International Psychogeriatrics

Review Article

Dementia and suicidal behavior: a review of the literature

Camilla Hawa1 c1, Daniel Harwooda2 and Keith Hawtona3

a1 St Andrew's Hospital, Northampton, U.K.

a2 Older Persons Mental Health Unit, St Mary's Hospital, Newport, Isle of Wight, U.K.

a3 Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, U.K.

ABSTRACT

Background: While dementia is more common in older people and suicide rates in many countries are higher among the elderly, there is some doubt about the association between these two phenomena.

Methods: A search of the major relevant databases was carried out to examine the evidence for this possible association.

Results: The association between dementia and suicide and also non-fatal self-harm did not appear strong but many studies have significant methodological limitations and there are few studies of suicide or self-harm in vascular, frontotemporal, Lewy body and HIV dementia where such behavior might be expected to be more common. Rates of self-harm may be increased in mild dementia and are higher before than after predictive testing for Huntington's disease. Overall, the risk of suicide in dementia appears to be the same or less than that of the age-matched general population but is increased soon after diagnosis, in patients diagnosed with dementia during hospitalization and in Huntington's disease. Putative risk factors for suicide in dementia include depression, hopelessness, mild cognitive impairment, preserved insight, younger age and failure to respond to anti-dementia drugs. Large, good quality prospective studies are needed to confirm these findings.

Conclusions: Further research should be undertaken to examine how rates of suicide and self-harm change during the course of the illness and vary according to the specific sub-type of dementia.

(Received October 27 2008)

(Revised December 01 2008)

(Revised February 25 2009)

(Accepted February 25 2009)

(Online publication April 16 2009)

Correspondence:

c1 Correspondence should be addressed to: Dr Camilla Haw, Consultant Psychiatrist, St. Andrew's Hospital, Billing Road, Northampton NN1 5DG, U.K. Phone: +44 1604 616186; Fax: +44 1604 616177. Email: chaw@standrew.co.uk.

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