Editor—Waern et al report that among elderly people (those aged 65 years or more) serious physical illness was associated with increased risk of suicide in men but not in women.1 In addition, mental illnesses, particularly mood disorders, were strongly associated with suicide. Thus, the authors called for further investigations into depression in the context of physical disease in elderly people.
ROBERT DISCALFANI/PHOTONICA
Finland has one of the world's highest death rates from suicide.2 The national Finnish hospital discharge register makes it possible to investigate reliably all hospital admissions for any physical diseases and mental disorders of each person living in Finland.3 We explored comorbid depression in the main categories of physical diseases as they appear in ICD-8 and ICD-9 in people aged 65 years and over who committed suicide.4
We used data on all suicides (1296 males, 289 females) committed during 1988-2000 in northern Finland in the province of Oulu. Details of the database and study protocols have been reported earlier.5 The lifetime diagnoses of the suicide victims, based on psychiatric and somatic admissions and relevant codes from the International Classification of Diseases, were extracted from the hospital discharge register until the end of 1999. Depression was defined to be present if any of the following ICD codes was found in the register: ICD-8, 2960, 2980, 3004; ICD-9, 2961, 2968, 3004; ICD-10, F32-F34.1.
The table shows that heart and vascular diseases and gastrointestinal, musculoskeletal, and neurological disorders were the most common physical diseases among male suicide victims, the prevalence varying from 24% to 56%. In comparison with disease free subjects in each physical disease category, male suicide victims with heart and vascular or neurological diseases had a significantly higher prevalence of any comorbid mental disorder as well as comorbid depression. Among women no association between any comorbid mental disorder or depression and physical diseases reached significance, although in most physical disease categories (except respiratory diseases) over half of the female suicide victims were found to have the given disease. However, this was probably because of the small number of female suicide victims in our data, which easily leads to type II error in statistical analyses.
In conclusion, our results are in line with the findings of Waern et al on neurological disorders, but they also highlight the importance of detecting comorbid depression among geriatric patients with heart and vascular diseases to prevent suicide among elderly people. The physical diseases of suicide victims in our data were extracted from the reliable national hospital discharge register, which means that only the information on diseases serious enough for hospital treatment were used in statistical analyses. Thus, the memory bias linked with personal interviews was avoided in our study.
Table.
Prevalences of physical illness, comorbid mental disorders, and comorbid depression among elderly people who committed suicide during 1998-2000 in northern Finland
| Physical illness (% (No))
|
Any comorbid mental disorder (% (No))
|
Comorbid depression (% (No))
|
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Men (n=115)
|
Women (n=43)
|
Men (n=37)
|
P value*
|
Women (n=29)
|
P value*
|
Men (n=18)
|
P value*
|
Women (n=22)
|
P value*
|
|||
| Heart and vascular | 57 (65) | 54 (23) | 40 (26) | 0.031 | 74 (17) | 0.259 | 22 (14) | 0.040 | 57 (13) | 0.327 | ||
| Respiratory | 20 (23) | 12 (5) | 30 (7) | 0.527 | 80 (4) | 0.469 | 13 (3) | 0.493 | 40 (2) | 0.477 | ||
| Gastrointestinal | 46 (53) | 35 (15) | 40 (21) | 0.084 | 67 (10) | 0.598 | 19 (10) | 0.267 | 53 (8) | 0.545 | ||
| Genitourinary | 18 (21) | 33 (14) | 38 (8) | 0.345 | 64 (9) | 0.510 | 29 (6) | 0.076 | 64 (9) | 0.192 | ||
| Musculoskeletal | 33 (38) | 49 (21) | 42 (16) | 0.083 | 71 (15) | 0.414 | 18 (7) | 0.375 | 52 (11) | 0.559 | ||
| Endocrine/metabolic | 9 (10) | 14 (6) | 40 (4) | 0.408 | 83 (5) | 0.351 | 30 (3) | 0.190 | 67 (4) | 0.355 | ||
| Neurological | 24 (28) | 19 (8) | 57 (16) | 0.002 | 50 (4) | 0.224 | 32 (9) | 0.009 | 50 (4) | 0.624 | ||
| Malignancy | 20 (23) | 14 (6) | 30 (7) | 0.527 | 100 (6) | 0.078 | 17 (4) | 0.507 | 83 (5) | 0.103 | ||
Fisher's exact test (two tailed) for comparing distribution of any comorbid mental disorder or depression between subjects with and without physical disease.
References
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