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A cross-national study of the relationship between elderly suicide rates and life expectancy and markers of socioeconomic status and health care

Published online by Cambridge University Press:  16 May 2007

Ajit Shah*
Affiliation:
Centre for Ethnicity and Health, University of Central Lancashire, Preston, U.K. and West London Mental Health NHS Trust, London, U.K.
Ravi Bhat
Affiliation:
Centre for Older Persons' Health, Shepparton, Victoria, Australia
Sheena MacKenzie
Affiliation:
Old Age Psychiatry, West London Mental Health NHS Trust, London, U.K.
Chris Koen
Affiliation:
Old Age Psychiatry, West London Mental Health NHS Trust, London, U.K.
*
Correspondence should be addressed to: Dr. Ajit Shah, West London Mental Health NHS Trust, Uxbridge Road, Southall, Middlesex, UB1 3EU, U.K. Phone: +44 208 354 8140; Fax: +44 208 354 8898. Email: [email protected].
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Abstract

Background: Socioeconomic status may influence cross-national variations in elderly suicide rates.

Methods: The relationship between suicide rates in both sexes in the age-bands 65–74 years and 75+ years and (i) life expectancy, (ii) measures of socioeconomic status (per capita gross national domestic product (GDP) and the Gini coeffcient), and (iii) measures of the quality and quantity of available healthcare services (the proportion of GDP spent on health, per capita expenditure on health and child mortality rates) was examined using data from the World Health Organization and the United Nations.

Results: The main findings were: (i) a significant negative correlation between the Gini coefficient and suicide rates for both sexes in both age-bands; (ii) a significant positive correlation between per capita expenditure on health and suicide rates for both sexes in both age-bands; (iii) the significant positive correlation between the proportion of GDP spent on health and suicide rates was only evident in males in both age-bands; (iv) a significant negative correlation between child mortality rates and suicide rates for both sexes in both age-bands; and, (v) the significant positive correlation between life expectancy and suicide rates was evident in females in both age-bands.

Conclusions: A potentially testable model with five sequential stages was proposed to explain these findings.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2007

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References

Abraham, V. J., Abraham, S. and Jacob, K. S. 2005. Suicide in the elderly in Kanyambadi block, Tamil Nadu, South India. International Journal of Geriatric Psychiatry, 20, 953955.CrossRefGoogle ScholarPubMed
Barraclough, B. M. 1971. Suicide in the elderly. British Journal of Psychiatry, 6, 8797.Google Scholar
Berk, M., Dodd, S. and Henry, M. 2006. The effect of macroeconomic variables on suicide. Psychological Medicine, 36, 181189.CrossRefGoogle ScholarPubMed
Blazer, D. G., Bachar, J. R. and Manton, K. G. 1986. Suicide in late life: review and commentary. Journal of the American Geriatrics Society, 13, 743749.Google Scholar
Cattell, H. 1988. Elderly suicides in London: an analysis of coroner's inquests. International Journal of Geriatric Psychiatry, 3, 251261.CrossRefGoogle Scholar
Cattell, H. and Jolley, D. 1995. One hundred cases of suicide in the elderly. British Journal of Psychiatry, 166, 451457.CrossRefGoogle Scholar
Conwell, Y., Rotenberg, M. and Caine, E. D. 1990. Completed suicides at age 50 and over. Journal of the American Geriatrics Society, 38, 640644.CrossRefGoogle ScholarPubMed
Conwell, Y., Olsen, K., Caine, E. D. and Flannery, C. 1991. Suicide in later life: psychological autopsy findings. International Psychogeriatrics, 3, 5966.CrossRefGoogle ScholarPubMed
Cutright, P. and Fernquist, R. M. 2000. Effects of social integration, period, region, and culture of suicide on male age-specific suicide rates: 20 developed countries, 1955–1898. Social Science Research, 29, 148172.CrossRefGoogle Scholar
Daradekh, T. K. 1989. Suicide in Jordan 1980–1985. Acta Psychiatrica Scandinavica, 79, 241244.CrossRefGoogle Scholar
Diekstra, R. F. W. 1989. Suicide and attempted suicide: an international perspective. Acta Psychiatrica Scandinavica, 80 (Suppl. 354), 124.CrossRefGoogle Scholar
Fukuda, Y., Nakamura, K. and Takano, T. 2005. Cause-specific mortality differences across socioeconomic position of municipalities in Japan, 1973–1977 and 1993–1998: increased importance of injury and suicide in inequality for ages under 75. International Journal of Epidemiology, 34, 100109.CrossRefGoogle ScholarPubMed
Gunnell, D., Middleston, N., Whitley, E., Dorling, D. and Frankel, S. 2003. Why are suicide rates rising in young men but falling in the elderly? A time-series analysis of trends in England and Wales 1950–1998. Social Science and Medicine, 57, 595611.CrossRefGoogle ScholarPubMed
Gunnell, D., Middleston, N., Whitley, E., Dorling, D. and Frankel, S. 2004. Influence of cohort effects on paterrns of suicide in England and Wales, 1950–1999. British Journal of Psychiatry, 182, 164170.CrossRefGoogle Scholar
Harwood, D., Hawton, K., Hope, T. and Jacoby, R. 2001 Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. International Journal of Geriatric Psychiatry, 16, 155165.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Jianlin, J. 2000. Suicide rates and mental health services in modern China. Crisis, 21, 118121.CrossRefGoogle ScholarPubMed
Kennedy, H. G., Iveson, R. C. and Hill, O. 1999. Violence, homicide and suicide: strong correlation and wide variation across districts. British Journal of Psychiatry, 175, 462466.CrossRefGoogle ScholarPubMed
Kiemo, K. 2004. Towards a socio-economic and demographic theory of elderly suicides: a comparison of 49 countries at various stages of development. www.soc.ou.se/publications/fulltext/diss2003-3.pdf (last accessed 2 February 2007).Google Scholar
Knox, K. L., Conwell, Y. and Caine, E. D. 2004. If suicide is a public health problem, what are we doing to prevent it? American Journal of Public Health, 94, 3745.CrossRefGoogle Scholar
Ko, S. M. and Kua, E. H. 1995. Ethnicity and elderly suicide rates in Singapore. International Psychogeriatrics, 7, 309317.CrossRefGoogle ScholarPubMed
Kowalski, G. S., Faupel, C. E. and Starr, P. D. 1987. Urbanisation and suicides: a study of American Counties. Social Forces, 66, 85101.CrossRefGoogle Scholar
Kua, E. H. and Ko, S. M. 1992. A cross cultural study of suicide in the elderly in Singapore. British Journal of Psychiatry, 160, 558559.CrossRefGoogle ScholarPubMed
Kua, E. H., Ko, S. M. and Ng, T. P. 2003. Recent trends in elderly suicide rates in a multi-ethnic Asian city. International Journal of Geriatric Psychiatry, 18, 533536.CrossRefGoogle Scholar
Lindesay, J. 1981 Suicide in the elderly. International Journal of Geriatric Psychiatry, 6, 355361.CrossRefGoogle Scholar
Lodhi, L. and Shah, A. K. 2005. Factors associated with the recent decline in suicide rates in England and Wales, 1985–1998. Medicine, Science and the Law, 45, 115120.CrossRefGoogle ScholarPubMed
Lorant, V., Kunst, A. E., Huisman, M., Costa, G. and Mackenbach, J. 2005. Socio-economic inequalities in suicide: a European comparative study. British Journal of Psychiatry, 187, 4954.CrossRefGoogle ScholarPubMed
Lynch, J. et al. 2004. Is income inequality a determinant of population health? Part 1. A systematic review. Millbank Q, 82, 599.CrossRefGoogle ScholarPubMed
McIntosh, J. L. 1984. Components of the decline in elderly suicides: suicide in young old and old old by race and sex. Death Education, 8, 113124.CrossRefGoogle Scholar
Moore, S. 2006. Peripherality, income inequality, and life expectancy: revisting the income inequality hypothesis. International Journal of Epidemiology,CrossRefGoogle Scholar
Moscicki, E. K. 1995. North American perspectives: epidemiology of suicide. International Psychogeriatrics, 7, 137148.CrossRefGoogle Scholar
Rehkopf, D. H. and Buka, S. L. 2006. The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychological Medicine, 36, 145157.CrossRefGoogle ScholarPubMed
Rezaeian, M., Dunn, G., St Leger, S. and Appleby, L. 2005. The ecological association between suicide rates and indices of deprivation in English local authorities. Social Psychiatry and Psychiatric Epidemiology, 40, 785791.CrossRefGoogle ScholarPubMed
Sartorius, N. 1995. Recent changes in suicide rates in selected Eastern European and other European countries. International Psychogeriatrics, 7, 301308.CrossRefGoogle ScholarPubMed
Seiden, R. H. 1981. Mellowing with age: factors affecting the non-white suicide rate. International Journal of Aging and Human Development, 13, 265284.CrossRefGoogle Scholar
Shah, A. K. (in press). The relationship between suicide rates and age: an analysis of multinational data from the World Health Organisation. International Psychogeriatrics.Google Scholar
Shah, A. K. and De, T. 1998. Suicide and the elderly. International Journal of Psychiatry in Clinical Practice, 2, 317.CrossRefGoogle ScholarPubMed
Shah, A. K. and Ganesvaran, T. 1994. Suicide in the elderly. In Chiu, E. and Ames, D. (eds.), Functional Psychiatric Disorders of the Elderly (pp. 221244). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Shah, A. K. and MacKenzie, S. (in press). Disorders of ageing across cultures. In Bhugra, D. (ed.), Textbook of Cultural Psychiatry. Cambridge: Cambridge University Press.Google Scholar
Shah, R., Uren, Z., Baker, A. and Majeed, A. 2002. Trends in suicide from drug overdose in the elderly in England and Wales, 1993–1999. International Journal of Geriatric Psychiatry, 17, 416421.CrossRefGoogle ScholarPubMed
Shah, A. K., Bhat, R., MacKenzie, S. and Koen, C. (in press). Elderly suicide rates: cross-national comparisons and association with sex and elderly age-bands. Medicine, Science and the Law.Google Scholar
Shimuzu, M. 1990. Depression and suicide in late life. In Hasegawa, K. and Homma, A. (eds.), Psychogeriatrics: Biomedical and Social Advances (pp. 330334). Amsterdam: Excerpta Medica.Google Scholar
Suh, G. H. and Shah, A. K. 2001. A review of the epidemiological transition in dementia – cross-national comparisons of the indices related to Alzheimer's disease and vascular dementia. Acta Psychiatrica Scandinavica, 104, 411.CrossRefGoogle ScholarPubMed
Vassilas, C. A. and Morgan, H. G. 1993. General practitioner's contact with victims of suicide. BMJ, 307, 300301.CrossRefGoogle Scholar
Vassilas, C. A. and Morgan, H. G. 1994. Elderly suicides' contact with their general practitioner before death. International Journal of Geriatric Psychiatry, 9, 10081009.Google Scholar
Vijayakumar, L., Nagaraj, K., Pirkis, J. and Whiteford, H. 2005. Suicide in developing countries (1): frequency, distribution, and association with socio-economic indicators. Crisis, 26, 104111.CrossRefGoogle Scholar
Wasserman, D., Cheng, Q. and Jiang, G. X. 2005. Global suicide rates among young people aged 15–19. World Psychiatry, 114–120.Google Scholar
Watanabe, N., Hasegawa, K. and Yoshinaga, Y. 1995. Suicide in later life in Japan: urban and rural differences. International Psychogeriatrics, 7, 253261.CrossRefGoogle ScholarPubMed
Whitley, E., Gunnell, D., Dorling, D. and Smith, G. D. 1999. Ecological study of social fragmentation, poverty, and suicide. BMJ, 319, 10341037.CrossRefGoogle ScholarPubMed
Woodbury, M. A., Manton, K. G. and Blazer, D. 1987. Trends in US suicide mortality rates 1968–1982: race and sex differences in age, period and cohort components. International Journal of Epidemiology, 17, 356–352.CrossRefGoogle Scholar
Yap, P. M. 1963. Ageing and mental health in Hong Kong. In Williams, R. H., Tibbets, C. and Donaghue, W. (eds.), Processes of Ageing: Social and Psychological Perspectives Vol. II (pp. 176191). New York: Atherton.Google Scholar
Yip, P. S. F. 2001. An epidemiological profile of suicides in Beijing, Chine. Suicide and Life-Threatening Behaviour, 31, 6270.Google Scholar
Yip, P. S. F. and Tan, R. C. E. 1998. Suicides in Hong Kong and Singapore: a tale of two cities. International Journal of Social Psychiatry, 44, 267279.CrossRefGoogle Scholar
Yip, P. S. F., Callanan, C. and Yuen, H. P. 2000. Urban/rural and gender differentials in suicide rates: East and West. Journal of Affective Disorders, 57, 99106.CrossRefGoogle ScholarPubMed
Yip, P. S. F., Liu, K. Y., Hu, J. and Song, X. M. 2005. Suicide rates in China during a decade of rapid social change. Social Psychiatry and Psychiatric Epidemiology, 40, 792798.CrossRefGoogle Scholar
Zhang, J. 1998. Suicide in the world: toward a population increase theory of suicide. Death Studies, 22, 525539.CrossRefGoogle Scholar