Following a dementia diagnosis, specific subgroups of patients are at an increased risk for suicide, including those diagnosed before age 65 years. These are the findings of a large population-based, case-control study published in JAMA Neurology.
Recognizing that patients with dementia may be at a higher risk for suicide — due to both the psychological reaction to the diagnosis and neuropsychiatric symptoms of dementia syndromes — researchers sought to explore the relationship between a dementia diagnosis and suicide risk in the general population and identify high-risk subgroups of individuals. This, in turn, would serve as a way in which to support targeted risk reduction efforts by clinical dementia services.
The study was conducted between January 1, 2001 and December 31, 2019 in England. Data were obtained with the use of integrated electronic health records from 3 sources that permitted the linking of information from primary care records, secondary care records, and death certificate data: (1) the Clinical Practice Research Datalink (CPRD); (2) the Hospital Episode Statistics (HES); and (3) the Office for National Statistics (ONS).
All of the study participants were registered in the ONS in England, with a death that was coded as suicide or open verdict. The analysis used up to 40 live control participants per suicide case who were randomly matched regarding primary care practice and date of suicide. All patients with a code that referred to a diagnosis of dementia were identified in primary care and secondary care databases.
Among 70,065,533 patients with available records in CPRD, 23,339,028 were eligible for study inclusion and 46,726,505 patients were excluded. Thus, the total patient sample comprised 594,674 individuals. Overall, 97.6% (580,159 of 594,674) of these patients were control individuals and 2.4% (14,515 of 594,674) of them died by suicide. In the control group, the median age at death was 81.6 years (range, 72.0 to 88.4 years), with 50.0% of the patients being men. Among the patients who died by suicide, the median age at death was 47.4 years (range, 36.0 to 59.7 years), with 74.8% of the patients being men.
Of those patients who died by suicide, 1.9% had a recorded dementia diagnosis (median age at death, 79.5 years; range, 67.1-85.5 years and median duration of follow-up,
2.3 years; range, 1.0-4.4 years).
Results of the study showed no overall statistically significant association between a diagnosis of dementia and the risk for suicide (adjusted odds ratio [aOR], 1.05; 95% CI, 0.85-1.29).
Suicide risk was significantly increased, however, among these specific subgroups:
- Patients diagnosed with dementia before age 65 years (aOR, 2.82; 95% CI, 1.84-4.33; P <.001)
- Patients diagnosed in the first 3 months following a diagnosis (aOR, 2.47; 95% CI, 1.49-4.09; P =.002)
- Patients with dementia and a psychiatric comorbidity (aOR, 1.52; 95% CI, 1.21-1.93; P <.001)
Additionally, in patients aged younger than 65 years and within 3 months of a diagnosis of dementia, the risk for suicide was 6.69 times higher (95% CI, 1.49-30.12) than in those individuals without dementia. This risk remained significantly increased even after 1 year of diagnosis (aOR, 2.45; 95% CI, 1.50-4.02).
There are several limitations of the study that warrant mention. Despite the large sample size, the number of patients with a diagnosis of dementia who had died of suicide was small, which likely could be interpreted as some of the subgroup analyses were estimated imprecisely. Further, the researchers lacked data to evaluate suicide risk in relation to other relevant information such as the stage of dementia, type, and source of social care provided to those patients with dementia.
The researchers concluded that an “Improved understanding of high-risk groups is required to support targeted suicide risk assessment in dementia services, especially in view of policy initiatives designed to deliver higher rates of timely dementia diagnosis.”
Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Alothman D, Card T, Lewis S, Tyrrell E, Fogarty AW, Marshall CR. Risk of suicide after dementia diagnosis. JAMA Neurol. Published online October 3, 2022. doi:10.1001/jamaneurol.2022.3094