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Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

      Objective

      The current study aims to examine the risk of suicide in persons diagnosed with dementia during a hospitalization and its relationship to mood disorders.

      Design

      Event-history analysis using time-varying covariates.

      Setting

      Population-based record linkage.

      Participants

      All individuals aged 50+ living in Denmark (N = 2,474,767) during January 1, 1990 through December 31, 2000.

      Measurements

      Outcome of interest is suicide. Relative risks are calculated based on person-days spent in each stratum.

      Results

      A total of 18,648,875 person-years were observed during the 11-year study period. During this period, 136 persons who previously had been diagnosed with dementia died by suicide. Men and women aged 50–69 years with hospital presentations of dementia have a relative suicide risk of 8.5 (95% confidence interval: 6.3–11.3) and 10.8 (95% confidence interval: 7.4–15.7), respectively. Those who are aged 70 or older with dementia have a threefold higher risk than persons with no dementia. The time shortly after diagnosis is associated with an elevated suicide risk. The risk among persons with dementia remains significant when controlling for mood disorders. As many as 26% of the men and 14% of the women who died by suicide died within the first 3 months after being diagnosed whereas 38% of the men and 41% of the women died more than 3 years after initial dementia diagnosis.

      Conclusions

      Dementia, determined during hospitalization, was associated with an elevated risk of suicide for older adults. Preventive measures should focus on suicidal ideation after initial diagnosis but also acknowledge that suicides can occur well after a dementia diagnosis has been established.

      Key Words

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      References

        • Zarit SH
        • Zarit J
        Dementia, delirium and other cognitive problems.
        in: Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment. Guildford Press, New York2006: 40-77
        • Ferri CP
        • Prince M
        • Brayne C
        • et al.
        Global prevalence of dementia: a Delphi consensus study.
        Lancet. 2005; 366: 2112-2117
        • Population Reference Bureau
        Trends in ageing, by world region. 2006.
        (Accessed October 26, 2006)
        • Sørensen J
        • Gudex C
        • Andersen C
        Demenssygdommes fremtidige økonomiske belastning af social-og sundhedsvæsnet [The future economic burden of dementia on the Danish health and social services].
        Ugeskr Laeger. 2006; 168: 3432-3436
        • Harwood D
        • Jacoby R
        Suicide behaviour among the elderly.
        in: Hawton K van Heeringen K The International Handbook of Suicide and Attempted Suicide. John Wiley & Sons Ltd, West Sussex, United Kingdom2000: 275-291
        • Margo GM
        • Finkel JA
        Early dementia as a risk factor for suicide.
        Hosp Community Psychiatry. 1990; 41: 676-678
        • Cina SJ
        • Smith MT
        • Collins KA
        • et al.
        Dyadic deaths involving Huntington's disease.
        Am J Forensic Med Pathol. 1996; 17: 49-52
        • Ferris SH
        • Hofeldt GT
        • Carbone G
        • et al.
        Suicide in two patients with a diagnosis of probable Alzheimer disease.
        Alzheimer Dis Assoc Disord. 1999; 13: 88-90
        • Vega U
        • Kishikawa Y
        • Ricanati E
        • et al.
        Suicide and Alzheimer disease.
        Am J Geriatr Psychiatry. 2002; 10: 484-485
        • Lim WS
        • Rubin EH
        • Coats M
        • et al.
        Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages.
        Alzheimer Dis Assoc Disord. 2005; 19: 214-219
        • Harris EC
        • Barraclough B
        Suicide as an outcome for mental disorders. A meta-analysis.
        Br J Psychiatry. 1997; 170: 205-228
        • Schneider B
        • Maurer K
        • Fröhlich L
        Demenz und Suizid.
        Fortschr Neurol Psychiatr. 2001; 69: 164-169
        • Erlangsen A
        • Mortensen PB
        • Vach W
        • et al.
        Psychiatric hospitalization and suicide among the very old in Denmark: population-based register study.
        Br J Psychiatry. 2005; 187: 43-48
        • Erlangsen A
        • Zarit SH
        • Tu X
        • et al.
        Suicide among older psychiatric inpatients: an evidence-based study if a high-risk group.
        Am J Geriatr Psychiatry. 2006; 14: 734-741
        • Lyness JM
        • Conwell Y
        • Nelson JC
        Suicide attempts in elderly psychiatric inpatients.
        J Am Geriatr Soc. 1992; 40: 320-324
        • Chiu HFK
        • Lam LCW
        • Pang AHT
        • et al.
        Attempted suicide by Chinese elderly in Hong Kong.
        Gen Hosp Psychiatry. 1996; 18: 444-447
        • Tsai CF
        • Tsai SJ
        • Yang CH
        • et al.
        Chinese demented inpatients admitted following a suicide attempt: a case series.
        Int J Geriatr Psychiatry. 2007; 22: 1106-1109
        • Draper B
        • MacCuspie-Moore C
        • Brodaty H
        Suicidal ideation and the ‘wish to die’ in dementia patients: the role of depression.
        Age Ageing. 1998; 27: 503-507
        • Rubio A
        • Vestner AL
        • Stewart JM
        • et al.
        Suicide and Alzheimer's pathology in the elderly: a case-control study.
        Biol Psychiatry. 2001; 49: 137-145
        • Barak Y
        • Aizenberg D
        Suicide amongst Alzheimer's disease patients: a 10-year survey.
        Dement Geriatr Cogn Disord. 2002; 14: 101-103
        • Turnbull Q
        • Wolf AM
        • Holroyd S
        Attitudes of elderly subjects towards “truth telling” for the diagnosis of Alzheimer's disease.
        J Geriatr Psychiatry Neurol. 2003; 16: 90-93
        • Snowdon J
        • Baume P
        A study of suicide of older people in Sydney.
        Int J Geriatr Psychiatry. 2002; 17: 261-269
        • Nilsson FM
        • Kessing LV
        • Sørensen TM
        • et al.
        Enduring increased risk of developing depression and mania in patients with dementia.
        J Neurol Neurosurg Psychiatry. 2002; 73: 40-44
        • Vinkers DJ
        • Gussekloo J
        • Stek ML
        • et al.
        Temporal relation between depression and cognitive impairment in old age: prospective population based study.
        BMJ. 2004; 329: 881-883
        • Chodosh J
        • Kado DM
        • Seeman TE
        • et al.
        Depressive symptoms as a predictor of cognitive decline: MacArthur studies of successful aging.
        Am J Geriatr Psychiatry. 2007; 15: 406-415
        • Hendrie HC
        Epidemiology of dementia and Alzheimer's disease.
        Am J Geriatr Psychiatry. 1998; 6: S3-S18
        • Kessing LV
        • Nielsson FM
        Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses.
        J Affect Disord. 2003; 73: 261-269
        • Erlangsen A
        • Vach W
        • Jeune B
        The effect of hospitalization with medical illnesses on suicide risk in the oldest old: a population-based register study.
        J Am Geriatr Soc. 2005; 53: 771-776
        • Conwell Y
        Dementia.
        Crisis. 1995; 16: 5
        • Lorke DE
        • Lu G
        • Cho E
        • et al.
        Serotonin 5-HT2A and 5-HT6 receptors in the prefrontal cortex of Alzheimer and normal aging patients.
        BMC Neurosci. 2006; 7: 36
        • Mann JJ
        Role of the serotonergic system in the pathogenesis of major depression and suicidal behavior.
        Neuropsychopharmacology. 2005; 21: 99-105
        • Mann JJ
        • Waternaux C
        • Haas GL
        • et al.
        Toward a clinical model of suicidal behavior in psychiatric patients.
        Am J Psychiatry. 1999; 156: 181-186
        • Hooyman NR
        • Kiyak HA
        Personality and social adaptation in old age.
        in: Social Gerontology. A Multidisciplinary Perspective. Allyn and Bacon, Boston1995: 210-222
        • Anstey KJ
        • von SC
        • Sargent-Cox K
        • et al.
        Prevalence and risk factors for depression in a longitudinal, population-based study including individuals in the community and residential care.
        Am J Geriatr Psychiatry. 2007; 15: 497-505
      1. International Statistical Classification of Diseases and Related Health Problems. 8th Rev. World Health Organisation, Geneva1965
      2. International Statistical Classification of Diseases and Related Health Problems. 10th Rev. World Health Organisation, Geneva1992
        • Charlson ME
        • Pompei P
        • Ales KL
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Deyo RA
        • Cherkin DC
        • Ciol MA
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Sundararajan V
        • Henderson T
        • Perry C
        • et al.
        New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.
        J Clin Epidemiol. 2004; 57: 1288-1294
        • Elandt-Johnson R
        • Johnson N
        Survival Models and Data Analysis. John Wiley & Sons, New York1999
        • Allison PD
        Event History Analysis. Regression for Longitudinal Event Data. Sage Publications, Newbury Park1984
      3. SAS System for SunOP. SAS Institute Inc., Cary, NC2003
        • Lillard LA
        • Panis CWA
        Multiprocess Multilevel Modeling aML. Ver 2. EconWare, Los Angeles, CA2003
        • Neugarten BL
        Dynamics of transition of middle age to old age.
        J Geriatr Psychiatry. 1970; 4: 71-87
        • Conwell Y
        • Duberstein PR
        • Cox C
        • et al.
        Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study.
        Am J Psychiatry. 1996; 153: 1001-1008
        • Peisah C
        • Snowdon J
        • Gorrie C
        • et al.
        Investigation of Alzheimer's disease-related pathology in community dwelling older subjects who committed suicide.
        J Affect Disord. 2007; 99: 127-132
        • Kolmos L
        • Bach E
        Sources of error in registering suicide.
        Acta Psychiatr Scand Suppl. 1987; 76: 22-43