Medline ® Abstracts for References 48-51

Fifty outpatients with concurrent psychiatric and physical illness who were referred following a suicidal attempt to the Outpatient Psychiatric Department, University of Athens, during a period of 3 years (1979-1981) were compared with a random sample of 85 psychiatric outpatients without concurrent physical illness who had attempted suicide at the same time period. Attempters suffering from both mental and physical illness were more often of an older age, married, pensioners or housewifes, were living with their own family, were suffering from organic psychotic condition or major affective disorder (depressive type) and more frequently used violent methods for attempting suicide. Among attempters the commonest physical illnesses were neurological diseases (40%), cardiovascular diseases (26%) and cancer (10%).

BACKGROUND: Suicide is a leading cause of death, and rates are especially high among the elderly. Medical illnesses may predispose to suicide, but few controlled studies have examined the association between specific diseases and suicide. We explored the relationship between treatment for several illnesses and the risk of suicide in elderly patients using a population-based approach.

METHODS: All Ontario residents 66 years or older who committed suicide between January 1, 1992, and December 31, 2000, were identified from provincial coroners' records. Their prescription records during the preceding 6 months were compared with those of living matched controls (1:4) to determine the presence or absence of 17 illnesses potentially associated with suicide.

RESULTS: During the 9-year study period, we identified 1354 elderly patients who died of suicide. The most common mechanisms involved firearms (28%), hanging (24%), and self-poisoning (21%). Specific illnesses associated with suicide included congestive heart failure (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.33-2.24),chronic obstructive lung disease (OR, 1.62; 95% CI, 1.37-1.92), seizure disorder (OR, 2.95; 95% CI, 1.89-4.61), urinary incontinence (OR, 2.02; 95% CI, 1.29-3.17), anxiety disorders (OR, 4.65; 95% CI, 4.07-5.32), depression (OR, 6.44; 95% CI, 5.45-7.61), psychotic disorders (OR, 5.09; 95% CI, 3.94-6.59), bipolar disorder (OR, 9.20, 95% CI, 4.38-19.33), moderate pain (OR, 1.91; 95% CI, 1.66-2.20), and severe pain (OR, 7.52; 95% CI, 4.93-11.46). Treatment for multiple illnesses was strongly related to a higher risk of suicide. Almost half the patients who committed suicide had visited a physician in the preceding week.

CONCLUSIONS: Many common illnesses are independently associated with an increased risk of suicide in the elderly. The risk is greatly increased among patients with multiple illnesses. These data may help clinicians to identify elderly patients at risk of suicide and open avenues for prevention.

BACKGROUND: More effective prevention of suicide requires a comprehensive understanding of sociodemographic, psychiatric and somatic risk factors. Previous studies have been limited by incomplete ascertainment of these factors. We conducted the first study of this issue using sociodemographic and out-patient and in-patient health data for a national population.

METHOD: We used data from a national cohort study of 7,140,589 Swedish adults followed for 8 years for suicide mortality (2001-2008). Sociodemographic factors were identified from national census data, and psychiatric and somatic disorders were identified from all out-patient and in-patient diagnoses nationwide.

RESULTS: There were 8721 (0.12%) deaths from suicide during 2001-2008. All psychiatric disorders were strong risk factors for suicide among both women and men. Depression was the strongest risk factor, with a greater than 15-fold risk among women or men and even higher risks (up to 32-fold) within the first 3 months of diagnosis. Chronic obstructive pulmonary disease (COPD), cancer, spine disorders, asthma and stroke were significant risk factors among both women and men(1.4-2.1-fold risks) whereas diabetes and ischemic heart disease were modest risk factors only among men (1.2-1.4-fold risks). Sociodemographic risk factors included male sex, unmarried status or non-employment; and low education or income among men.

CONCLUSIONS: All psychiatric disorders, COPD, cancer, spine disorders, asthma, stroke, diabetes, ischemic heart disease and specific sociodemographic factors were independent risk factors for suicide during 8 years of follow-up. Effective prevention of suicide requires a multifaceted approach in both psychiatric and primary care settings, targeting mental disorders (especially depression), specific somatic disorders and indicators of social support.

BACKGROUND: Research suggests that people suffering from chronic pain have elevated rates of suicidality. With an ageing population, more research is essential to gain a better understanding of this association.

AIMS: To document the prevalence and correlates of chronic pain and suicide, and estimate the contribution of chronic pain to suicidality.

METHOD: Data from the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative household survey on 8841 people, aged 16-85 years, was analysed.

RESULTS: The odds of lifetime and past 12-month suicidality were two to three times greater in people with chronic pain. Sixty-five percent of people who attempted suicide in the past 12 months had a history of chronic pain. Chronic pain was independently associated with lifetime suicidality after controlling for demographic, mental health and substance use disorders.

CONCLUSIONS: Health care professionals need to be aware of the risk of suicidality in patients with chronic pain, even in the absence of mental health problems.