Suicide in the elderly: approach to social determinants of health in the Dahlgren and Whitehead model

Abstract

Objective: Identify in literature the social determinants of health related to suicide in the elderly, according to the model proposed by Dahlgren and Whitehead. Method: Integrative review of articles indexed in the databases BDENF, CINAHL, LILACS, and MEDLINE, with the following main descriptors: aged, suicide, social determinants of health, and risk factors. Primary studies were included which addressed social determinants of health and suicide in the elderly. Results: From the 19 articles analyzed, three categories emerged: proximal social determinants of health (male gender, mental disorders, physical illnesses, white race, 70-74 years old); intermediate social determinants of health (substance abuse, use of alcohol or psychotropic drugs, marital status, marital, social, and family problems, violence, previous suicide attempt, history of admission to psychiatric service); and distal social determinants of health (schooling, economic issues, sanitation, stressful events). Conclusion: Proximal determinants have more effects on suicide. Intermediate determinants are composed mainly of changeable factors. Distal determinants showed lesser associations.

Perfil geográfico, temporal, epidemiológico e toxicológico das vítimas idosas de suicídio no Rio Grande do Sul, Brasil, entre 2017 e 2019

“…De acordo com vários outros estudos, inclusive internacionais, o sexo masculino prevalece entre os idosos que se suicidam [1][2][3]8,10,[13][14][15]18,[23][24][25][30][31][32], apesar de a variável sexo não se mostrar associada à idade das vítimas, segundo dados do Canadá [33], o que foi igualmente observado no RS.…”

“…No que se refere à raça, os resultados obtidos nesse trabalho foram similares aos de 2002-2013 também no RS, assim como aos de Santa Catarina, Paraná [14] e EUA (1997-2011) [32]. Por outro lado, Debates em Psiquiatria, Rio de Janeiro, 2021; 11:1-28 https://doi.org/10.25118/2763-9037.2021.v11.205 possivelmente em função da maior prevalência de descendentes europeus, o percentual da raça branca entre os idosos que se suicidaram no RS foi maior que o observado no Brasil [2,15].…”

“…No que diz respeito ao consumo de bebidas alcoólicas e de outras substâncias psicoativas, já foram demonstradas associações com o suicídio de idosos nos EUA, Inglaterra, País de Gales, Cingapura e China [32], contudo esses estudos não trazem detalhamentos em relação às classes farmacológicas mais prevalentes.…”

“…Nesse aspecto, há de se destacar a importância da realização de exames periciais toxicológicos em todos os óbitos por suicídio. Para que haja ações no sentido de minimizar esses fatores passíveis de intervenção [32], é necessário que as relações entre as vítimas e o consumo de álcool e/ou medicamentos sejam melhor estabelecidas.…”

A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement

“…For example, Stanley et al (2016) comprehensively reviewed key extant psychological and sociological theories of suicide, discussing each theory's applicability to the understanding and prevention of suicide among older adults. Others have conducted reviews from sociological perspectives, exploring the social determinants of health related to suicide in later life (Carvalho et al, 2020), and the impact of socio-economic status (Ju et al, 2016), living environments (Li and Katikireddi, 2019;Dautovich et al, 2021) and gender (Canetto, 1992;Heisel et al, 2020) on suicide and related behaviours in later life. Building on this existing knowledge base, the present work adopts a systematic scoping review approach to develop a conceptual framework that describes the grey areas of ageing and suicide; with a view to articulating (a) how these behaviours are expressed/present themselves, (b) the risk factors in their development, and (c) how formal conceptualisation might frame a realm for engagement with older adults towards a better understanding of what informs suicide prevention and interventions.…”