Three subgroups of patients are at increased risk for suicide following a diagnosis of dementia ― a finding that paves the way for more targeted suicide risk assessment and intervention, new research suggests.
In a large population-based, case-control study, results showed an increased risk for suicide among those with younger-onset dementia, defined as being diagnosed before age 65; those diagnosed within the previous 3 months; and those who also had mental illness.
"Doctors should be aware that these groups are at increased risk and consider early signposting/referral to appropriate mental health services," senior investigators Charles Marshall, MRCP, PhD, clinical senior lecturer and honorary consultant neurologist, Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom, told Medscape Medical News.
"Perhaps more importantly, the design and remuneration of dementia diagnosis services need to take account of the importance of providing adequate resources for postdiagnostic support and risk assessment," Marshall said.
The findings were published online October 3 in JAMA Neurology.
Fear and Worry
The researchers reviewed the electronic medical records from 2001 to 2019 for roughly 594,000 adults. Among the 4940 adults diagnosed with dementia, 95 (1.9%) died by suicide.
There was no overall significant association between a dementia diagnosis and suicide risk (adjusted odds ratio [aOR], 1.05; 95% CI, 0.85 – 1.29).
However, compared with adults who had not been diagnosed with dementia, suicide risk was significantly increased among peers diagnosed with dementia before age 65 (aOR, 2.82; 95% CI, 1.84 – 4.33).
The risk was more than twofold higher within the first 3 months of diagnosis (aOR, 2.47; 95% CI, 1.49 – 4.09) and in those with comorbid psychiatric illness (aOR, 1.52; 95% CI, 1.21 – 1.93).
Among adults younger than 65 years who were within 3 months of diagnosis, suicide risk was nearly seven times higher than among their peers without dementia (aOR, 6.69; 95% CI, 1.49 – 30.12).
Adults with dementia who died by suicide were significantly younger at their time of death than peers with dementia who died of other causes (median age, 79.7 years vs 87.9 years).
"Given the current efforts to improve rates of dementia diagnosis, these findings emphasize the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups," the investigators write.
Marshall noted that the elevated suicide risk after a dementia diagnosis in these subgroups may be due to a combination of the stress of diagnosis and neurodegenerative effects of the disease.
"A dementia diagnosis can be devastating, and many patients have fears for their future quality of life and fears that they may be a burden to those around them. In addition, we know that depression, anxiety, and social isolation can be early symptoms of Alzheimer's disease; and all of these may increase suicide risk too," Marshall said.
Examining "Devastating" Outcomes
Commenting on the findings for Medscape Medical News, Beth Kallmyer, MSW, vice president of care and support for the Alzheimer's Association, said this large study is one of few that have examined the "devastating" psychological effects of being diagnosed with dementia.
For example, a study published last year showed that adults older than 65 who were diagnosed with Alzheimer's disease were twice as likely to die from suicide than older adults who did not suffer from dementia, as reported by Medscape Medical News.
Receiving a diagnosis of Alzheimer's at an early age is "rare, unexpected, and overwhelming ― making it very difficult to accept. The worry or fear about being a burden to family members can lead to thoughts of suicide," said Kallmyer, who was not involved with the research.
"Individuals diagnosed with younger-onset Alzheimer's face additional challenges because they are often raising families and taking care of their own parents. Losing their ability to work is especially devastating since they are often in the prime earning years," she said.
Kallmyer noted that it is not uncommon for individuals living with dementia to have suicidal thoughts, but having suicidal thoughts and taking action on them is very different.
"The signs to look for in a person living with Alzheimer's disease are the same as any other situation: talking about wanting to die, fear of being a burden, feeling hopeless and helpless, withdrawing from friends and family, changes in sleeping and eating habits," she said.
She added that one of the most important things a healthcare provider can tell someone facing a dementia diagnosis is that they are not alone and that support is available.
The Alzheimer's Association has support groups and disease education programs for individuals living with Alzheimer's, Kallmyer noted.
The study received no specific funding. Marshall and Kallmyer have reported no relevant financial relationships.
JAMA Neurol. Published online October 3, 2022. Abstract
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Cite this: Three Groups at Increased Risk for Suicide After a Dementia Diagnosis - Medscape - Oct 06, 2022.