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Am J Psychiatry 1996; 153:1001-1008
Copyright © 1996 by American Psychiatric Association
Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study
Y Conwell, PR Duberstein, C Cox, JH Herrmann, NT Forbes and ED Caine
Department of Psychiatry, University of Rochester School of Medicine, NY, USA. conwell@metro.bst.rochester.edu
OBJECTIVE: Psychiatric illness is a potent risk factor for suicide, rates
of which differ markedly with age. The purpose of this study was to examine
whether the psychiatric diagnoses of suicide victims vary predictably with
age. METHOD: DSM-III-R axis I diagnoses of 141 persons aged 21 to 92 years
who had completed suicide were established by the psychological autopsy
method. Multiple logistic regression analyses were used to determine
whether age, gender, or their interaction predicted the presence of
specific disorders. RESULTS: One or more axis I conditions were diagnosable
in 90.1% of the suicide victims. Substance use disorders were most
frequent, followed by mood disorders and primary psychotic illness. Younger
age at death was a significant predictor of substance abuse or dependence
and primary psychoses, while older age predicted major mood disorders.
Comorbidity of substance use and mood disorders was common. Among victims
with substance abuse or dependence, older age at death predicted major
depression; among victims with mood disorders, younger age at death
predicted comorbid substance abuse or dependence. CONCLUSIONS: The
distribution of psychiatric illnesses in suicide victims differs across the
life course. Age-related patterns of addictive and psychotic disorders echo
their prevalence in the general population. In contrast, the relationship
between age and mood disorders among suicide victims is distinctly
different from that of the general population. These findings suggest that
risk for suicide increases with age in individuals with major affective
illness. Depressed elderly men are particular targets for suicide
prevention strategies.
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