Suicide ideation, attempts and deaths in people living with dementia (PLWD): A systematic review and meta‐analysis of prevalence and risk factors

Abstract

AbstractBackgroundSuicide is a major public health concern. However, little is known about whether dementia is associated with suicide outcomes, and if so what the risk factors for suicide are in this group. This study aimed to conduct meta‐analyses to examine pooled associations between dementia and suicide outcomes (ideation, attempts, death by suicide) as well as pooled associations between risk factors (sex, dementia subtype) and suicidality in people living with dementia (PLWD).MethodSystematic searches were conducted in Medline, Embase, Psycinfo, Cinahl Plus, and Web of Science for keywords related to dementia and suicide. Quantitative studies with a sample of PLWD and suicidality as an outcome and that were available in English were included. Experimental studies, case reports and studies with a focus on euthanasia/assisted suicide, or self‐harm without suicidal intentionality were excluded. Relevant effect sizes were extracted and inverse variance weighted meta‐analyses were run using a random‐effects model.Result55 studies were included. Meta analyses showed that compared to people without dementia, having dementia was significantly associated with death by suicide (OR = 2.48, 95% CI:1.82;3.38), and suicidal ideation (OR = 2.29, 95% CI:1.75‐2.99), but not suicide attempts. Men with dementia were more at risk of attempting (OR = 1.28, 95% CI:1.25;1.31) and death by suicide (OR = 2.84, 95% CI:1.51;5.37) than women with dementia, but there was no difference in suicidal ideation. Compared with Alzheimer’s disease, people with vascular dementia (VaD), frontotemporal dementia (FTD), and other dementia (OD) types were significantly more likely to attempt suicide. People with Lewy body dementia (LBD) were significantly more likely to report suicidal ideation.ConclusionPLWD are at higher risk of suicidal ideation and death by suicide than those without dementia, but not suicide attempts. This could suggest that PLWD are not more likely to attempt suicide but are more likely to be successful when an attempt is made. Key risk factors for suicide attempts amongst PLWD are being male, sub‐type of dementia diagnosis (VaD, FTD and OD), while having a diagnosis of LBD is a risk factor for suicidal ideation. These results are important for understanding and managing risk in PLWD.