Serious physical illness appears to be a strong risk factor for suicide in elderly people, study findings in the British Medical Journal show.

Although the suicide risk associated with physical illness was not as great as with mental disorders, Margden Waern (Gothenburg University, Sweden) and colleagues warn that it is still an independent risk factor, particularly among men.

For the study, the team obtained the records of 46 men and 39 women aged 65 years and over who had committed suicide and had undergone forensic examination. Interviews were also carried out with relatives of the suicide victims. For a control group, 84 men and 69 women were identified from the tax register.

Visual impairment, neurological disorders, and malignant disease were all independently associated with an increased risk of suicide, with odds ratios of 7.0, 3.8, and 3.4, respectively. Serious physical illness or disability in any organ category was also a risk factor for suicide.

Investigating sex differences in suicide risk, the researchers found that, while physical illness was associated with a four-fold increase in suicide rate in men, there was no such association in women. They acknowledge that this may be because of a small female sample size.

Nevertheless, overall, mental illness was the strongest risk factor for suicide. Evident in 82% of suicide victims, mood disorders were the most prevalent, regardless of physical illness status.

'Further research should focus on the detection and treatment of depression and suicidal ideation in the context of physical disease,' Waern et al conclude.

BMJ 2002; 324: 1355?1377

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