154047 Physical illness and suicide among older adults

Tuesday, November 6, 2007

Matthew Miller, MD, ScD , Health Policy and Management, Harvard School of Public Health, boston, MA
Helen Mogun, MS , Division of Pharmacoepidemiology, Harvard University, Brigham and Women's Hospital, Boston, MA
Deborah Azrael, PhD , Harvard School of Public Health, Boston, MA
Katherine Hempstead, PhD , Center for Health Statistics, New Jersey Department of Health and Senior Services, Trenton, NJ
Daniel H. Solomon, MD, MPH , Division of Pharmacoepidemiology, Harvard University, Brigham and Women's Hospital, Boston, MA
CONTEXT: Older adults have higher rates of suicide and medical illness than any other age group. It is unclear, however, whether physical illness independently contributes to the risk of elder suicide. OBJECTIVE: To determine whether specific physical illnesses are associated with an increased risk of suicide. DESIGN: Case-control study. SETTING AND PATIENTS: A total of 1408 New Jersey residents aged 65 years or older and enrolled in Medicare and the Pharmacy Assistance for the Aged and Disabled program. Case patients (n=128) died by suicide during the study period, 1994-2002. Control patients (n=1280) were frequency-matched to case patients (10:1) for age and sex. MAIN OUTCOME MEASURE: Adjusted odds ratio (OR) of suicide adjusted for age, sex, race, medical and psychiatric comorbidity, and use of prescription medications, including antidepressants and other psychoactive drugs. RESULTS: Most suicide victims and controls had identifiable physical illnesses (68% of suicides vs. 63% of controls). Suicides were significantly more likely to have several distinct physical illnesses in unadjusted analyses, but in adjusted analyses only malignancy remained associated with suicide (OR=2.3, 95% CI 1.1 4.8). Suicide also remained associated with affective disorders (OR 2.3, 95% CI 1.3 4.2), anxiety/personality disorders (OR 2.2, 95%CI 1.3 3.6), and treatment with antidepressants (OR=2.0, 95% CI 1.2, 3.2) and opioid analgesics (OR 1.6, 95%CI 1.0 -2.5). CONCLUSION: Our findings support an association between malignancy and suicide in older Americans.

Learning Objectives:
1. Recognize discrete physical illnesses that are associated with an increased risk of suicide 2. Discuss the influence of controlling for mental illness on the association of physical illness and suicide. 3. Describe opportunities for intervention to decrease the risk of suicide among older adults

Keywords: Suicide, Elderly

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.