Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-18T16:45:13.632Z Has data issue: false hasContentIssue false
  • English
  • Français

Dementia and suicidal behavior: a review of the literature

Published online by Cambridge University Press:  16 April 2009

Camilla Haw ,
Daniel Harwood  and
Keith Hawton
Camilla Haw*
Affiliation:
St Andrew's Hospital, Northampton, U.K.
Daniel Harwood
Affiliation:
Older Persons Mental Health Unit, St Mary's Hospital, Newport, Isle of Wight, U.K.
Keith Hawton
Affiliation:
Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, U.K.
*
Correspondence should be addressed to: Dr Camilla Haw, Consultant Psychiatrist, St. Andrew's Hospital, Billing Road, Northampton NN1 5DG, U.K. Phone: +44 1604 616186; Fax: +44 1604 616177. Email: [email protected].
Get access

Abstract

Background: While dementia is more common in older people and suicide rates in many countries are higher among the elderly, there is some doubt about the association between these two phenomena.

Methods: A search of the major relevant databases was carried out to examine the evidence for this possible association.

Results: The association between dementia and suicide and also non-fatal self-harm did not appear strong but many studies have significant methodological limitations and there are few studies of suicide or self-harm in vascular, frontotemporal, Lewy body and HIV dementia where such behavior might be expected to be more common. Rates of self-harm may be increased in mild dementia and are higher before than after predictive testing for Huntington's disease. Overall, the risk of suicide in dementia appears to be the same or less than that of the age-matched general population but is increased soon after diagnosis, in patients diagnosed with dementia during hospitalization and in Huntington's disease. Putative risk factors for suicide in dementia include depression, hopelessness, mild cognitive impairment, preserved insight, younger age and failure to respond to anti-dementia drugs. Large, good quality prospective studies are needed to confirm these findings.

Conclusions: Further research should be undertaken to examine how rates of suicide and self-harm change during the course of the illness and vary according to the specific sub-type of dementia.

Keywords

dementiasuicideattempted suicideself-harm
Type
Review Article
Information
International Psychogeriatrics , Volume 21 , Issue 3 , June 2009 , pp. 440 - 453
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aarsland, D., Cummings, J. L., Yenner, G. and Miller, B. (1996). Relationship of aggressive behavior to other neuropsychiatric symptoms in patients with Alzheimer's disease. American Journal of Psychiatry, 153, 243–247.Google ScholarPubMed
Ahearn, E. P. et al. (2001). MRI correlates of suicide attempt history in unipolar depression. Biological Psychiatry, 50, 266–270.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S. (1991). Psychological autopsy of an elderly suicide. International Journal of Geriatric Psychiatry, 6, 45–50.Google Scholar
Almqvist, E. W., Bloch, M., Brinkman, R., Craufurd, D. and Hayden, M. R. (1999). A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease. American Journal of Human Genetics, 64, 1293–1304.CrossRefGoogle ScholarPubMed
Ashby, D., Ames, D., West, C. R., MacDonald, A., Graham, N. and Mann, A. H. (1991). Psychiatric morbidity as predictor of mortality for residents of local authority homes for the elderly. International Journal of Geriatric Psychiatry, 6, 567–575.CrossRefGoogle Scholar
Ayalon, L., Mackin, S., Arean, P. A., Chen, H. and McDonel Herr, E. C. (2007). The role of cognitive functioning and distress in suicidal ideation in older adults. Journal of the American Geriatrics Society, 55, 1090– 1094.Google Scholar
Baliko, L., Csala, B. and Czopf, J. (2004). Suicide in Hungarian Huntington's disease patients. Neuroepidemiology, 23, 258–260.Google Scholar
Ballard, C., Bannister, C., Solis, M., Oyebode, F. and Wilcock, G. (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135–144.CrossRefGoogle ScholarPubMed
Bamford, C., Lamont, S., Eccles, M., Robinson, L., May, C. and Bond, J. (2004). Disclosing a diagnosis of dementia: a systematic review. International Journal of Geriatric Psychiatry, 19, 151–169.Google Scholar
Barak, Y. and Aizenberg, D. (2002). Suicide amongst Alzheimer's disease patients: a 10-year survey. Dementia and Geriatric Cognitive Disorders, 14, 101–103.CrossRefGoogle Scholar
Barraclough, B. (1971). Suicide in the elderly. British Journal of Psychiatry, Special supplement 6, 87–97.Google Scholar
Beautrais, A. L. (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32, 1–9.Google Scholar
Bird, T. D. (1999). Outrageous fortune: the risk of suicide in genetic testing for Huntington disease. American Journal of Human Genetics, 64, 1289–1292.CrossRefGoogle ScholarPubMed
Broadstock, M., Michie, S. and Marteau, T. (2000). Psychological consequences of predictive genetic testing: a systematic review. European Journal of Human Genetics, 8, 731–738.Google Scholar
Burns, A., Jacoby, R. and Levy, R. (1990). Psychiatric phenomena in Alzheimer's disease. IV. Disorders of behaviour. British Journal of Psychiatry, 157, 86–94.CrossRefGoogle ScholarPubMed
Buter, T. C., van den Hout, A., Matthews, F. E., Larsen, J. P., Brayne, C. and Aarsland, D. (2008). Dementia and survival in Parkinson disease: a 12-year population study. Neurology, 70, 1017–1022.Google Scholar
Callahan, C. M., Hendrie, H. C., Nienaber, N. A. and Tierney, W. M. (1996). Suicidal ideation among older primary care patients. Journal of the American Geriatrics Society, 44, 1205–1209.Google Scholar
Carney, S. S., Rich, C. L., Burke, P. A. and Fowler, R. C. (1994). Suicide over 60: the San Diego study. Journal of the American Geriatrics Society, 42, 174–180.CrossRefGoogle ScholarPubMed
Chan, S. S., Lyness, J. M. and Conwell, Y. (2007). Do cerebrovascular risk factors confer risk for suicide in later life? A case-control study. American Journal of Geriatric Psychiatry, 15, 541–544.CrossRefGoogle ScholarPubMed
Chiu, H. F. K., Lam, L. C. W., Pang, A. H. T., Leung, C. M. and Wong, C. K. (1996). Attempted suicide by Chinese elderly in Hong Kong. General Hospital Psychiatry, 18, 444–447.CrossRefGoogle ScholarPubMed
Chiu, H. F. K. et al. (2004). Elderly suicide in Hong Kong: a case-controlled psychological autopsy study. Acta Psychiatrica Scandinavica, 109, 299–305.Google Scholar
Codori, A. M., Slavney, P. R., Rosenblatt, A. and Brandt, J. (2004). Prevalence of major depression one year after predictive testing for Huntington's disease. Genetic Testing, 8, 114–119.Google Scholar
Cohen, D., Vergon, T. L. and Malphurs, J. (1998). Case studies of suicide in older persons with Alzheimer's disease and related dementias. Journal of Mental Health and Aging, 4, 397–402.Google Scholar
Conwell, Y., Olsen, K., Caine, E. D. and Flannery, C. (1991). Suicide in later life: psychological autopsy findings. International Psychogeriatrics, 3, 59–66.Google Scholar
Conwell, Y. et al. (2000). Completed suicide among older patients in primary care practices: a controlled study. Journal of the American Geriatrics Society, 48, 23–29.CrossRefGoogle ScholarPubMed
Cooper, J. P. (2002). Self-harm and dementia. Internet Journal of Mental Health, 1.Google Scholar
de Jonghe-Rouleau, A. P., Pot, A. M. and de Jonghe, J. F. M. (2005). Self-injurious behavior in nursing home residents with dementia. International Journal of Geriatric Psychiatry, 20, 651–657.Google Scholar
De Leo, D. and Evans, R. (2004). Global trends and suicide mortality. In De Leo, D. and Evans, R., International Suicide Rates and Prevention Strategies (pp. 15–20), Goettingen: Hogrefe & Huber.Google Scholar
Decruyenaere, M. et al. (2003). Psychological distress in the 5-year period after predictive testing for Huntington's disease. European Journal of Human Genetics, 11, 30–38.Google Scholar
Department of Health (2009). Living Well with Dementia: A National Dementia Strategy. London: Department of Health.Google Scholar
Dewey, M. E., Davidson, I. A. and Copeland, J. R. M. (1993). Expressed wish to die and mortality in older people: a community replication. Age and Ageing, 22, 109–113.CrossRefGoogle ScholarPubMed
Di Maio, L., Squitieri, F., Napolitano, G., Campanella, G., Trofatter, J. A. and Conneally, P. M. (1993). Suicide risk in Huntington's disease. Journal of Medical Genetics, 30, 293–295.Google Scholar
Dombrovski, A. Y. et al. (2008). Cognitive performance in suicidal depressed elderly: preliminary report. American Journal of Geriatric Psychiatry, 16, 109–115.CrossRefGoogle ScholarPubMed
Donovan, N. J., Kendall, D. L., Heaton, S. C., Kwon, S., Velozo, C. A. and Duncan, P. W. (2008). Conceptualizing functional cognition in stroke. Neurorehabilitation and Neural Repair, 22, 122–135.Google Scholar
Doshi, P. K., Chhaya, N. and Bhatt, M. H. (2002). Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson's disease. Movement Disorders, 17, 1084–1085.CrossRefGoogle ScholarPubMed
Draper, B. (1994). Suicidal behaviour in the elderly. International Journal of Geriatric Psychiatry, 9, 655–661.CrossRefGoogle Scholar
Draper, B., Maccuspie-Moore, C. and Brodaty, H. (1998). Suicidal ideation and the “wish to die” in dementia patients: the role of depression. Age and Ageing, 27, 503–507.CrossRefGoogle Scholar
Draper, B., Brodaty, H. and Low, L. F. (2002). Types of nursing home residents with self-destructive behaviours: analysis of the harmful behaviours scale. International Journal of Geriatric Psychiatry, 17, 670–675.Google Scholar
Draper, B., Brodaty, H., Low, L. F. and Richards, V. (2003). Prediction of mortality in nursing home residents: impact of passive self-harm behaviors. International Psychogeriatrics, 15, 187–196.CrossRefGoogle ScholarPubMed
Erlangsen, A., Zarit, S. H., Tu, X. and Conwell, Y. (2006). Suicide among older psychiatric inpatients: an evidence-based study of a high-risk group. American Journal of Geriatric Psychiatry, 14, 734–741.CrossRefGoogle ScholarPubMed
Erlangsen, A., Zarit, S. H. and Conwell, Y. (2008). Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data. American Journal of Geriatric Psychiatry, 16, 220–228.CrossRefGoogle ScholarPubMed
Faber, R. A. (2003). Suicide in neurological disorders. Neuroepidemiology, 22, 103–105.CrossRefGoogle ScholarPubMed
Farrer, L. A. (1986). Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. American Journal of Medical Genetics, 24, 305–311.CrossRefGoogle ScholarPubMed
Ferris, S. H., Hofeldt, G. T., Carbone, G., Masciandaro, P., Troetel, W. M. and Imbimbo, B. P. (1999). Suicide in two patients with a diagnosis of probable Alzheimer disease. Alzheimer Disease and Associated Disorders, 13, 88–90.Google Scholar
Florio, E. R., Hendryx, M. S., Jensen, J. E., Rockwood, T. H., Raschko, R. and Dyck, D. G. (1997). A comparison of suicidal and nonsuicidal elders referred to a community mental health center program. Suicide and Life-Threatening Behavior, 27, 182–193.CrossRefGoogle ScholarPubMed
Forsell, Y., Jorm, A. F. and Winblad, B. (1997). Suicidal thoughts and associated factors in an elderly population. Acta Psychiatrica Scandinavica, 95, 108–111.Google Scholar
Funkiewiez, A. et al. (2004). Long term of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 75, 834– 839.Google Scholar
Grabbe, L., Demi, A., Camann, M. A. and Potter, L. (1997). The health status of elderly persons in the last year of life: a comparison of deaths by suicide, injury, and natural causes. American Journal of Public Health, 87, 434–437.Google Scholar
Harris, E. C. and Barraclough, B. (1994). Suicide as an outcome for medical disorders. Medicine, 73, 281– 296.CrossRefGoogle ScholarPubMed
Harris, E. C. and Barraclough, B. (1997). Suicide as an outcome for mental disorders: a meta-analysis. British Journal of Psychiatry, 170, 205–228.Google Scholar
Harris, E. C. and Barraclough, B. (1998). Excess mortality of mental disorder. British Journal of Psychiatry, 173, 11–53.CrossRefGoogle ScholarPubMed
Harwood, D. G. and Sultzer, D. L. (2002). “Life is not worth living”: hopelessness in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 15, 38–43.Google 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, 155–165.Google Scholar
Hawton, K. et al. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders, 50, 269–276.Google Scholar
Heinik, J. (1997). Resurgence of painful past experiences as a cause of the suicide attempt in a dementia sufferer. Clinical Gerontologist, 18, 59–62.Google Scholar
Heisel, M. J., Flett, G. L. and Besser, A. (2002). Cognitive functioning and geriatric suicide ideation: testing a mediational model. American Journal of Geriatric Psychiatry, 10, 428–436.Google Scholar
Henriksson, M. M. et al. (1995). Mental disorders in elderly suicide. International Psychogeriatrics, 7, 275–286.CrossRefGoogle ScholarPubMed
Hepple, J. and Quinton, C. (1997). One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry, 171, 42–46.CrossRefGoogle ScholarPubMed
Hierholzer, R. (2002). Suicide in dementia: case studies of failure as a risk factor. Clinical Gerontologist, 24, 159–163.Google Scholar
Hiroeh, U., Appleby, L., Mortensen, P. B. and Dunn, G. (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet, 358, 2110–2112.CrossRefGoogle ScholarPubMed
Huntington, G. (1872). On chorea. Medical and Surgical Reporter, 26, 317–321.Google Scholar
Ito, T. et al. (2002). A study of suicidal cases of vascular dementia. Seishin Igaku, 44, 1295–1303.Google Scholar
Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine, 24, 145–153.Google Scholar
Jorm, A. F., Henderson, A. S., Scott, R., Korten, A. E., Christensen, H. and MacKinnon, A. J. (1995). Factors associated with the wish to die in elderly people. Age and Ageing, 24, 389–392.Google Scholar
Juurlink, D. N., Herrmann, N., Szalai, J. P., Kopp, A. and Redelmeier, D. A. (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine, 164, 1179–1184.CrossRefGoogle ScholarPubMed
Kaye, K., Grigsby, J., Robbins, L. J. and Korzun, B. (1990). Prediction of independent functioning and behavior problems in geriatric patients. Journal of the American Geriatrics Society, 38, 1304–1310.CrossRefGoogle ScholarPubMed
Keene, J., Hope, T., Fairburn, C. G. and Jacoby, R. (2001). Death and dementia. International Journal of Geriatric Psychiatry, 16, 969–974.Google Scholar
Keilp, J. G., Sackeim, H. A., Brodsky, B. S., Oquendo, M. A., Malone, K. M. and Mann, J. J. (2001). Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry, 158, 735–741.CrossRefGoogle ScholarPubMed
King, D. A., Conwell, Y., Cox, C., Henderson, R. E., Denning, D. G. and Caine, E. D. (2000). A neuropsychological comparison of depressed suicide attempters and nonattempters. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 64–70.Google Scholar
Kishi, Y., Robinson, R. G. and Kosier, J. T. (1996). Suicidal plans in patients with stroke: comparison between acute-onset and delayed-onset suicidal plans. International Psychogeriatrics, 8, 623–634.Google Scholar
Kishi, Y., Robinson, R. G. and Kosier, J. T. (2001). Suicidal ideation among patients with acute life-threatening physical illness: patients with stroke, traumatic brain injury, myocardial infarction, and spinal cord injury. Psychosomatics, 42, 382–390.Google Scholar
Kishikawa, Y., Friedland, R. P., Ueda, H., Kitabayashi, Y. and Fukui, K. (2007). Socio-psychological factors in suicide with Alzheimer's disease: comparative case studies of two patients in the USA and Japan. Psychogeriatrics, 7, 37–39.Google Scholar
Knopman, D. S., Kitto, J., Deinard, S. and Heiring, J. (1988). Longitudinal study of death and institutionalization in patients with primary degenerative dementia. Journal of the American Geriatrics Society, 36, 108–112.Google Scholar
Larsson, M. U., Luszcz, M. A., Bui, T. H. and Wahlin, T. B. R. (2006). Depression and suicidal ideation after predictive testing for Huntington's disease: a two-year follow-up study. Journal of Genetic Counseling, 15, 361–374.Google Scholar
Lawrence, D., Almeida, O. P., Hulse, G. K., Jablensky, A. V. and Holman, C. D. J. (2000). Suicide and attempted suicide among older adults in Western Australia. Psychological Medicine, 30, 813–821.Google Scholar
Lebret, S., Perret-Vaille, E., Mulliez, A., Gerbaud, L. and Jalenques, I. (2006). Elderly suicide attempters: characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 1052–1059.Google Scholar
Lieberman, A. (2006). Are dementia and depression in Parkinson's disease related? Journal of the Neurological Sciences, 248, 138–142.CrossRefGoogle ScholarPubMed
Lim, W. S., Rubin, E. H., Coats, M. and Morris, J. C. (2005). Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages. Alzheimer Disease and Associated Disorders, 19, 214–219.Google Scholar
London School of Economics Personal Social Services Research Unit and Institute of Psychiatry King's College London (2007). Dementia UK, London: Alzheimer's Society. (Available at: http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=2.)Google Scholar
Lyness, J. M., Conwell, Y. and Nelson, J. C. (1992). Suicide attempts in elderly psychiatric inpatients. Journal of the American Geriatrics Society, 40, 320–324.Google Scholar
MacDonald, A. J. D. and Dunn, G. (1982). Death and the expressed wish to die in the elderly: an outcome study. Age and Ageing, 11, 189–195.Google Scholar
Mann, J. J. (2003). Neurobiology of suicidal behaviour. Nature Reviews Neuroscience, 4, 819–828.Google Scholar
Margo, G. M. and Finkel, J. A. (1990). Early dementia as a risk factor for suicide. Hospital and Community Psychiatry, 41, 676–678.Google Scholar
Meiser, B. and Dunn, S. (2000). Psychological impact of genetic testing for Huntington's disease: an update of the literature. Journal of Neurology Neurosurgery and Psychiatry, 69, 574–578.Google Scholar
Meltzer, C. C. et al. (1998). Serotonin in aging, late-life depression, and Alzheimer's disease: the emerging role of functional imaging. Neuropsychopharmacology, 18, 407– 430.Google Scholar
Mendez, M. F., Bagert, B. A. and Edwards-Lee, T. (1997). Self-injurious behavior in frontotemporal dementia. Neurocase, 3, 231–235.Google Scholar
Menghini, V. V. and Evans, J. M. (2000). Suicide among nursing home residents: a population-based study. Journal of the American Directors Association, 1, 47–50.Google ScholarPubMed
Myslobodsky, M., Lalonde, F. M. and Hicks, L. (2001). Are patients with Parkinson's disease suicidal? Journal of Geriatric Psychiatry and Neurology, 14, 120–124.Google Scholar
Nelson, F. L. and Farberow, N. L. (1980). Indirect self-destructive behavior in the elderly nursing home patient. Journals of Gerontology, 35, 949–957.Google Scholar
Nowers, M. (1993). Deliberate self-harm in the elderly: a survey of one London borough. International Journal of Geriatric Psychiatry, 8, 609–614.Google Scholar
Osgood, N. J., Brant, B. A. and Lipman, A. (1991). A scientific study of suicide in institutions. InOsgood, N. J., Brant, B. A. and Lipan, A. (eds.), Suicide among the Elderly in Long-Term Care Facilities (pp. 37–64). New York: Greenwood Press.Google Scholar
Osvath, P., Kovacs, A., Voros, V. and Fekete, S. (2005). Risk factors of attempted suicide in the elderly: the role of cognitive impairment. International Journal of Psychiatry in Clinical Practice, 9, 221–225.Google Scholar
Paulsen, J. S., Hoth, K. F., Nehl, C. and Stierman, L. (2005). Critical periods of suicide risk in Huntington's disease. American Journal of Psychiatry, 162, 725–731.Google Scholar
Peisah, C., Snowdon, J., Gorrie, C., Kril, J. and Rodriguez, M. (2007). Investigation of Alzheimer's disease-related pathology in community dwelling older subjects who committed suicide. Journal of Affective Disorders, 99, 127–132.Google Scholar
Pierce, D. (1987). Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 2, 105–110.CrossRefGoogle Scholar
Pierce, D. W. (1996). Repeated deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 11, 983–986.Google Scholar
Pies, R. W. and Popli, A. P. (1995). Self-injurious behavior: pathophysiology and implications to treatment. Journal of Clinical Psychology, 56, 580–588.Google Scholar
Pohjasvaara, T., Vataja, R., Leppävuori, A., Kaste, M. and Erkinjuntti, T. (2001). Suicidal ideas in stroke patients 3 and 15 months after stroke. Cerebrovascular Diseases, 12, 21–26.Google Scholar
Préville, M., Hébert, R., Boyer, R., Bravo, G. and Seguin, M. (2005). Physical health and mental disorder in elderly suicide: a case-control study. Aging and Mental Health, 9, 576–584.Google Scholar
Rao, R., Dening, T., Brayne, C. and Huppert, F. A. (1997). Suicidal thinking in community residents over eighty. International Journal of Geriatric Psychiatry, 12, 337–343.Google Scholar
Rapp, M. A. et al. (2006). Increased hippocampal plaques and tangles in patients with Alzheimer's disease with a lifetime history of major depression. Archives of General Psychiatry, 63, 161–167.CrossRefGoogle ScholarPubMed
Ravina, B. et al. (2007). The impact of depressive symptoms in early Parkinson disease. Neurology, 69, 342–347.CrossRefGoogle ScholarPubMed
Robins Wahlin, T. B. (2007). To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington's disease. Patient Education and Counseling, 65, 279–287.Google Scholar
Robins Wahlin, T. B., Bäckman, L., Lundin, A., Haegermark, A., Winblad, B. and Anvret, M. (2000). High suicidal ideation in persons testing for Huntington's disease. Acta Neurologica Scandinavica, 102, 150–161.Google Scholar
Robins, A. H. (1976). Depression in patients with parkinsonism. British Journal of Psychiatry, 128, 141–145.Google Scholar
Robinson, R. G., Morris, P. L. P. and Fedoroff, J. P. (1990). Depression and cerebrovascular disease. Journal of Clinical Psychiatry, 51 (Suppl. 7), 26–31.Google Scholar
Rohde, K., Peskind, E. R. and Raskind, M. A. (1995). Suicide in two patients with Alzheimer's disease. Journal of the American Geriatrics Society, 43, 187–189.CrossRefGoogle ScholarPubMed
Rubio, A., Vestner, A. L., Stewart, J. M., Forbes, N. T., Conwell, Y. and Cox, C. (2001). Suicide and Alzheimer's pathology in the elderly: a case-control study. Biological Psychiatry, 49, 137–145.Google Scholar
Ruths, F. A., Tobiansky, R. I. and Blanchard, M. (2005). Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London. International Journal of Geriatric Psychiatry, 20, 106–112.Google Scholar
Schneider, B., Maurer, K. and Frölich, L. (2001). Dementia and suicide. Fortschritte der Neurologie Psychiatrie, 69, 164–169.Google Scholar
Scocco, P. et al. (2006). Suicidal behaviour in nursing homes: a survey in a region of north-east Italy. International Journal of Geriatric Psychiatry, 21, 307–311.Google Scholar
Selnes, O. A. and Vinters, H. V. (2006). Vascular cognitive impairment. Nature Clinical Practice Neurology, 2, 538–547.Google Scholar
Snowdon, J. and Baume, P. (2002). A study of suicides of older people in Sydney. International Journal of Geriatric Psychiatry, 17, 261–269.Google Scholar
Steinbart, E. J., Smith, C. O., Poorkaj, P. and Bird, T. D. (2001). Impact of DNA testing for early-onset familial Alzheimer disease and frontotemporal dementia. Archives of Neurology, 58, 1828–1831.Google Scholar
Stenager, E. N., Wermuth, L., Stenager, E. and Boldsen, J. (1994). Suicide in patients with Parkinson's disease: an epidemiological study. Acta Psychiatrica Scandinavica, 90, 70–72.Google Scholar
Stenager, E. N., Madsen, C., Stenager, E. and Boldsen, J. (1998). Suicide in patients with stroke: epidemiological study. BMJ, 316, 1206–1210.Google Scholar
Suominen, K., Henriksson, M., Isometsä, E., Conwell, Y., Heilä, H. and Lönnqvist, J. (2003). Nursing home suicides: a psychological autopsy study. International Journal of Geriatric Psychiatry, 18, 1095–1101.Google Scholar
Takahashi, Y. et al. (1995). Suicide and aging in Japan: an examination of treated elderly suicide attempters. International Psychogeriatrics, 7, 239–251.CrossRefGoogle ScholarPubMed
Teasdale, T. W. and Engberg, A. W. (2001). Suicide after a stroke: a population study. Journal of Epidemiology and Community Health, 55, 863–866.Google Scholar
Teri, L., Baer, L. C. and Reifler, B. V. (1991). Depression in Alzheimer's patients: investigation of symptom patterns and frequency. Clinical Gerontologist, 11, 47–58.CrossRefGoogle Scholar
Tsai, C. F., Tsai, S. J., Yang, C. H. and Hwang, J. P. (2007). Chinese demented inpatients admitted following a suicide attempt: a case series. International Journal of Geriatric Psychiatry, 22, 1106–1109.Google Scholar
Turnbull, Q., Wolf, A. M. D. and Holroyd, S. (2003). Attitudes of elderly subjects toward “truth telling” for the diagnosis of Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 16, 90–93.CrossRefGoogle ScholarPubMed
Turvey, C. L. et al. (2002). Risk factors for late-life suicide: prospective, community-based study. American Journal of Geriatric Psychiatry, 10, 398–406.Google Scholar
Upadhyaya, A. K., Conwell, Y., Duberstein, P. R., Denning, D. and Cox, C. (1999). Attempted suicide in older depressed patients: Effect of cognitive functioning. American Journal of Geriatric Psychiatry, 7, 317–320.Google Scholar
Vega, U., Kishikawa, Y., Ricanati, E. and Friedland, R. P. (2002). Suicide and Alzheimer disease. American Journal of Geriatric Psychiatry, 10, 484–485.Google Scholar
Waern, M., Rubenowitz, E., Runeson, B., Skoog, I., Wilhelmsson, K. and Allebeck, P. (2002a). Burden of illness and suicide in elderly people: case-control study. BMJ, 324, 1355–1357.Google Scholar
Waern, M. et al. (2002b). Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry, 159, 450–455.Google Scholar
Waern, M., Rubenowitz, E. and Wilhelmson, K. (2003). Predictors of suicide in the old elderly. Gerontology, 49, 328–334.Google Scholar