI and no SI). Multiple logistic regression OR = 1.17 (CI 1.02–1.35) Activities of daily living limitations: Passive SI mean = 1.5 (SD 1.6); Active SI mean = 0.7 (SD 0.5); No SI mean = 1.0 (SD 1.3). p = 0.017 (significant difference between passive SI and no SI). Multiple logistic regression OR = 1.07 (CI 0.83–1.38). p = 0.587 Instrumental activities of daily living limitations: Passive SI mean = 3.9 (SD 1.3); Active SI mean = 2.8 (SD 2.0); No SI mean = 3.2 (SD 1.5). p = 0.005. Multiple logistic regression OR = 1.17 (CI 0.89–1.54) Vision impairment: Passive SI 9.4%; Active SI 20.0%; No SI 5.5%. P = 0.130 ‘A great deal’ of pain: Passive SI 48.2%; Active SI 33.3%; No SI 26.0 %. p = 0.002 (significant difference between passive SI and no SI). Multiple logistic regression: OR = 1.32 (CI 0.69–2.53)
Takahashi et al., 1995 Japan	Physical illness (case note review) Malignant illnesses (case note review)	Geriatric hospital admissions N = 100^c Suicide attempt n = 50	Physical illness: Suicide attempt: 82%; No suicide attempt: 86%, p = NS Malignant illnesses: Suicide attempt: 10% in cases; No suicide attempt: 16%, p = NS
Tan & Wong, 2008 Singapore	Number of medical conditions	Geriatric psychiatry inpatients and outpatients with depression N = 80 (69% women) Past week suicidal thinking n = 43	≥2 medical conditions: Suicidal thinking: 53%, No suicidal thinking: 47%, p = 1.000 ≥3 medical conditions: Suicidal thinking: 57.1%, No suicidal thinking: 42.9%, p = 1.000
Tsoh et al., 2005 Hong Kong	Number of physical illnesses Instrumental activities of daily living (Instrumental Activities of Daily Living Scale) (Lawton & Brody, 1969) five specific physical conditions	Consecutive admissions from one hospital of persons who attempted suicide. Community-comparison respondents. N = 158 (60% women) Suicide attempt n = 66	Number of physical illnesses: Unadjusted: OR = 2.6 (CI 1.8–3.7) Instrumental activities of daily living: Unadjusted: OR = 0.1 (CI 0.04–0.2); Adjusted: OR = 0.3 (95% CI 0.1–0.7) Diabetes mellitus: Unadjusted: OR = 3.3 (CI 1.4–7.6) Stroke: Unadjusted: OR = 11.8 (CI 3.3–42.1) Arthritis: Unadjusted: OR = 4.6 (CI 2.1–9.9); Adjusted: OR = 22.6 (CI 3.2–157.3) Bone fracture: Unadjusted: OR = 20.0 (CI 2.5–158.1) Malignancy: Unadjusted: OR = 5.2 (CI 1.4–19.9)

Abbreviations: NS: Not significant.

Note: ^aStudy participants are aged 65 and above unless otherwise specified.

^b95 % for all studies. ^c % women not shown.

Table 4. Post-mortem studies.

Authors, year, country	Physical factor (measure of physical factor	Sample^a N and % women Outcome and n	Strength of association
Jia et al., 2014 China	Physical illnesses (informant or comparison subjects report)	Suicide cases (informant psychological autopsy interviews). Comparison cases with similar demographics. N = 179^b Suicide n = 92	Physical illness (yes vs. no): Unadjusted: OR = 3.11 (CI^c 1.47–6.59); Adjusted: OR = 3.44 (CI 1.44–8.24) One physical illnesses: Unadjusted: OR = 2.64 (CI 1.14–6.11); Adjusted: OR = 2.94 (CI 1.12–7.72) Two physical illnesses: Unadjusted: OR = 3.44 (CI 1.38–8.57); Adjusted: OR = 4.02 (CI 1.40–11.53) Three or more physical illnesses: Unadjusted: OR = 10.67 (CI 1.94–58.63); Adjusted: OR = 4.08 (CI 0.64–25.88)
Rubenowitz, Waern, Wilhelmson, & Allebeck, 2001^d Sweden	Somatic illness (Paykel Recent Life Change Questionnaire) (Paykel et al., 1969)	Consecutive suicide cases undergoing forensic examination. Comparison cases with similar demographics. N = 238 (46% women) Suicide n = 85	Somatic illness (Paykel): Men and women: 0–6 months preceding suicide: OR = 2.8 (CI 1.5–5.2); 7–12 months: OR = 2.2 (CI 1.2–3.9); 13–24 months: OR = 2.1 (CI 1.2–3.7); 0–24 months: OR = 2.3 (CI 1.2–4.4); Men: 0–6 months preceding suicide: OR = 3.4 (CI 1.4–8.1); 7–12 months: OR = 2.6 (CI 1.1–5.9); 13–24 months: OR = 2.2 (CI 1.0–4.8); 0–24 months: OR = 3.2 (CI 1.3–7.9); Women: 0–6 months preceding suicide: OR = 2.2 (CI 0.9–5.5); 7-12 months: OR = 1.9 (CI 0.8–4.4); 13–24 months: OR = 2.1 (CI 0.9–4.9); 0–24 months: OR = 1.7 (CI 0.7–4.1)
Tsoh et al., 2005 Hong Kong	Number of physical illnesses Hospitalization in past 3 months for physical disorder(s) Instrumental activities of daily living (Lawton & Brody, 1969) Four specific physical conditions	Suicide cases (informant psychological autopsy interviews). Community-comparison respondents. N = 158 (56% women) Suicide n = 67	Number of physical illnesses: Unadjusted: OR = 1.9 (CI 1.4–2.6) Hospitalization in past 3 months for physical disorder(s): Unadjusted: OR = 6.8 (CI 3.1–14.7) Instrumental activities of daily living: Unadjusted OR = 0.2 (CI 0.1–0.4); Adjusted OR = 0.2 (CI 0.06–0.7) Chronic obstructive airway disease (COAD): Unadjusted OR = 2.6 (CI 1.1–6.4) Arthritis: Unadjusted: OR = 2.4 (CI 1.1–5.5); Adjusted: OR = 11.5 (CI 2.4–56.1) Bone fracture: Unadjusted: OR = 15.7 (CI2.0–125.0) Malignancy: Unadjusted: OR = 7.7 (CI 2.1–28.2); Adjusted: OR = 24.3 (CI 2.8–214.1)
Waern et al., 2002^d Sweden	Serious physical condition (Cumulative Illness Rating Scale-Geriatrics) (Miller et al., 1992) (a rating of ≥3) Overall physical burden score >10	Consecutive suicide cases undergoing forensic examination. Comparison cases with similar demographics. N = 238 (46% women) Suicide n = 85	Any serious physical condition: Men and women: OR = 3.0 (CI 1.6–5.5); Multivariate logistic regression: OR = 6.4 (CI 2.0–20.0); Men: OR = 4.2 (CI 1.8–9.5); Women: OR = 2.1 (CI 0.8–5.3) Overall physical burden score >10: Men and women: OR = 1.4 (CI 0.7–2.7); Men: OR = 2.8 (CI 1.2–6.5); Women: OR = 0.4 (CI 0.1–1.4) Eyes, ears, nose, throat: OR = 6.6 (CI 2.4–17.9) Visual impairment: OR = 7.0 (CI 2.3–21.4). Multivariate logistic regression: OR = 11.4 (CI 2.4–54.5) Heart: OR = 1.0 (CI 0.4–2.5) Vascular: OR = 1.1 (CI 0.3–4.0) Haematopoietic: OR = 3.2 (CI 0.2–53.9) Respiratory: OR = 0.7 (CI 0.1–3.5) Lower gastrointestinal track: OR = 3.3 (CI 0.7–14.8) Renal: OR = 2.2 (CI 0.1–39.7) Upper gastrointestinal tract: OR = 6.4 (CI 0.5–79.2) Genitourinary: OR = 3.0 (CI 1.0–9.0) Endocrine/metabolic: OR = 2.7 (CI 0.6–11.4) Stroke: OR = 2.8 (CI 1.0–8.3) Neurological: OR = 3.8 (CI 1.5–9.4); Multivariate logistic regression: OR = 9.0 (CI 2.0–40.1) Musculoskeletal: OR = 1.6 (CI 0.7–3.9) Malignancy: OR = 3.4 (CI 1.2–9.8); Multivariate logistic regression: OR = 4.7 (CI 1.2–18.2)
Waern, Rubenowitz, & Wilhelmson, 2003d Sweden	Somatic disorder (Cumulative Illness Rating Scale-Geriatrics (Miller et al., 1992) (a rating of ≥3)	Consecutive suicide cases undergoing forensic examination. Comparison cases with similar demographics. N = 238 (46% women) Suicide 65–74 n = 47; 75+ n = 38^e	Somatic illness: 65-74 years: OR = 2.2 (CI 0.9–5.5); 75+: OR = 3.5 (CI 1.3–9.7) Serious somatic disorder: 65–74 years: OR = 2.0 (CI 0.8–5.0); 75+: OR = 4.5 (CI 1.7–11.8); Final logistic regression model: OR = 5.2 (CI 1.1–24.2)

Note: ^aStudy participants are aged 65 and above unless otherwise specified.

^b% women not shown.

^c95 % for all studies.

^dSubstudies from same psychological autopsy study.

^eFor results for specific conditions (all NS), see article.

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