Dementia Diagnosis Linked to Suicide

Suicide risk was higher in people recently diagnosed with dementia, especially younger patients, a case-control study in England showed.

Compared with people who didn’t have dementia, suicides rose in people who received a dementia diagnosis in the past 3 months (adjusted OR 2.47, 95% CI 1.49-4.09), according to Danah Alothman, BMBCh, MPH, of the University of Nottingham in England, and colleagues.

For people under age 65, suicide risk within 3 months of diagnosis was 6.69 times (95% CI 1.49-30.12) higher than in patients without dementia, the researchers reported in JAMA Neurology.

At any point after diagnosis, suicide risk remained elevated for younger people with dementia (adjusted OR 2.82, 95% CI 1.84-4.33). And at any point and at any age, people with psychiatric comorbidities had a 1.52 times higher risk of suicide (95% CI 1.21-1.90).

“Improving access to a dementia diagnosis is an important healthcare priority,” co-author Charles Marshall, MRCP, PhD, of Wolfson Institute of Population Health at Queen Mary University of London, said in a statement.

“However, a dementia diagnosis can be devastating, and our work shows that we also need to ensure that services have the resources to provide appropriate support after a diagnosis is given,” Marshall pointed out.

Suicide deaths are more common among people with any diagnosed neurologic disorder. Among Medicare patients, death by suicide increased after Alzheimer’s or dementia diagnoses, with the highest risk among people 65 to 74 years old and in the first 90 days after diagnosis.

But in these and other analyses, suicide risk among people under age 65 has been overlooked, Alothman and colleagues noted — a factor which may become increasingly important as Alzheimer’s and dementia diagnoses are made at earlier and earlier stages.

“Given the high risk of both suicide attempt and suicide death associated with a recent dementia diagnosis, we suggest that the current efforts for prompt dementia diagnosis should be accompanied by suicide risk assessment measures focused on the period immediately after diagnosis and in those with young-onset dementia,” the researchers wrote.

Screening and managing psychiatric illnesses in dementia patients also may help mitigate increased suicide risk, they added.

Alothman and co-authors evaluated medical databases and death records in England from 2001 through 2019. They included files from the Office for National Statistics in England with a death coded as suicide or open verdict, matching up to 40 control participants with each suicide case. Findings were adjusted for sex and age at suicide or index date.

The researchers looked at records for 594,674 people: 580,159 were controls (median age at death was 81.6 and 50% were men), and 14,515 died by suicide (median age at death was 47.4 and 74.8% were men).

Over a median follow-up of 2.3 years, 4,940 patients received a dementia diagnosis. Of these patients, 95 died by suicide (1.9% of people with dementia). Most dementia patients who died by suicide were men (58 people, 61.1%). Their median age at dementia diagnosis was 75.1, and their median age at death was 79.5.

While suicide risks were higher for younger patients, patients with psychiatric comorbidity, and patients recently diagnosed, no overall significant association emerged between dementia diagnosis and suicide (adjusted OR 1.05, 95% CI 0.85-1.29).

The number of patients with a dementia diagnosis who died by suicide in this study was small; as a result, some subgroup analyses may have been imprecisely estimated, Alothman and co-authors acknowledged. The researchers also had no information about dementia stages or social care provided to dementia patients.