Sex Differences in Correlates of Suicide Attempt Lethality in Late Life

Abstract

Suicide attempts are more lethal in men than in women and this sex difference is more pronounced in old age, when suicide rates in men are highest in most countries, including the United States. To understand this sex difference, the authors assessed correlates of suicide attempt lethality in older men and women. Our cross-sectional study enrolled 125 adults (84 aged 50-69 and 41 aged 70 and older) with major depression and a suicide attempt admitted to community and university hospitals in Rochester, NY. and Pittsburgh, PA. Assessments included a structured diagnostic interview, the Lethality Scale, the Suicide Intent Scale, the Cumulative Illness Rating Scale (CIRS) measuring burden of physical illness, and the Mini-Mental Status Examination (MMSE). Attempt lethality was higher in older (70+) than in younger (50-69) men and lower in older than in younger women. Association between suicidal intent and attempt lethality was the strongest in older men compared with the other groups. Higher attempt lethality in older men was partly explained by their higher levels of intent, and not by CIRS, MMSE, substance use disorders, or living alone. In younger, but not in older women, suicide intent was correlated with attempt lethality. Older men act more decisively on their suicidal intent than older women and this difference is more pronounced with increasing age. These findings might partially explain the sex differences in suicide deaths worldwide.