Academy of Psychosomatic Medicine
Annotated Abstracts of Journal Articles
Annotation by Kemuel Philbrick, MD, FAPM
PUBLICATION #1 — Suicide
A systematic review of physical illness, functional disability, and suicidal behaviour among older adults
Fässberg MM, Cheung G, Canetto SS, et al
ANNOTATION (Kemuel Philbrick)
The Finding: Fifty-nine international quantitative studies were reviewed to ascertain which, if any, specific physical illnesses and/or functional disabilities are associated with suicidal behavior (subdivided into death wishes, suicidal ideation, nonfatal suicidal behavior, and/or completed suicide) in adults aged 65 and older.
Strengths and Weaknesses: This review was an ambitious undertaking to examine what is available in the world’s literature to clarify the association between common comorbidities of advancing age and the known heightened risk of suicide in the elderly; it represents a prodigious review of potentially informative studies resulting in close scrutiny of 61 different patient samples from four continents.
Relevance: The risk for suicide conferred by physical illness and functional disability, while increased, remains modest compared to the risk associated with psychiatric comorbidity. The consultation psychiatrist often has the opportunity to assess both side-by-side. This opportunity will be strengthened by increased integration of psychiatric care into primary care and particularly geriatric and palliative care settings. When choices must be made about where to deploy integrated mental health professionals due to limited resources, it may be worth first choosing areas such as oncology, neurology, or pain clinics.
Objectives: To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older.
Method: Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review.
Results: Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed.
Conclusion: Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.
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