Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study

Background. The role of physical illness and life problems in contributing to suicide in older people is potentially important with regard to suicide prevention. Method. The aim of the study was to determine the life problems other than psychiatric illness contributing to suicide in older people. Semi-structured psychological autopsy interviews, covering life problems and physical illness prior to death, were conducted with informants for 100 people aged 60 years old and over who died through suicide in five English counties. Interviews were completed with informants for 54 age- and sex-matched control subjects who died through natural causes. Results. The three most frequent life problems associated with suicide were physical illness, interpersonal problems, and bereavement. Physical health problems were present in 82 % and felt to be contributory to death in 62 %. Pain, breathlessness and functional limitation were the most frequent symptoms. Interpersonal problems were present in 55 % of the sample and contributory in 31 %. The corresponding figures for bereavement-related problems were 47 % and 25 %. In the case-control analysis, the problems found to be risk factors for suicide were problems related to a bereavement over 1 year before death (OR 3.5, 95% CI 1.2-10.6), and problems with accommodation (OR 5.0, 95 % CI 1.1-22.8), finances (p = 0.01), and retirement (p = 0.02). Conclusion. Physical illness, interpersonal problems and bereavement are commonly associated with suicide in older people, but financial, accommodation, retirement and long-term bereavement-related problems may be more specific risk factors.