Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 153 No. 2 (2023)

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

  • Nathalie Dieudonné Rahm
  • Sophie Pautex
DOI
https://doi.org/10.57187/smw.2023.40042
Cite this as:
Swiss Med Wkly. 2023;153:40042
Published
08.02.2023

Summary

BACKGROUND: Older adults are at risk of assisted and self-initiated suicide. The links between prior attempts and assisted suicide in the elderly have not been investigated. Hence, we aimed to investigate and describe the occurrence, timing and determinants of suicide attempts prior to assisted and self-initiated suicide.

METHODS: We developed a retrospective study of all assisted and self-initiated suicides among people over 65 years in the canton of Geneva, Switzerland, for a 10-year period (2010–2019). Cases were identified by cross-referencing hospitals’ routinely collected electronic data and a forensic report database. Cases were characterised in terms of sociodemographic factors, mental health disorders, main comorbidities, temporal sequence, methods of injury, medical complications and disclosure rates of previous attempts. The study used descriptive statistics.

RESULTS: A total of 26 of 497 (5.2%) and 20 of 149 (13.4%) older adults had made previous attempts before assisted and self-initiated suicide, respectively. More than half of them had made a single attempt, mostly by medication poisoning, sometimes more than 10 years before dying. Individuals who made two attempts were significantly more represented among the assisted suicide decedents. One self-initiated suicide decedent and half of the assisted suicide cases had disclosed that they had considered suicide. Individual characteristics were similar, except for assisted suicide decedents, who were eight years older than self-initiated suicide decedents. Almost all the individuals had mental disorders. Depression, anxiety and chronic pain were particularly prevalent among decedents of assisted suicide. The substantial representation of women in both groups may be an indication of their vulnerability, possibly related to chronic pain and life stressors.

CONCLUSIONS: Our results show commonalities between older assisted and self-initiated suicide decedents who made an attempt (s) before suicide. Further research is needed to demonstrate the overlap between the determinants of assisted suicide and other forms of suicidality and to support a suicide prevention strategy applicable to both types of suicide.

References

  1. Statistiques des causes de décès en Suisse. Données sur les suicides et les tentatives de suicide en Suisse. Available from: https://www.bfs.admin.ch/bfs/fr/home/statistiques/sante/enquetes/ecod.html
  2. Plan d’action pour la prévention du suicide en Suisse. Available from: https://www.bag.admin.ch/bag/fr/home/strategie-und-politik/politische-auftraege-und-aktionsplaene/aktionsplan-suizidpraevention/Datenlage-Suizide-Suizidversuche-Schweiz.html
  3. Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry. 2002 Sep;181(3):193–9. https://doi.org/10.1192/bjp.181.3.193 DOI: https://doi.org/10.1192/bjp.181.3.193
  4. World Health Organization. 2021. [Accessed June 06, 2021]. Available from: https://www.who.int/teams/mental-health-and-substance-use/suicide-data
  5. Paraschakis A, Douzenis A, Michopoulos I, Christodoulou C, Vassilopoulou K, Koutsaftis F, et al. Late onset suicide: distinction between “young-old” vs. “old-old” suicide victims. How different populations are they? Arch Gerontol Geriatr. 2012;54(1):136–9. https://doi.org/10.1016/j.archger.2011.02.011 DOI: https://doi.org/10.1016/j.archger.2011.02.011
  6. Probert-Lindström S, Berge J, Westrin Å, Öjehagen A, Skogman Pavulans K. Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32-year follow-up study. BMJ Open. 2020 Oct;10(10):e038794. https://doi.org/10.1136/bmjopen-2020-038794 DOI: https://doi.org/10.1136/bmjopen-2020-038794
  7. Hoertel N, Sabatier J, Blanco C, Olfson M, Schuster JP, Airagnes G, Peyre H, Limosin F. Contributing factors to heterogeneity in the timing of the onset of nonfatal suicidal behavior: Results from a nationally representative study. J Clin Psychiatry. 2020 Apr 7;81(3):19m13017. Doi: https://doi.org/10.4088/JCP.19m13017. PMID: 32271505. DOI: https://doi.org/10.4088/JCP.19m13017
  8. Chung DT, Ryan CJ, Hadzi-Pavlovic D, Singh SP, Stanton C, Large MM. Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry. 2017 Jul;74(7):694–702. https://doi.org/10.1001/jamapsychiatry.2017.1044 DOI: https://doi.org/10.1001/jamapsychiatry.2017.1044
  9. Choi NG, DiNitto DM, Marti CN, Kaplan MS. dinitto DM, Marti CN, Kaplan MS. Older suicide decedents: intent disclosure, mental and physical health, and suicide means. Am J Prev Med. 2017 Dec;53(6):772–80. https://doi.org/10.1016/j.amepre.2017.07.021 DOI: https://doi.org/10.1016/j.amepre.2017.07.021
  10. Conwell Y, Duberstein PR, Cox C, Herrmann J, Forbes N, Caine ED. Age differences in behaviors leading to completed suicide. Am J Geriatr Psychiatry. 1998;6(2):122–6. https://doi.org/10.1097/00019442-199805000-00005 DOI: https://doi.org/10.1097/00019442-199805000-00005
  11. Canetto SS, Mcintosh JL. A comparison of physician-assisted/Death-with-Dignity-Act death and suicide patterns in older adult women and men. Am J Geriatr Psychiatry. 2021; https://doi.org/10.1016/j.jagp.2021.06.003 DOI: https://doi.org/10.1016/j.jagp.2021.06.003
  12. Vilpert S, Borrat-Besson C, Borasio GD, Maurer J. Associations of end-of-life preferences and trust in institutions with public support for assisted suicide: evidence from nationally representative survey data of older adults in Switzerland. Plos One. 2020 Apr 23;15(4):e0232109. Doi: https://doi.org/10.1371/journal.pone.0232109. Erratum in: plos One. 2020 Jun 18;15(6):e0234954. PMID: 32324815; PMCID: PMC7179897. DOI: https://doi.org/10.1371/journal.pone.0232109
  13. Khurana M, Shoham N, Cooper C, Pitman AL. Association between sensory impairment and suicidal ideation and attempt: a cross-sectional analysis of nationally representative English household data. BMJ Open. 2021 Feb;11(2):e043179. https://doi.org/10.1136/bmjopen-2020-043179 DOI: https://doi.org/10.1136/bmjopen-2020-043179
  14. Henson KE, Brock R, Charnock J, Wickramasinghe B, Will O, Pitman A. Risk of suicide after cancer diagnosis in England. JAMA Psychiatry. 2019 Jan;76(1):51–60. https://doi.org/10.1001/jamapsychiatry.2018.3181 DOI: https://doi.org/10.1001/jamapsychiatry.2018.3181
  15. Bergerot CD, Philip EJ, Bergerot PG, Pal SK. Distress and quality of life among patients with advanced genitourinary cancers. Eur Urol Focus. 2020 Nov;6(6):1150–4. https://doi.org/10.1016/j.euf.2019.10.014 DOI: https://doi.org/10.1016/j.euf.2019.10.014
  16. Al Rabadi L, LeBlanc M, Bucy T, Ellis LM, Hershman DL, Meyskens FL Jr, et al. Trends in Medical Aid in Dying in Oregon and Washington. JAMA Netw Open. 2019 Aug;2(8):e198648. https://doi.org/10.1001/jamanetworkopen.2019.8648 DOI: https://doi.org/10.1001/jamanetworkopen.2019.8648
  17. Dierickx S, Onwuteaka-Philipsen B, Penders Y, Cohen J, van der Heide A, Puhan MA, et al. Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison. Int J Public Health. 2020 Jan;65(1):65–73. https://doi.org/10.1007/s00038-019-01281-6 DOI: https://doi.org/10.1007/s00038-019-01281-6
  18. Steck N, Junker C, Maessen M, Reisch T, Zwahlen M, Egger M; Swiss National Cohort. Suicide assisted by right-to-die associations: a population based cohort study. Int J Epidemiol. 2014 Apr;43(2):614–22. https://doi.org/10.1093/ije/dyu010 DOI: https://doi.org/10.1093/ije/dyu010
  19. Dieudonné-Rahm N, Burkhardt S, Pautex S. In-hospital care prior to assisted and unassisted suicide in swiss older people: a state-level retrospective study. BMC Geriatr. 2019 Nov;19(1):300. https://doi.org/10.1186/s12877-019-1325-6 DOI: https://doi.org/10.1186/s12877-019-1325-6
  20. Hartog ID, Zomers ML, van Thiel GJ, Leget C, Sachs AP, Uiterwaal CS, et al. Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey. BMC Geriatr. 2020 Sep;20(1):342. https://doi.org/10.1186/s12877-020-01735-0 DOI: https://doi.org/10.1186/s12877-020-01735-0
  21. Gamondi C, Pott M, Payne S. Families’ experiences with patients who died after assisted suicide: a retrospective interview study in southern Switzerland. Ann Oncol. 2013 Jun;24(6):1639–44. https://doi.org/10.1093/annonc/mdt033 DOI: https://doi.org/10.1093/annonc/mdt033
  22. Mezuk B, Ko TM, Kalesnikava VA, Jurgens D. Suicide among older adults living in or transitioning to residential long-term care, 2003 to 2015. JAMA Netw Open. 2019 Jun;2(6):e195627. https://doi.org/10.1001/jamanetworkopen.2019.5627 DOI: https://doi.org/10.1001/jamanetworkopen.2019.5627
  23. Couillet A, Terra JL, Brochard N, Chauliac N. Barriers to the Prevention of Suicide in Nursing Homes. Crisis. 2017 Nov;38(6):423–32. https://doi.org/10.1027/0227-5910/a000466 DOI: https://doi.org/10.1027/0227-5910/a000466
  24. Fetisov VA, Bogomolov DV, Dzhuvalyakov PG, Zbrueva YV, Kabakova SS. Sudebno-meditsinskie aspekty problemy viktimnosti lits preklonnogo vozrasta (na primere samoubiĭstva onkologicheskogo bol'nogo) [The forensic medical aspects of the problem of victimization of the elderly persons as exemplified by a case of suicide of an oncological patient]. Sud Med Ekspert. 2019;62(1):46-49. Russian. Doi: https://doi.org/10.17116/sudmed20196201146. PMID: 30724894. DOI: https://doi.org/10.17116/sudmed20196201146
  25. Conejero I, Olié E, Courtet P, Calati R. Suicide in older adults: current perspectives. Clin Interv Aging. 2018 Apr;13:691–9. https://doi.org/10.2147/CIA.S130670 DOI: https://doi.org/10.2147/CIA.S130670
  26. Conejero I, Navucet S, Keller J, Olié E, Courtet P, Gabelle A. A complex relationship between suicide, dementia, and amyloid: A narrative review. Front Neurosci. 2018 Jun;12:371. https://doi.org/10.3389/fnins.2018.00371 DOI: https://doi.org/10.3389/fnins.2018.00371