title: Predicting suicide in older adults - a community-based cohort study in Taipei City, Taiwan.
abstract: BACKGROUND
  Older adults worldwide are at a greater risk of suicide than other age groups. There is a scarcity of prospective studies exploring risk factors for suicide in older people and their discriminative ability to identify future suicide.
  
  
  METHODS
  We examined a prospective cohort of senior Taipei City residents between 2005 and 2009 (N=101,764). Cox proportional hazards regression analysis was used to determine significant risk factors and to construct a predictive score. The accuracy of the derived score in the prediction was tested by Receiver Operating Characteristic analysis.
  
  
  RESULTS
  Male sex (Hazard Ratio [HR]=3.41, p<0.001), lower education (HR=3.31, p<0.001) and lower income (HR=2.52, p=0.01) were associated with an increased risk of suicide, as well as depressed mood (HR=1.44, p=0.02; per unit increase in a 4-point scale) and insomnia (HR=1.30, p=0.03; per unit increase in a 4-point scale). The derived prediction score yielded a sensitivity of 0.63 a specificity of 0.73 and an area under curve of 0.73. Removing depressed mood from the prediction model did not significantly alter suicide predictability (P=0.11).
  
  
  CONCLUSIONS
  The dataset examined did not contain information regarding to important risk factors such as substance misuse and prescribed medications and the measures of mental health were relatively limited.
  
  
  CONCLUSIONS
  Prediction of suicide based on factors recorded in a routine health screen of elderly people was unsatisfactory; the strongest predictors were factors that cannot be easily altered. Further understanding of how the socioeconomic condition of seniors contributes to suicide may provide valuable insights for intervention targeting this growing population-at-risk.
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Galen Chin-Lun
authors.initials: GC
authors.lastname: Hung
authors.affiliation: Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.
authors.forename: Chi-Leung
authors.initials: CL
authors.lastname: Kwok
authors.affiliation: Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.
authors.forename: Paul S F
authors.initials: PS
authors.lastname: Yip
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan. Electronic address: ychen@tpech.gov.tw.
authors.forename: Ying-Yeh
authors.initials: YY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D057187:Independent Living; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology
keywords: Health examination; Older adults; Prediction; Suicide; Taiwan