Magazine article Clinical Psychiatry News

Suicidality Tied to Physical Disability, Pain, Isolation

Magazine article Clinical Psychiatry News

Suicidality Tied to Physical Disability, Pain, Isolation

Article excerpt

AT THE AAGP ANNUAL MEETING

NEW ORLEANS -- Suicidal thoughts and actions among the elderly seem to have diverse drivers such as physical disability, pain, and loneliness.

About 6% of those aged 65 years and older expressed a death wish or suicidal behavior, in a large population-based study. That number almost tripled among subjects who had high levels of functional disability, Dr. Margda Waern reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Waern, a psychiatrist at the University of Gothenburg, Sweden, discussed a pooled analysis of the EURODEP study, which examined the relationship between depressive symptoms and physical functioning in 14 cross-sectional European cohorts. EURODEP comprised almost 23,000 respondents aged 65 years and older and has been mined many times since its publication in 2005.

Dr. Waern examined data from 11 of the EURODEP studies, comprising 15,580 subjects. Most of the centers used the Katz Index of Independence in Activities of Daily Living scale to assess physical function. To harmonize the data on functional disability, Dr. Waern instead trichotomized them into no disability, intermediate disability, and high disability. She also examined a broad measure of suicidality--"death wishes"--which she said encompassed the continuum of suicidal thoughts to active ideation.

"We saw what I would call a very nice dose-response relationship between high levels of functional disability and death wishes," she said.

Dr. Waern teased out more detailed data with a multivariate regression model of 11,000 subjects. Functional disability remained a strong independent risk factor. Intermediate disability conferred a 60% increased risk of death wish, and a high level more than doubled the risk (odds ratio, 2.4). Perceived loneliness was a strong independent risk factor, associated with a near tripling, compared with those who did not feel lonely (OR, 2. …

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