Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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The characteristics of elderly suicidal attempters in the emergency department in Korea: a retrospective study

  • Ji-Seon Jang (Department of Psychiatry, Yeungnam University College of Medicine) ;
  • Wan-Seok Seo (Department of Psychiatry, Yeungnam University College of Medicine) ;
  • Bon-Hoon Koo (Department of Psychiatry, Yeungnam University College of Medicine) ;
  • Hey-Geum Kim (Department of Psychiatry, Yeungnam University College of Medicine) ;
  • Seok-Ho Yun (Department of Psychiatry, Yeungnam University College of Medicine) ;
  • So-Hey Jo (Department of Psychiatry, Yeungnam University College of Medicine) ;
  • Dae-Seok Bai (Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital) ;
  • Young-Gyo Kim (Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital) ;
  • Eun-Jin Cheon (Department of Psychiatry, Yeungnam University College of Medicine)
  • Received : 2023.09.11
  • Accepted : 2023.10.14
  • Published : 2024.01.31
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Abstract

Background: Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group. Methods: Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18-64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group. Results: Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01). Conclusion: Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.

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References

  1. Organization for Economic Co-operation and Development (OECD). Suicide rates [Internet]. Paris: OECD; 2019 [cited 2023 Apr 28]. https://data.oecd.org/healthstat/suicide-rates.htm.
  2. Centers for Disease Control and Prevention (CDC). WISQRS Cost of Injury: number of injuries and associated costs [Internet]. Atlanta: CDC; 2020 [cited 2023 Apr 26]. https://wisqars.cdc.gov/cost/?y=2020&o=MORT&i=2&m=20810&g=00&s=0&u=TOTAL&t=COMBO&a=5Yr&g1=0&g2=199&a1=0&a2=199&r1=MECH&r2=INTENT&r3=NONE&r4=NONE&c1=c2=.
  3. Korea National Health Insurance Service (NHIS). The socio-economic cost analysis report of the ten major causes of death [Internet]. Wonju: NHIS; 2017 [cited 2023 Apr 26]. https://www.nhis.or.kr/nhis/about/wbhaec07810m01.do?-mode=view&articleNo=125013&article.offset=0&articleLimit=10&srSearchVal=%EC%82%AC%ED%9A%8C%EA%B2%BD%EC%A0%9C%EC%A0%81.
  4. Statistics Korea. Cause of death statistics results 2020 [Internet]. Daejeon: Statistics Korea; 2020 [cited 2023 Apr 28]. https://www.kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=403046.
  5. Korean Statistical Information Service. Population situation board [Internet]. Daejeon: Statistics Korea; 2023 [cited 2023 Apr 28]. https://kosis.kr/visual/populationKorea/PopulationDashBoardMain.do.
  6. Kim DW, Cho SE, Kang JM, Woo SK, Kang SG, Yeon BK, et al. Risk factors for serious suicide attempts: difference between older and younger attempters in the emergency department. Front Psychiatry 2020;11:607811.
  7. Fassberg MM, Cheung G, Canetto SS, Erlangsen A, Lapierre S, Lindner R, et al. A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging Ment Health 2016;20:166-94.
  8. Valera Ortin J, Luceron Lucas-Torres MI. Suicide related factors in the elderly: a systematic review. Rev Esp Salud Publica 2021;95:e202110166.
  9. Lee J, Lee J. Statistical analysis of the factors of suicidal ideation risk of Korean elderly: using a panel logit GLMM. Health Soc Welf Rev 2020;40:264-94.
  10. Korea Foundation for Suicide Prevention. White paper on suicide prevention 2022. Sejong: Ministry of Health and Welfare;2023.
  11. Korea Institute for Health and Social Affairs. Survey on the status of the elderly 2020. Sejong: Korea Institute for Health and Social Affairs; 2021.
  12. Hong S, Lee WJ, Kim DH, Seol SH, Lee JY, In SK, et al. Elderly patients visiting the emergency department for deliberate self-poisoning: do they present a more severe poisoning severity score than the nonelderly patients in the initial 24 h? Aging ClinExp Res 2019;31:1139-46.
  13. Tsirigotis K, Gruszczynski W, Tsirigotis M. Gender differentiation in methods of suicide attempts. Med Sci Monit 2011;17:PH65-70.
  14. Koo YW, Kolves K, De Leo D. Suicide in older adults: differences between the young-old, middle-old, and oldest old. Int Psychogeriatr 2017;29:1297-306.
  15. Um TW. Elderly suicide and it's related factors: focused on the role of social support and mastery in the effects of hopelessness and depression on suicidal ideation. Korean J Soc Welf 2007;59:355-79.
  16. Seo GS. Health behavior in the aged and related variables. J Korea Gerontol Soc 2008;28:1201-12.
  17. Park ES, Kim SJ, Kim SI, Chun YJ, Lee PS, Kim HJ, et al. Establishment of quality of life prediction model for the elderly. J Korea Gerontol Soc 1998;18:37-61.
  18. Korean Statistical Information Service. Current status of medical benefit recipients by age and gender [Internet]. Daejeon: Statistics Korea; 2021 [cited 2023 Apr 28]. https://kosis.kr/statHtml/statHtml.do?orgId = 350&tblId = DT_920015_N101.
  19. Ju YJ, Park EC, Han KT, Choi JW, Kim JL, Cho KH, et al. Low socioeconomic status and suicidal ideation among elderly individuals. Int Psychogeriatr 2016;28:2055-66.
  20. Yur'yev A, Leppik L, Tooding LM, Sisask M, Varnik P, Wu J, et al. Social inclusion affects elderly suicide mortality. Int Psychogeriatr 2010;22:1337-43.
  21. Brendel RW, Lagomasino IT, Perlis RH, Stern TA. The suicidal patient. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, editors. Massachusetts General Hospital comprehensive clinical psychiatry. Philadelphia, PA: Mosby/Elsevier; 2008. p. 733-45.
  22. Bostwick JM, Pabbati C, Geske JR, McKean AJ. Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. Am J Psychiatry 2016;173:1094-100.
  23. O'Connell H, Chin AV, Cunningham C, Lawlor BA. Recent developments: suicide in older people. BMJ 2004;329:895-9.
  24. Wiktorsson S, Stromsten L, Renberg ES, Runeson B, Waern M. Clinical characteristics in older, middle-aged and young adults who present with suicide attempts at psychiatric emergency departments: a multisite study. Am J Geriatr Psychiatry 2022;30: 342-51.
  25. Holmstrand C, Rahm Hallberg I, Saks K, Leino-Kilpi H, Renom Guiteras A, Verbeek H, et al. Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries. Aging Ment Health 2021;25:1730-9.
  26. Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Medical illness and the risk of suicide in the elderly. Arch Intern Med 2004;164:1179-84.
  27. Wang G, Jia C, Ma Z, Zhou L. Physical diseases and elderly suicide in rural China: a case-control psychological autopsy study. Aust N Z J Psychiatry 2022;56:560-8.
  28. Min SG. Modern psychiatry. 5th ed. Seoul: Ilchokak Publishers; 2006.
  29. Harwood DM, Hawton K, Hope T, Jacoby R. Suicide in older people: mode of death, demographic factors, and medical contact before death. Int J Geriatr Psychiatry 2000;15:736-43.
  30. Santos MC, Giusti BB, Yamamoto CA, Ciosak SI, Szylit R. Suicide in the elderly: an epidemiologic study. Rev Esc Enferm USP 2021;55:e03694.
  31. Choi MM, Kim DY, Kim G. Psychological autopsy study on suicide in rural areas in Korea. Korean J Soc Welf 2015;67:55-81.
  32. Chong YS, Jeong YJ. A review on variables related to suicide of the Korean youth and elderly: an application of vulnerability stress model to suicide. Korean J Develop Psychol 2015;28: 227-54.
  33. Conwell Y, Duberstein PR, Cox C, Herrmann J, Forbes N, Caine ED. Age differences in behaviors leading to completed suicide. Am J Geriatr Psychiatry 1998;6:122-6.
  34. Bennett AT, Collins KA. Elderly suicide: a 10-year retrospective study. Am J Forensic Med Pathol 2001;22:169-72.
  35. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav 1998;28:1-23.
  36. Organization for Economic Co-operation and Development (OECD). Society at a glance 2016: OECD Social Indicators. Paris: OECD Publishing; 2017.
  37. Korea Foundation for Suicide Prevention. White paper on suicide prevention 2019. Sejong: Ministry of Health and Welfare; 2019.
  38. Song SJ, Park GJ, Lee JH, Kim SC, Kim H, Lee SW. The characteristics of elderly individuals who attempted suicide by poisoning: a nationwide cross-sectional study in Korea. J Korean Med Sci 2020;35:e286. 38 https://doi.org/10.12701/jyms.2023.01004