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Proposed by the EPA sections on Old Age Psychiatry and Suicidology and Suicide Prevention -At advanced age, rates of males diverge even more from those of females. A better understanding of these factors may reduce the toll of suicide at these extreme ages as Prof. de Leo is going to discuss. Prof. Zeppegno will focus on the even twofold rate of suicidal behaviours when there is a chronic or terminal illness. Psychiatrists and geriatricians will likely meet mentally competent older adults expressing a wish to die: sometimes entangled with e.g.chronic illness, sometimes in the absence of terminal illness, but due to the feeling that they have already lived a completed life. The possibility of a "rational suicide" will be discussed. Prof. Stek is going to discuss the problem that in late life depression the clinical management of suicidality is often complicated by the presence of physical and neuropsychiatric comorbidity. Moreover, in The Netherlands the position of euthanasia in end of life choices may interfere with available diagnostic and treatment options. The challenges of well substanciated decision making in these situations will be discussed. Although interventions for suicide prevention are known, their relative effect for the elderly in general have not been explored. Prof. van der Feltz-Cornelis will discuss in her lecture what could be aspects of relevance for interventions in this specific age group. And finally Prof. Hegerl will show – at the example of a recent increase in gassing suicides – which role the media and especially the internet plays for the methods of suicide and what it could mean for suicide prevention.
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W0023 - Suicide in the Very Old
, W0024 - Rational Suicide in the Elderly
, W0026 - What Interventions Work for Suicide Prevention? And Do They Work for the Elderly?
, ABSTRACT
Abstract Body
Background: Suicides occur more often in the young and in the elderly. However, although several studies have been performed to evaluate the effect of suicide prevention in the young, no studies have explored this in the elderly. Somatic comorbidity is associated with elevated suicide risk, especially in case of pain, which occurs often in the elderly.
Objective: To explore if suicide prevention interventions might be applicable in the elderly and if somatic comorbidity might be relevant for their application.
Method: Evidence synthesis of controlled studies evaluating suicide prevention interventions and of collaborative care trials for depressive disorder in patients with and without somatic comorbidity.
Results: Elderly living alone and with multimorbidity are more prone to suicide risk. Hence interventions involving admission in a general hospital after a suicide attempt, short intervention and follow up might be well applicable in the elderly. In terms of outpatient interventions, and IPD analysis found that collaborative care for depressive disorder is effective in reducing suicidality, especially in the elderly. This effect is independent of somatic comorbidity.
Conclusion: There is potential to develop and evaluate suicide prevention interventions for the elderly. Such interventions should address depression, multimorbidity and social isolation and may be provided at general hospital and at outpatient level.
W0027 - Media and Suicidal Behaviour
, ABSTRACT
Abstract Body
Media coverage of suicidal behaviour can induce copycat suicides. This has been clearly confirmed by analysis of suicides following the huge media coverage of the railway suicide of the German national goal keeper in 2009. A socalled ‘Werther effect’ was not only visible in Germany, but also in neighbouring countries (1). Even more disturbing is the fact that these effects were not only short-lived, but a higher number of railway suicides was observed compared to baseline over a two year period (2). Increased cognitive availability of railway suicides might explain this finding. It adds to the important discussion concerning the risks and benefits of public antisuicidal campaigns. Destigmatisaton and normalisation of suicidal behaviour will on the one hand, facilitate helpseeking behaviour of people at risk, but on the other hand, will lower the threshold for committing suicide. Even when the wording within a antisuicide campaign is in line with recomendations of media guidelines, secondary reporting e.g. within social media will not be controllable. Social media are likely to contribute to the spreading and the choice of more lethal suicide methods, as has been shown for carbon monoxide poisoning and poisoning by other gasses (3). An increase of knowledge about and access to more lethal poisoning methods will have a major impact on suicide rates.
1) KOBURGER et al (2015), J Affect Disord 185:38-46
2) HEGERL et al (2013), J Affect Disord. 146: 39-44.
3) PAUL et al (2017), PLoS One 12: e0190136.
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