Suicide in the elderly: a psychological autopsy study in a north Italy area (1994-2004)

Objectives: The aim of the present cross-sectional study was to evaluate the role of several variables hypothesized in previous research to be associated with suicide in older adults. Design: Psychological autopsy study. Setting: Suicides who were resident in the province of Parma and Piacenza and who died between 1994 and 2004. Participants: Ninety-nine elderly suicides ( age >= 65 years; 77 men and 22 women) and 134 younger comparison suicides ( 115 men and 19 women). Younger victims were subdivided in two more homogeneous groups: young adults ( age < 36 years) and adults ( age: 36-64 years). Measurements: Direct proxy-based interviews with relatives and family physicians. Results: Elderly victims were nine times ( OR=9.09; 95% CI: 1.32-62.63) more likely to live alone, 26 times ( OR = 26.76; 95% CI: 9.04-79.24) more likely to be retired, and 14 times ( OR = 14.57; 95% CI: 2.48 - 85.65) more likely to have attended school for no more than 5 years than adult suicides. Although, more than 50% of older suicides were diagnosed as DSM-IV-TR depressed, only 20%-30% of them had been treated with medications. Conclusion: Diverse patterns of risk factors for suicide have to be evaluated in older adults. Physicians must be aware that the concomitant presence of depressive symptoms and several life events ( especially loss and loneliness in women and physical illness in men) should be considered warning signs for suicidal behavior.