Link Between Chronic Pain and Suicide in Elderly Men
It is becoming clear that the extent or severity of physical ailments and functional impairment needs to be carefully examined in order to successfully prevent suicide in late life.
Rates of suicide for both genders increase significantly with advancing age, with the 85-and-older age group being at the highest risk. In the United States, this age pattern is observed particularly among men. Although mood disorders are known risk factors, it has been proposed that symptoms of depression alone cannot adequately explain late-life self-harm and suicidal behavior.
For example, psychological autopsy studies show that major depression is present in approximately 50% of suicides. Comorbid psychiatric and physical health problems, however, are frequently observed among older adults.
In a new study published by the journal Preventative Medicine, investigators further examined the association between poor physical health and the risk of suicide.1 Results indicate that the presence of multiple health morbidities is associated with suicidal behavior among older men.
Previous reports indicate that, among older adults, functional disability and poor self-rated health is associated with suicidal behavior, including suicidal ideation. Various specific cardiovascular (eg, history of myocardial infarction), pulmonary (eg, COPD), genitourinary (eg, prostate and male genital disorders), and musculoskeletal (eg, arthritis/rheumatism) conditions, as well as chronic pain and cancer, are also associated with the wish to die. It is becoming clear that the extent or severity of physical ailments and functional impairment needs to be carefully examined in order to successfully prevent suicide in late life.
In the current study, investigators followed more than 38 000 Australian men aged 65-85 years (median=72) for up to 16 years to examine the association between suicide attempts or completion and poor physical function. During the study, 1.2% (n=443) of men attempted suicide.
Once the participants with a history of a past suicide attempt (n=240) were excluded from the analyses, bipolar disorder, depressive disorder, alcohol use disorder, and substance use disorder at baseline were associated with a novel suicide attempt. Illnesses affecting 3 or more health systems were also associated with a past suicide attempt.
The past suicide attempt was not a robust predictor of future suicide completion, but bipolar disorder and depressive disorders were associated with increased risk of suicide completion. A total of 69 men died by suicide during follow-up, which represents 0.3% of all deaths recorded in the sample. Bipolar and depressive disorders accounted for approximately 17% of all cases of completed suicide in the sample.
With regard to participants who completed suicide, more than 55% had illnesses affecting 5 or more health systems. “Having 5 or more health systems affected by disease over the study period increased by >11 times the risk of suicide, and the presence of this multiplicity of morbidities accounts for about ¾ of the deaths by suicide [in the current sample],” the authors wrote in their publication.
“Postponement of morbidity and frailty should become a target of effective suicide prevention programs for older men,” they concluded.
- Almeida OP, McCaul K, Hankey GJ, et al. Suicide in older men: the health in men cohort study (HIMS). Prev Med. 2016;93:33-38.