Mental Disorder in Elderly Suicides: A Case-Control Study

TLDR

The authors aimed to assess the importance of various psychiatric disorders in relation to suicide among individuals aged 65 or older. They used a psychological autopsy approach, interviewing 85 suicide cases and 153 living controls, and assigned DSM‑IV Axis I diagnoses from interviews and records. Nearly all suicide victims (97 %) had at least one Axis I disorder, with recurrent major depression and substance use disorders being the strongest risk factors, while other disorders also increased risk, indicating a heterogeneous psychiatric profile among elderly suicide victims.

Abstract

OBJECTIVE: The authors’ goal was to study the importance of different psychiatric disorders in relation to suicide in individuals 65 years old or older. METHOD: The psychological autopsy approach was used to study 85 cases of suicide among subjects who were 65 years old or older; 153 living comparison subjects from the same age group who were randomly selected from the tax register were interviewed face-to-face. Retrospective axis I diagnoses were made according to DSM-IV on the basis of interview data and medical records. RESULTS: Ninety-seven percent of the suicide victims fulfilled criteria for at least one DSM-IV axis I diagnosis, compared with 18% of the living comparison subjects. Recurrent major depressive disorder was a very strong risk factor for suicide, as was substance use disorder. An elevated risk was also associated with minor depressive disorder, dysthymic disorder, psychotic disorder, single-episode major depressive disorder, and anxiety disorder. Comorbid axis I disorders were observed in 15 (38%) of the 39 elderly subjects with major depressive disorder who had committed suicide. CONCLUSIONS: Although recurrent major depressive disorder was the mental disorder most strongly associated with suicide, the findings of this study suggest that elderly individuals who commit suicide represent a heterogeneous group with regard to mental disorders, implying a need for differentiated prevention strategies.