Suicide in older men: The health in men cohort study (HIMS).
Suicide rates are high in later life, particularly among older men. Mood disorders are known risk factors, but the risk of suicide associated with poor physical health remains unclear. We completed a cohort study of a community representative sample of 38,170 men aged 65-85 in 1996 who were followed for up to 16years. Data on suicide attempts and completion were obtained from the Western Australia Data Linkage System, as was information about medical and mental health diagnoses. 240 (0.6%) participants had a recorded history of past suicide attempt, most commonly by poisoning (85%). Sixty-nine men died by suicide during follow up (0.3% of all deaths), most often by hanging (50.7%). Age-adjusted competing risk regression showed that past suicide attempt was not a robust predictor of future suicide completion (sub-hazard ratio, SHR=1.58, 95% CI=0.39, 6.42), but bipolar (SHR=7.82, 95% CI=3.08, 19.90), depressive disorders (SHR=2.26, 95% CI=1.14, 4.51) and the number of health systems affected by disease (SHR for 3-4 health systems=6.02, 95% CI=2.69, 13.47; SHR for ≥5 health systems=11.18, 95% CI=4.89, 25.53) were. The population fraction of suicides attributable to having 5 or more health systems affected by disease was 79% (95% CI=57%, 90%), and for any mood disorder (bipolar or depression) it was 17% (95% CI=3%, 28%). Older Australian men with multiple health morbidities have the highest risk of death by suicide, even after taking into account the presence of mood disorders. Improving the overall health of the population may be the most effective way of decreasing the rates of suicide in later life.
School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia; WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Australia. Electronic address: osvaldo.almeida@uwa.edu.au.
Osvaldo P
OP
Almeida
WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia.
Kieran
K
McCaul
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia.
Graeme J
GJ
Hankey
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Endocrinology, Fiona Stanley Hospital, Perth, Australia.
Bu B
BB
Yeap
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
Jonathan
J
Golledge
WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
Leon
L
Flicker
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D054526:Men's Health; D012307:Risk Factors; D019966:Substance-Related Disorders; D013405:Suicide / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
Aged; Alcohol; Bipolar disorder; Cohort study; Depression; Frailty; Men; Substance use; Suicide