Recognizing that males age 75 and older have the highest rates of
suicide in nearly all industrialized countries, the International
Psychogeriatric Association’s Task Force on Late-Life Suicide promotes
increasing scientific knowledge of the epidemiology, risk factors, and
clinical management of late life suicidal behavior. This IPA task force has
supported a number of workshops and symposia on late life suicide at recent
Congresses and other international meetings. Publications from these
presentations highlight a number of important findings: Older suicides are
more likely than younger suicides to have late-onset, affective disorders, and
alcohol use is less common than in younger suicides. Older suicide victims
often have not received psychiatric care, but rather have visited a primary
care provider prior to their suicide, suggesting an opportunity for screening
and prevention. Thus, the task force is currently focusing on prevention of
suicidal behavior through adequate treatment of late life depression in
primary care.
Suicide in Late Life: Education About Prevention The IPA Task
Force on Suicide in Late Life has sponsored several workshops. The first took
place in Sydney, Australia, as part of the IPA Seventh International Congress
in October 1995. Participants reviewed methodologies and research approaches
to the study of late-life suicide.
More recently, the task force sponsored two activities at the Tenth World
Congress of Psychiatry in Madrid, Spain. A forum entitled "The Final Days:
Suicide and Unrecognized Psychopathology" presented perspectives on primary
care physicians' ability to recognize psychopathology in at-risk elderly
persons from several researchers: Dr. Diego DeLeo (from Italy), Dr. James
Lindesay (from the United Kingdom), Dr. Markus Henriksson (from Finland), and
Dr. Yeates Conwell (from the United States). Dr. Eric Caine chaired the forum.
The IPA-sponsored workshop at Madrid entitled "Physical Illness and
Late-Life Suicide: Implications and Interventions" considered depression in
the elderly presenting in primary care settings, as well as approaches to
interventions to detect and treat depression in primary care. In the first
part of the workshop, rates of depression and physical illness occurring in
completed suicides, suicide attempters, and persons attending primary care
clinics were considered. Dr. Yeates Conwell and Dr. Eric Caine (both from the
University of Rochester, NY, USA), presented data on rates of physical illness
and depressive symptoms in completed suicides, as well as rates of depressive
symptoms among patients in primary care settings. Dr. Markus Henriksson of the
National Public Health Institute of Helsinki described the rates of primary
care contact of elderly suicides and their physical and psychiatric diagnoses.
Dr. Evaristo Nieto of Barcelona Hospital, Spain, described the physical and
psychiatric illness characteristics of consecutively hospitalized elderly
suicide attempters.
In the second part of the workshop, a number of interventions to detect and
treat depression were reviewed. Dr. Wolfgang Rutz presented the initial impact
and follow-up of an intervention conducted on the island of Gotland, Sweden.
In this famous study, all primary care physicians on the island were trained
to detect and more aggressively treat depression. Suicide rates were found to
decrease over the following 2 years, but to increase in later years to rates
again comparable to those in the rest of Sweden. Dr. James Lindesay of
Leicester University reviewed the changes in primary care and practice
policies in the United Kingdom that have made screening for depression among
the elderly more routine. Dr. Diego DeLeo reviewed the Tele-Help/Tele-Check
service in the Venero region of Italy and the success of telephone case
management in reducing suicide rates and inappropriate health service use
among the elderly. Dr. S. Rajukumar provided an overview of suicide prevention
needs in India. These include the challenge of the legalities of suicidal
behavior and how they discourage help-seeking, as well as the many other
competing public healthcare demands in a developing nation.
Dr. James Lindesay and Dr. Jouko Lonnqvist (from Helsinki) had the
challenging task of trying to summarize the limitations of both sets of
presentations. Dr. Lindesay described how the lesson of screening for
Alzheimer's disease could be adapted to screening for depression in the
elderly as a measure of improved care, with the possible consequence of lower
suicide rates. Dr. Lonnqvist considered the challenge of intervention studies
to decrease suicides, given that the goal is to further decrease an already
low base-rate behavior, and the difficulty of obtaining appropriate control
groups. Co-chairs Dr. Eric Caine and Jane Pearson, PhD (from the National
Institute of Mental Health, United States), also discussed research strategies
to deal with these challenges, such as assessing depression dimensionally in
primary care and considering suicidal ideation as well as attempts and
completion.
Suicide in Late Life: Focus Is on Development of Intervention Strategies
and Research
The IPA Task Force on Suicide in Late Life, chaired by Dr. Eric Caine,
is continuing its work to develop and disseminate strategies to prevent
suicide in late life, and to identify working principles and preventative
intervention research with regard to late-life suicide.
Older males are at the greatest risk for suicide in almost all
industrialized nations. The rapid changes in the political and social scene
in eastern Europe have produced large changes in suicide rates in varying
age and gender groups. Psychological autopsy research suggests that older
suicides typically have late onset depression, are in contact with friends
and family, and often present to primary care practitioners within a month
of death.
Efforts are needed to capitalize on this knowledge and to develop
preventative strategies. Swedish studies have suggested that improving
primary care practitioners’ knowledge of assessment and treatment of
depression can reduce suicide rates, while Italian and Japanese studies have
indicated that the role of family members is crucial in identifying and
helping older depressed people obtain appropriate treatment. Indian reports
have described how known effective interventions must be adapted to
particular health, legal, and cultural circumstances.
The task force intends to explore whether there are identifiable risk
factors for late-life suicide and, based on these, what promising
intervention strategies can be identified. Subsequent evaluation of these
interventions may address the reliability and validity of identified risk
factors, proposed interventions, and evaluations in a variety of cultures.
Late-Life Suicide Book Now Available Suicide and Aging:
International Perspectives,” a special issue of International Psychogeriatrics
from summer 1995 (Volume 7, Number 2), is now a book.
In August, Springer Publishing Company reissued Volume 7, Number 2 of the
journal as a hardbound book entitled Suicide and Aging: International
Perspectives. The book contains the same material as the special journal
issue, which was edited by Jane L. Pearson, PhD, of the National Institute of
Mental Health, and Yeates Conwell, MD, of the University of Rochester Medical
Center.
IPA hopes that this publication will draw lasting and productive attention
to the important but often overlooked problem of late-life suicide. In nearly
all industrialized countries, suicide rates rise significantly in old age, and
suicide is more likely among men than women. Relatively little is known about
the reasons that age and gender risk factors are consistent across cultures or
about the reasons that some other factors are more variable. Suicide and Aging
may stimulate further questions and in turn lead to improved prevention and
intervention efforts.
Chapter topics include the epidemiology of suicide; patterns of psychiatric
diagnosis; cultural influences on aging and suicide; suicide, life course, and
life story; psychobiology; mental disorders, especially depression, in elderly
suicide; recent life events and suicide; changes in suicide rates; differences
in urban and rural suicide rates; and directions for future research. There is
a strong international focus; the chapters deal with late-life suicide in
Australia, Eastern Europe, Finland, Germany, Japan, Singapore, the United
Kingdom, and the United States.
Suicide and Aging (254 pages, $43.95 hardcover, ISBN 08261-93706)
may be ordered from Springer Publishing Company, 536 Broadway, New York, NY
10012 USA, fax 1 +212.941.7842.
Suicide and Aging: International Perspectives, Jane L. Pearson, PhD,
Yeates Conwell, MD, Editors Table of Contents
Contributors
vii
Foreword
ix
Introduction
Suicide in Late Life: Challenges and
Opportunities for Research - Jane L. Pearson and Yeates Conwell
xi
Part I: North American
Perspectives
1. Epidemiology of Suicide
3
Eve K. Moscicki
2. Suicide and Aging I: Patterns
of Psychiatric Diagnosis
15
Yeates Conwell and David Brent
3. Suicide and Aging II: The
Psychobiological Interface
31
Yeates Conwell, Wilfrid N. Raby, and
Eric D. Caine
4. Openness to Experience and
Completed Suicide Across the Second Half of Life
49
Paul R. Duberstein
5. Suicide, Life Course, and Life
Story
65
Bertram J. Cohler and Michael J.
Jenuwine
6. Six Elderly Suicides in a
1-Year Period in a Rural Midwestern Community
87
Sanford I. Finkel and Marshall Rosman
Part II: International
Perspectives
7. Reflections on Cultural
Influences on Aging and Old-Age Suicide in Germany
99
Reinhard Schmitz-Scherzer
8. Suicide and Aging in Japan: An
Examination of Treated Elderly Suicide Attempters
107
Yoshitomo Takahashi, Hideto Hirasawa,
Keiko Koyama, Osamu, Asakawa, Matazo Kido, Hiroshi Onose, Masahiko
Udagawa, Yoshihiro Ishikawa, and Masato Uno
9. Suicide in Later Life in
Japan: Urban and Rural Differences
121
Naoki Watanabe, Kazuo Hasegawa, and Yoko
Yoshinaga
10. Suicide in the Elderly: The
United Kingdom Perspective
131
Michael S. Dennis and James Lindesay
11. Mental Disorders in Elderly
Suicide
143
Markus M. Henriksson, Mauri J.
Marttunen, Erkki T. Isomets, Martti E. Heikkinen, Hillevi M.Aro, Kimmo
I. Kuoppasalmi, Jouko K. Lönnqvist
12. Recent Life Events in Elderly
Suicide: A Nationwide Study in Finland
155
Martti E. Heikkinen and Jouko K.
Lönnqvist
13. Recent Changes in Suicide
Rates in Selected Eastern European and Other European Countries
169
Norman Sartorius
14. Ethnicity and Elderly Suicide
in Singapore
177
Soo Meng Ko and Ee Heok Kua
15. Suicide in the Multiethnic
Elderly Population of Australia, 1979 Other 16 Peter Walter
Burvill
Part III: Commentaries
16. From a Cultural Stance:
Suicide and Aging in a Changing World
205
Ellen Corin
17. Future Directions for
Research on Late-Life Suicide
