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Suicidal behavior in late life: Population and patient perspectives

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Suicidal behavior in late life:

Population and patient perspectives

Akademisk avhandling som för avläggande av medicine doktorsexamen vid Sahlgrenska Akademin vid Göteborgs universitet

kommer att offentligt försvaras i hörsal Ivan Östholm, Medicinaregatan 13, Göteborg, fredagen den 13 juni 2014 kl. 9.00

av

Madeleine Mellqvist Fässberg

Fakultetsopponent: Professor Øivind Ekeberg Akuttmedisinsk avdeling, Oslo universitetssykehus

Avdeling for atferdsvitenskap, Institutt for medisinske basalfag, Universitetet i Oslo

Avhandlingen baseras på fyra delarbeten:

I. Fässberg, M.M., Östling, S., Braam, A.W., Bäckman, K., Copeland, J.R.M., Fichter, M., Kivelä, S-L., Lawlor, B.A., Lobo, A., Magnússon, H., Prince, M.J., Reischies, F.M., Turrina, C., Wilson, K., Skoog, I., Waern, M. Functional Disability and Death Wishes in older Europeans: Results from the EURODEP Concerted Action. Social Psychiatry and Psychiatric Epidemiology. 2014 Feb 20.

II. Fässberg, M.M., Östling, S., Börjesson-Hanson, A., Skoog, I., Waern, M. Suicidal feelings in the twilight of life: A cross-sectional population-based study of 97-year-olds.

BMJ Open. 2013 Feb 1;3(2).

III. Fässberg, M.M., Joas, E., Hällström, T., Östling, S., Gustafson, D., Wiktorsson, S., Kaplan, M., Hawton, K., Skoog, I., Waern, M. Suicidal thoughts and attempts in a population-based sample of women followed over 42 years: The influence of early life adversity. In manuscript.

IV. Mellqvist, M., Wiktorsson, S., Joas, E., Östling, S., Skoog, I., Waern, M. Sense of coherence in elderly suicide attempters: The impact of social and health-related factors.

International Psychogeriatrics. 2011 Aug; 23(6):986-93.

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ABSTRACT

Older adults have high rates of suicide, and the strong role of depression is often emphasized in studies on suicidal behaviour in this age group. The literature regarding other factors is rather sparse. This thesis utilizes data from three population-based studies and one clinical study with the aim of increasing knowledge about factors associated with suicidal behavior in late life.

Study I is based on data from EURODEP, a multicenter study involving 15,890 adults (9,429 women, 6461 men) aged 64-104 years. In Study II, all 97-year-olds living in Gothenburg were invited to take part and 269 (197 women, 72 men) without dementia participated. The Prospective Population Study on Women, initiated in 1968, provided data for study III; 800 middle-aged women were examined in 1968 and followed over a 42-year period. In Study IV a hospital cohort of 80 individuals (42 women, 38 men) aged 70-91 were interviewed after a suicide attempt.

Findings from study I showed that both intermediate and high functional disability was associated with death wishes in both sexes. Results remained after adding depressive symptoms to the model. Among the 97-year-olds in study II, 11.5 % reported suicidal feelings in accordance with the Paykel questions and the majority (77.4 %) of these fulfilled criteria for neither major nor minor depression. Sleep problems and deficient social contacts were associated with suicidal feelings; relationships were independent of depression. One fourth of the women who participated in study III had experienced suicidal thoughts at some point during their life and 8 % had made at least one suicide attempt. Onset of suicidal behavior occurred after age 40 in half the women. Women who reported five or more early childhood adversities were significantly younger when they had their first-episode of suicidal thoughts. In study IV a strong association with between major depression and low Sense of Coherence (SOC) was observed. Low SOC was associated with deficient social contacts and having moved in the past five years, and these relationships remained also after adjustment for depression.

While early detection and treatment of depression is imperative, interventions to reduce suicidal behavior in later life may also need to target functional disability, pain and sleep problems, and limited social networks.

Keywords: Older adults, death wishes, suicidal feelings, suicidal thoughts, suicide attempt, functional disability, social factors, early childhood adversity, Sense of Coherence.

ISBN: 978-91-628-9057-5

References

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