Physical illness and suicide among older adults

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.