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Cited by 542Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseOpioid Use Disorder Treatment

Medical illness and the risk of suicide in the elderly

Juurlink, David N., Herrmann, Nathan, Szalai, John P., Kopp, Alexander, Redelmeier, Donald A.·2004·Archives of Internal Medicine
DOI 10.1001/archinte.164.11.1179
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Abstract

BACKGROUND: Suicide is a leading cause of death, and rates are especially high among the elderly. Medical illnesses may predispose to suicide, but few controlled studies have examined the association between specific diseases and suicide. We explored the relationship between treatment for several illnesses and the risk of suicide in elderly patients using a population-based approach. METHODS: All Ontario residents 66 years or older who committed suicide between January 1, 1992, and December 31, 2000, were identified from provincial coroners' records. Their prescription records during the preceding 6 months were compared with those of living matched controls (1:4) to determine the presence or absence of 17 illnesses potentially associated with suicide. RESULTS: During the 9-year study period, we identified 1354 elderly patients who died of suicide. The most common mechanisms involved firearms (28%), hanging (24%), and self-poisoning (21%). Specific illnesses associated with suicide included congestive heart failure (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.33-2.24), chronic obstructive lung disease (OR, 1.62; 95% CI, 1.37-1.92), seizure disorder (OR, 2.95; 95% CI, 1.89-4.61), urinary incontinence (OR, 2.02; 95% CI, 1.29-3.17), anxiety disorders (OR, 4.65; 95% CI, 4.07-5.32), depression (OR, 6.44; 95% CI, 5.45-7.61), psychotic disorders (OR, 5.09; 95% CI, 3.94-6.59), bipolar disorder (OR, 9.20, 95% CI, 4.38-19.33), moderate pain (OR, 1.91; 95% CI, 1.66-2.20), and severe pain (OR, 7.52; 95% CI, 4.93-11.46). Treatment for multiple illnesses was strongly related to a higher risk of suicide. Almost half the patients who committed suicide had visited a physician in the preceding week. CONCLUSIONS: Many common illnesses are independently associated with an increased risk of suicide in the elderly. The risk is greatly increased among patients with multiple illnesses. These data may help clinicians to identify elderly patients at risk of suicide and open avenues for prevention.

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  • Patients with three physical illnesses had approximately a threefold increase in estimated relative risk for suicide compared with those with no diagnosis, and those with seven or more illnesses had approximately nine times greater risk.

    “They found that patients with three physical illnesses had approximately a threefold increase in estimated relative risk for suicide compared with subjects who had no diagnosis, whereas older adults who had seven or more illnesses had approximately nine times greater risk for suicide.”

    From Suicide in older adults (2011) · cites this paper as [26]

  • Juurlink and colleagues reported that the association between severe pain and suicide was somewhat stronger for men (OR = 9.9) than women (OR = 3.3).

    “Juurlink and colleagues, for example, reported that the association between severe pain and suicide was somewhat stronger for men (OR = 9.9) than women (OR = 3.3) (26).”

    From Suicide in older adults (2011) · cites this paper as [26]

  • Conditions such as HIV/AIDS, epilepsy, Huntington's disease, multiple sclerosis, renal and peptic ulcer disease, heart and lung diseases, spinal cord injury, and systemic lupus erythematosus have been associated with increased suicide risk in some studies.

    “Other diverse conditions such as HIV/AIDS, epilepsy, Huntington's disease and multiple sclerosis, renal and peptic ulcer disease, heart and lung diseases, spinal cord injury and systemic lupus erythematosus have also been found to be associated with increased suicide risk in some studies (25-27).”

    From Suicide in older adults (2011) · cites this paper as [26]

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Authors
Juurlink, D. N., Herrmann, N., Szalai, J. P., Kopp, A., & Redelmeier, D. A.
Affiliations
University of Toronto (CA)
Corresponding author
Juurlink, David N.
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2004-06-14
Volume
164
Issue
11
Pages
1179
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.164.11.1179
OpenAlex
W2081548941
Cited by
542
References
53
Citations by year
2026: 8 · 2025: 11 · 2024: 11 · 2023: 12 · 2022: 39 · 2021: 31 · 2020: 29 · 2019: 18 · 2018: 41 · 2017: 32 · 2016: 31 · 2015: 42 · 2014: 34 · 2013: 27 · 2012: 37
FWCI
20.80
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
older adults, disease, suicide risk factors, congestive heart failure, chronic obstructive pulmonary disease, epilepsy, urinary incontinence, depression, anxiety disorders, psychosis, bipolar disorder, pain, polypharmacy, prescription drugs, firearms, hanging, self-poisoning, coroner records
MeSH terms
Suicide Prevention, Aged, Disease, Female, Health Services, Health Status, Humans, Male, Ontario, Risk Factors, Suicide, Confidence Intervals, Odds Ratio, Case-Control Studies, Risk Assessment

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