Suicide risk within 1 year of dementia diagnosis in older adults: a nationwide retrospective cohort study

Abstract

Background: Although severe dementia could protect against suicide death by decreasing a person’s capacity to implement a suicide plan, patients with early dementia may have better cognition, giving them more sustained insight into their disease and better enabling them to carry out a suicide plan. This study investigated suicide risk in older adults within 1 year of receiving a diagnosis of dementia. Methods: This study used National Health Insurance Service Senior Cohort data and included 36 541 older adults with newly diagnosed dementia (a Mini-Mental State Examination score ≤ 26 and a Clinical Dementia Rating score ≥ 1 or a Global Deterioration Scale score ≥ 3), including Alzheimer disease, vascular dementia and other/unspecified dementia, from 2004 to 2012. We selected older adults without dementia through 1:1 propensity-score matching using sex, age, comorbidities and index year, with follow-up throughout 2013. We estimated adjusted hazard ratios (AHRs) of suicide deaths within 1 year after diagnosis using a time-dependent Cox proportional hazards model. Results: We verified 46 suicide deaths during the first year after a dementia diagnosis. Older adults with dementia had an increased risk of suicide death compared to those without dementia (AHR 2.57; 95% confidence interval [CI] 1.49–4.44). Older adults with Alzheimer disease (AHR 2.50; 95% CI 1.41–4.44) or other/unspecified dementia (AHR 4.32; 95% CI 2.04–9.15) had an increased risk of suicide death compared to those without dementia. Patients with dementia but without other mental disorders (AHR 1.96; 95% CI 1.02–3.77) and patients with dementia and other mental disorders (AHR 3.22; 95% CI 1.78–5.83) had an increased risk of suicide death compared to patients without dementia. Patients with dementia and schizophrenia (AHR 8.73; 95% CI 2.57–29.71), mood disorders (AHR 2.84; 95% CI 1.23–6.53) or anxiety or somatoform disorders (AHR 3.53; 95% CI 1.73–7.21), respectively, had an increased risk of suicide death compared to patients with those conditions but without dementia. Limitations: This study examined only elderly patients in South Korea, a population with a substantially higher suicide rate than the global population. Caution must be exercised when generalizing the results to populations with dissimilar backgrounds. Conclusion: Patients with dementia had an increased risk of suicide death within 1 year after diagnosis compared to those without dementia.

Suicide among Older Adults with Dementia: Effects of Korea’s Long-Term Care Insurance System

“…Regarding ADL and cognitive functioning, the suicide rate among older adults with dementia was higher when their ADL and cognitive functioning were mild rather than severe. This is consistent with recent studies showing that older adults diagnosed with dementia very recently are more likely to attempt suicide [4,14,[16][17][18][19][20][21]. In Korea, a study assessing the effects of "a suicide prevention program" for older adults with mild dementia showed positive effects on perceived health conditions, social support, depression, and suicidal intentions over time [25].…”

“…Among the older adults who committed suicide due to dementia, the overall suicide attempts and suicide rates were higher among patients with mild dementia who had been recently diagnosed [14,[16][17][18]. Similarly, suicide attempts among these patients were higher than among older adults with light cognitive impairment [19][20][21].…”

“…Several studies have verified the cause of suicide in older people with dementia at the individual level [12][13][14][15][16][17][18][19][20][21]. According to the interpersonal theory of suicidal behavior, the most dangerous aspect of suicidal desire is the coexistence of both a thwarted belongingness-feeling disconnected from a social relationship-and a perceived burdensomeness-perceiving oneself as a burden on others [14].…”

“…LTCS: Long-Term Care Service.2 Income level: first quintile (Medical aid beneficiaries), second quintile (The NHI premium for the tenth quantile: first-third), third quintile (fourth-fifth), fourth quintile (sixth-eighth), and fifth quintile (ninth-tenth) 3. Activity Daily Limitation: Independent (score[13][14][15][16][17][18][19], partially dependent (score 20-26), and fully dependent (score 27-39) 4. Cognitive ability: Good (score 0-5) and Bad (score 6-10).…”

Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults

“…They verified 46 deaths by suicide during the 1st year after a dementia diagnosis. Older adults with dementia had an increased risk of death by suicide than those without dementia (31).…”