AJP nov97 Book Forum • Suicide and Aging: International Perspectives

Suicide in the elderly is an important public health problem. This excellent book, based on an NIMH workshop and a special edition of International Psychogeriatrics, broadens our understanding of its multiple etiologies. There are 17 chapters from 40 established authors, including chapters invited from Germany, Japan, the United Kingdom, Finland, Singapore, and Australia.

Mosciki reviews suicide epidemiology around the globe. The only contentious entry is that “suicide is a complex, long-term outcome,” which might justify the inclusion of a clergyperson among the invited authors. Conwell and Brent draw attention to the idea that aging may play a role in determining the biological basis of suicide—referring to demonstrated age-related diminution in 5-HT receptor binding.

Schmitz-Scherzer writes a interesting chapter, stating that German society lacks interest in the problems of old people and that there is a devaluing of them. He questions whether biases in retrospective methodologies have inflated estimates of risk for suicide associated with depression—“I submit that suicide in later life is not always based on pathologic mental processes.”

Watanabe et al., writing of Japan, compare suicide rates of the elderly in two regions: urban Kawasaki and rural Higashikubiki. The reader might expect the rural population to have the lower rate because there is often greater preservation of traditional family structures in rural areas. This is not the case, however. The family structure of the urban area was not described, and further reports will be welcomed.

Sartorious, writing on the Eastern European countries, reports a recent relative increase in general suicide rates. Distinctively, in these countries, the suicide rate of those over 75 years old has decreased. He discusses the role of economic, cultural, and health service factors influencing these trends.

One of the many joys of the book is the chapter by Ko and Kua in which they report that the suicide rate of the general population in Singapore is highest for Indians, followed by Chinese and, finally, by Malays. For the elderly, however, the rate is highest among the Chinese. Through an encyclopedic local knowledge, these authors are able to identify some of the sociocultural factors that account for the different rates.

Burvill reports on suicide in the elderly of Australia, a multiethnic society with 25% of its elderly born outside the country. He found marked heterogeneity in rates among the various migrant groups. The suicide rates of migrant groups was mostly higher than in their country of origin. Migrants from countries with high suicide rates generally had high rates in Australia and vice versa. Possible reasons for these findings are discussed.

A commentary by Corrin that invites researchers to use “anthropological imagination” adds little. The so-called bridging concepts of this chapter are simply pillars without the spans needed and suggested by the term.

This is an excellent, unique book. It brings together much wisdom on a troubling human problem. It is essential to any decent library and should be recommended reading for students of psychiatry, geriatrics, public health, and the other social sciences.