title: A multidimensional risk factor model for suicide attempts in later life.
abstract: BACKGROUND
  Elderly suicide is a public health problem worldwide, and the risk factors are multidimensional. Chronic mental health problems, personality traits, stressful life events, comorbid medical conditions, social isolation, unemployment, and poverty are associated with higher risk for suicide in later life. There was a relative paucity of data on the neurobiological markers of elderly suicide.
  
  
  OBJECTIVE
  This study examines the conjoint roles of cerebrovascular risk factors (CVRFs) and other established biopsychosocial risk factors in older adults who had made a recent suicide attempt.
  
  
  METHODS
  A cross-sectional, case-controlled study.
  
  
  METHODS
  A tertiary care setting in a public sector and a community setting.
  
  
  METHODS
  Cases (N=77) were nondemented Chinese adults aged ≥65 years, enrolled in a regional psychogeriatric service following a suicide attempt; comparison subjects (N=99) were community-dwelling nondemented older adults with no lifetime history of suicide. Measures of sociodemographic profile, life events, suicidal behavior, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I psychopathology, personality traits, functional status, physical health, CVRFs, and executive cognitive functions were administered.
  
  
  RESULTS
  WEIGHTED SUM OF CVRF SCORE WAS SIGNIFICANTLY HIGHER IN OLDER WOMEN WHO HAD MADE A RECENT SUICIDE ATTEMPT (MEAN: 10.56; standard deviation [SD]: 5.46) than comparison subjects (mean: 7.24; SD: 4.04) (t=3.52, P=0.001; df=99). Logistic regression showed that CVRF score (Exp[B]: 1.289, P=0.033), DSM-IV depressive disorders (current) (Exp[B]: 348, P<0.001), number of life events in the past 12 weeks (Exp[B]: 10.4; P<0.001), and being married (Exp[B]: 12.2, P<0.048) significantly increased odds for suicide attempt status in older women (Nagelkerke R (2): 0.844). Association of CVRF score and suicide attempt status was not observed in older men for whom number of life events in the past 12 weeks (Exp[B]: 9.164; P<0.001), higher neuroticism (Exp[B]: 1.028; P=0.048), and impaired performance on a Modified Card Sorting Test (Exp[B]: 0.646; P=0.032) significantly increased odds for suicide attempt status in a logistic regression model (Nagelkerke R (2): 0.611).
  
  
  CONCLUSIONS
  Risk factors for cerebrovascular diseases may be associated with higher risk for attempted suicide in older women, but not in older men. Older men and women have distinct risk factor profiles that may inform targeted intervention and prevention strategies.
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Sau Man Sandra
authors.initials: SM
authors.lastname: Chan
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Fung Kum Helen
authors.initials: FK
authors.lastname: Chiu
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Chiu Wa Linda
authors.initials: CW
authors.lastname: Lam
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Sau Man Corine
authors.initials: SM
authors.lastname: Wong
authors.affiliation: Department of Psychiatry, University of Rochester, Rochester, NY, USA.
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
keywords: chronic medical illness; cognitive function; later life; suicide