Abstract
This study investigates the epidemiology and psychiatric morbidity of the wish to be dead, suicidal ideation, and suicidal intent in a group of elderly persons (> 70 years). A representative community sample of 516 persons aged 70 to 105 was extensively investigated by psychiatrists using the structured interview GMS-A and various other self-rating and observer-rating scales. Diagnoses were made according to DSM-III-R and clinical judgment. In a cross-section of this population, we found the following prevalence rates: At the time of the study, 14.7% of the elderly community had symptoms of tiredness of life, 5.4% wished to die, and 1% showed suicidal ideation or gestures. Depending on the intensity of suicidality, 80% to 100% were clinically diagnosed as suffering from psychiatric disorders and 50-75% showed symptoms fulfilling the criteria of at least one specific psychiatric diagnosis. Further, logistic regression analysis showed a significant influence of major depression and specific DSM-III-R diagnosis on suicidality in old age. Our conclusion is that suicidal ideation in the elderly is usually a sign of a mental illness warranting diagnosis and treatment rather than assisted suicide.
References
1987). Diagnostic and statistical manual of mental disorders, 3rd ed. revised . Washington: American Psychiatric Press
(Angst, J (1987). Verlauf der affektiven Psychosen [The course of affective disorders]. In H Kisker, J Lauter, E Meyer, C Müller & E Strömgren (Eds.). Psychiatrie der Gegenwart (Bd. 5). Berlin, Heidelberg, New York: Springer-VerlagAsukai, N (1995). Suicide and mental disorder. Psychiatry and Clinical Neurosciences, 49, 591– 597Bachman, JG , Kirsten, H , Alcser, HD , Doukas, DJ , Lichtenstein, RL , Corning, AD , Brody, W (1996). Attitudes of Michigan physicians and the public toward legalizing physician-assisted suicide and voluntary euthanasia. The New England Journal of Medicine, 334, 303– 309Baltes, PB , Baltes, MM (1990). Successful aging: Perspectives from the behavioral sciences . Cambridge: Cambridge University PressBaltes, PB , Mayer, KU , Helmchen, H et al. (1996). Die Berliner Altersstudie (BASE): Überblick und Einführung [Berlin Aging Study: An introduction]. In KU Mayer, PB Baltes (Eds.), Die Berliner Altersstudie [Berlin Aging Study] (pp. 21-54). Berlin: Akademie VerlagBattin, MP (1987). Age rationing and the just distribution of health care: Is there a duty to die?. Ethics, 97, 317– 340Barnow, S (1999). Epidemiologie, Psychiatrische Komorbidität und psychosoziale Risikoindikatoren von Alterssuizidalität oder: Ist der Wunsch alter Menschen zu sterben “normal”? Ergebnisse der Berliner Altersstudie (BASE) [Epidemiology, mental comorbidity, and psychosocial suicidal risk factors of aged persons. Results from the Berlin Aging Study (BASE)]. Psychologische Dissertation Greifswald,Barnow, S , Linden, M Risikofaktoren von Todeswünschen Hochbetagter: Berücksichtigung empirischer Befunde zur Diskussion der sogenannten Euthanasiedebatte: Ergebnisse der Berliner Altersstudie (BASE) [Psychosocial risk factors of suicidal intention among the elderly: Empirical results and discussion of the so-called euthanasia debate]. Fortschritte Neurologie und Psychiatrie, submittedBöcker, F (1975). Suizidhandlungen alter Menschen [Suicidal attempts of older persons]. Münchner Medizinische Wochenschrift, 117, 201– 214Conwell, Y , Duberstein, PR , Cox, C et al. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. American Journal of Psychiatry, 153, 1001– 1008Copeland, JRM , Dewey, ME , Henderson, AS et al. (1988). The Geriatric Mental State (GMS) used in the community: Replication studies of the computerized diagnosis AGECAT. Psychological Medicine, 18, 219– 223Deutscher, Ärztetag (1996). Erklärung des Deutschen Ärztetages zur Euthanasie [Resolution of the Assembly of German Physicians on euthanasia]. Deutsches Ärzteblatt, 93, 1339– 1347Diekstra, RFW (1996). Erfahrungen in den Niederlanden: “Assisted suicide.” [Experiences in the Netherlands: “Assisted suicide]. In Anschütz F & Wedler HL (Eds.), Suizidprävention und Sterbehilfe [Suicide prevention and euthanasia] (pp. 77-90). Berlin, Wiesbaden: UllsteinElwitz, J (1977). Die Bedeutung der Krankheit im Suizidgeschehen des Alters [The meaning of illness in the context of suicidality among the elderly]. Medizinische Dissertation Erlangen,Ernst, K (1995). Alterssuizid: Ein ethischer Sonderfall? [Suicide in old age: Ethically a special issue?]. Zeitschrift für Gerontopsychologie und Psychiatrie, 8, 39– 40Feuerlein, W (1977). Ursachen, Motivation und Tendenzen von Selbstmordhandlungen im Alter [Etiology, motivation, and tendencies of suicide in the elderly]. Aktuelle Gerontologie, 7, 67– 74Gallo, JJ , Anthony, JC , Muthen, BO (1994). Age differences in the symptoms of depression: A latent trait analysis. Journal of Gerontology, 49, 251– 64Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56– 62Hautzinger, M (1988). Die CES-D Skala. Ein Depressionsinstrument für Untersuchungen der Allgemeinbevölkerung [The CED-D scale: A self-rating scale for depression in the general population]. Diagnostica, 34, 167– 173Helmchen, H , Baltes, MM , Geiselmann, B , Kanowski, S , Linden, M , Reischies, FM , Wagner, M , Wilms, HU (1996). Psychische Erkrankungen im Alter [Psychiatric disorders in the elderly]. In KU Mayer, PB Baltes (Eds.), Die Berliner Altersstudie [The Berlin Aging Study] (pp. 185-220). Berlin: Akademie VerlagKanowski, S (1994). Age-dependent epidemiology of depression. Gerontology, 40, 1– 4Kaplan, LM , Asmis, GM , Sanderson, WC et al. (1994). Suicide assessment: Clinical interview vs. self report. Journal of Clinical Psychology, 50, 294– 298Katona, CE (1995). Detecting and managing depression in older people. Human Psychopharmacology Clinical and Experimental, 10, 229– 234King, E (1994). Suicide in the mentally ill. An epidemiological sample and implications for clinicians. British Journal of Psychiatry, 165, 658– 663Kreitmann, N (1980). Die Epidemiologie von Suizid und Parasuizid [The epidemiology of suicide and parasuicide]. Nervenarzt, 5, 131– 138Lauter, H , Meyer, JE (1992). Die neue Euthanasie-Diskussion aus psychiatrischer Sicht [The new euthanasia discussion from the psychiatric viewpoint]. Fortschritte der Neurologie, Psychiatrie, 60, 441– 448Lee, MA , Nelson, HD , Tilden, VP et al. (1996). Legalizing assisted suicide—views of physicians in Oregon. The New England Journal of Medicine, 334, 310– 315Lindenberger, U , Gilberg, R , Pötter, U et al. (1996). Stichprobenselektivität und Generalisierbarkeit der Ergebnisse in der Berliner Altersstudie [Selectivity and generalizability in the BASE]. In KU Mayer, PB Baltes (Eds.), Die Berliner Altersstudie [The Berlin Aging Study] (pp. 85-108). Berlin: Akademie VerlagLinden, M , Barnow, S (1997). The wish to die in very old persons near the end of life: A psychiatric problem? Results from the Berlin Aging Study (BASE). International Psychogeriatrics, 9, 291– 307Lindner-Braun, C (1990). Soziologie des Selbstmordes [The Sociology of suicide]. Opladen: Westdeutscher VerlagLönnqvist, JK , Henriksson, MM , Isometsa, ET et al. (1995). Mental disorders and suicide prevention. Psychiatry and Clinical Neuroscience, 49, 111– 116Mayer, UM , Baltes, PB (1996). Die Berliner Altersstudie [The Berlin Aging Study]. Berlin: Akademie VerlagMellick, E , Buckwalter, KC , Stolley, JM (1992). Suicide among elderly white men: Development of a profile. Journal of Psychosocial Nurse Mental Health Service, 30, 29– 34Overall, JE , Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Report, 10, 799– 812Pilowsky, I (1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 89– 93Ringel, E (1953). Der Selbstmord [Suicide]. Wien: Verlag für medizinische Wissenschaften W. MaudrichRoy, A (1982). Risk factors for suicide in psychiatric patients. Archives of General Psychiatry, 39, 1089– 1095Simon, RI (1989). Silent suicide in the elderly. Bulletin American Academic Psychiatry Law, 17, 83– 95Stumpfe, KD (1988). Psychodynamik des Selbstmordes im Alter [The psychodynamics of suicide in the elderly]. Zeitschrift für Gerontologie, 21, 45– 51Summa, JD (1986). Krankheit und Alter beim Suizid alter Menschen [Physical disorders as a risk factor for suicidal acts in old age]. Münchner Medizinische Wochenschrift, 128, 545– 547Van der Wal, G , Onwuteka-Philipsen, BD (1996). Cases of euthanasia and assisted suicide reported to the Public Prosecutorn in North Holland over 10 years. British Medcial Journal, 312, 612– 613Von Zerssen, D (1976). Die Beschwerden-Liste als Test [The Complaint List]. Therapiewoche, 21, 1908– 1914