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Title: Risk factors for suicide in older people and grief experiences of bereaved relatives and friends : a descriptive and case control study
Author: Harwood, Daniel
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2004
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Introduction: Suicide rates in older people are high in most countries of the world, and remain high in older men in the UK. Recent Government policy has set targets to reduce suicide rates. There has never been a controlled psychological autopsy study of suicide in older people in the UK to examine the risk factors for suicide in this age group, and worldwide there has been very little research on the role of cognitive impairment, personality factors, and life problems as risk factors for suicide in older people. Although evidence suggests that those bereaved through suicide may be particularly vulnerable to developing severe grief reactions, there have been few controlled studies on the topic and little is known about grief experiences of individuals bereaved through suicide of older people. There has been no recent UK study systematically examining the impact of the legal procedures following a suicide on bereaved relatives and friends. Aims of the study: For a sample of older people dying through suicide: 1. To describe the demographic characteristics, circumstances of death, and contact with primary care and psychiatric services. 2. To determine the prevalence of psychiatric disorder, personality disorder, and significant maladaptive personality traits. 3. To determine the nature and frequency of life problems due to physical illness, bereavement, occupation and retirement, finances, accommodation, and other factors preceding death. 4. To compare the rate of these psychiatric and life problem variables with a control group of people who had died through natural causes. For a sample of relatives and friends bereaved through the suicide of an older person: 1. To describe the nature and frequency of problems, especially those related to the legal sequelae of suicide. 2. To determine the frequency of grief symptoms hypothesised to be particularly prominent in post-suicide bereavement compared to a group bereaved through death from natural causes. Method: For the study on risk factors for suicide, 195 individuals 60 years and over at the time of death who had died through suicide in four counties in central England between January 1995 and May 1998 were the study subjects. Information on demographic factors, circumstances of death, contact with health services, psychiatric history and life problems before death was collected from coroners' records and medical notes. A semi-structured psychological autopsy interview with a relative or friend of the deceased was performed in 100 cases, and ICD-10 psychiatric and personality disorder diagnoses were made for each subject. Similar information was collected for a control group of 54 subjects, age and sex matched with the suicide group who had died through natural causes in same time period. For the study on bereavement after suicide, the problems experienced during legal procedures after death and the grief experiences of 85 relatives and friends bereaved through the suicide of someone 60 years old or over (recruited from the participants from the first part of the study) were examined. In a case-control study the bereavement reactions in a sub-group of 46 of this sample were compared with 46 of the control group who had been bereaved through a natural death. Interviews were semi-structured and included the Grief Experience Questionnaire (GEQ). Results: A. Risk factors for suicide: 1. 67.7% of the suicide subjects were male, and a higher proportion of men than women were divorced or single. 2. The commonest methods of suicide were hanging in men and drug overdose in women. Analgesics, antidepressants, and hypnotic drugs were the commonest types used in overdose. 3. 49.8% of the suicide group had seen their GP in the month before death, and 15.4% were under psychiatric care at the time of death. 4. 77% of the suicide sample had a psychiatric disorder at the time of death, most often depression (63%). 5. Personality disorder or personality trait accentuation was present in 44%, with anankastic (obsessional) or anxious traits the most frequent. 6. Depression, personality disorder, and personality trait accentuation emerged as predictors of suicide in the case-control analysis. 7. Physical illness was the commonest life problem associated with suicide and was a contributory factor to death in 62% of cases. Distressing symptoms were commonly secondary to non life-threatening illnesses. 8. The presence of unresolved problems from a bereavement over one year before death emerged as a predictor of suicide in the case-control study. B. Bereavement after suicide: 1. Forty-two percent of those bereaved through suicide reported problems in their dealings with the coroner's office, and 38.8% described distress caused by media reporting of the inquest. 2. In the case-control study of grief reactions, those bereaved through suicide scored higher on subscales of the GEQ measuring stigmatisation, shame, sense of rejection, and 'unique reactions' compared with those bereaved through natural death. Conclusions: Given the high proportion of drug overdoses in the sample, effective strategies to prevent suicide in older people might include improving the prescribing of analgesics and antidepressants. Personality factors, as well as depression, are important risk factors for suicide in older people and thorough personality assessment should be included in any risk assessment. The impact of physical symptoms, even those due to non life- threatening illnesses in contributing to suicide in older people needs to be recognised by clinicians. Problems in the media reporting of inquests and in inquest procedures are potentially remediable sources of distress for bereaved relatives. The common themes of stigma, shame, and a sense of rejection in bereavement after suicide suggest that these areas should be specifically addressed in the counselling of relatives bereaved in this way.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: WM Psychiatry