Lower Suicide Risk Research Articles

Screening for Suicide Risk in the College Population

Suicide is the third leading cause of death in college students, but there is limited consensual evidence to guide clinicians’ assessment and management of suicide. The aim of the current study was to assess the capability of a simple and practical measure, the Beck Depression Inventory (BDI) suicide item, to identify college students at high risk of suicide. Exploration of this research question could have important implications in this vulnerable population for identifying those at risk for suicide. Six-hundred-and-fifty-seven college students participated in a mental health screening and completed the BDI and the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is a detailed measure of suicide risk. We dichotomized the BDI suicide item, which measures suicidal ideation within the past week (presence vs. absence of suicidal ideation) as well as the SBQ-R total score (low vs. high risk of suicide). We computed the kappa statistic for the examination of agreement between these two measures. The kappa coefficient for the BDI suicide item and the SBQ-R was 0.57 for dichotomized scores. The BDI suicide item had a positive predictive value of 74 %, and a negative predictive value of 93 %. In a hierarchical linear regression, the BDI suicide item alone significantly predicted elevated scores on the SBQ-R [Chi square (1) = 128.427, p < 0.001]. These results suggest that affirmative responses on the single BDI suicide item indicate elevated suicide risk. However this single item screening approach will miss some at-risk students.

On the Relevance of Seizure Activity to Suicide Risk

It is evident to researchers that the detection of the increased risk of suicide, as a result of the use of certain psychotropics, is a difficult task due to the inherently high risk of suicide in patients prescribed these medications. Selective serotonin reuptake inhibitors (SSRIs), for example, were found to increase the risk of suicide, especially, in younger age groups, even when adjusting for risks caused by the illness itself (FDA review). We seem to be faced with a similar situation in relation to the use of anti-epileptic drugs (AEDs). The latter is evident in a large FDA meta-analysis that has shown AEDs to increase the risk of suicide in three different groups of patients: patients with epilepsy, patients with psychiatric disorders (e.g. depression), and patients with other disorders (e.g. chronic pain) [2]. Naturally, this is a complex area considering that all three groups of patients do potentially have a higher risk of depression and suicide! Notwithstanding the finding that patients with psychiatric disorders on AEDs were found to have a lower suicide risk, when compared to patients with epilepsy on AEDs, is interesting. The latter observation is consistent with three more studies, all of which have failed to detect an increase in suicide rates in patients with bipolar affective disorder receiving AEDs, but paradoxically, an increased rate in patients with epilepsy receiving AEDs [3-5]. The FDA finding that suicide risk is higher in the AED arm of patients with epilepsy when compared to the AED arm of psychiatrically ill patients, from the outset sounds almost counter-intuitive. However, the mystery is amenable to understanding if we entertain the possibility that in some patients, the risk of suicide can directly be affected by seizure activity (increased or decreased) irrespective of the underlying psychopathological ailments (e.g. depression).

Suicide among first-generation and second-generation immigrants in Sweden: association with labour market marginalisation and morbidity

BackgroundPrevious research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in...

Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars

PurposeWe conducted a retrospective cohort mortality study to determine the postservice suicide risk of recent wartime veterans comparing them with the US general population as well as comparing deployed veterans to nondeployed veterans. MethodsVeterans were identified from the Defense Manpower Data Center records, and deployment to Iraq or Afghanistan war zone was determined from the Contingency Tracking System. Vital status of 317,581 deployed and 964,493 nondeployed veterans was followed from the time of discharge to December 31, 2009. Underlying causes of death were obtained from the National Death Index Plus. ResultsBased on 9353 deaths (deployed, 1650; nondeployed, 7703), of which 1868 were suicide deaths (351; 1517), both veteran cohorts had 24% to 25% lower mortality risk from all causes combined but had 41% to 61% higher risk of suicide relative to the US general population. However, the suicide risk was not associated with a history of deployment to the war zone. After controlling for age, sex, race, marital status, branch of service, and rank, deployed veterans showed a lower risk of suicide compared with nondeployed veterans (hazard ratio, 0.84; 95% confidence interval, 0.75–0.95). Multiple deployments were not associated with the excess suicide risk among deployed veterans (hazard ratio, 1.00; 95% confidence interval, 0.79–1.28). ConclusionsVeterans exhibit significantly higher suicide risk compared with the US general population. However, deployment to the Iraq or Afghanistan war, by itself, was not associated with the excess suicide risk.

State-level social capital and suicide mortality in the 50 U.S. states

This study investigated whether state levels of social capital are associated with rates of completed suicides in the fifty U.S. states. To do this we regressed state-level suicide rates on an index of social capital, along with other variables known to influence suicide rates such as gun ownership, income inequality, alcohol abuse and dependence, drug abuse and dependence, serious mental illness, unemployment, percent of population living in urban areas, poverty, population instability, and living in a “suicide belt” state. Suicide rates were aggregated from 1999 to 2002, and examined separately by sex and different race/ethnic groups. The results showed that White men and women in states with higher levels of social capital had significantly lower rates of suicide when controlling for the other influential variables. When we examined sub-dimensions of social capital, we found that community organizations (for White women) and group membership (for White men) were particularly strongly associated with lower suicide risk.

Meaning made of stress among veterans transitioning to college: examining unique associations with suicide risk and life-threatening behavior.

Meaning made of stress has been shown to be a unique predictor of mental and physical health. In this study, we examined the unique associations between two facets of meaning made of stress (comprehensibility and footing in the world) and suicide risk and life-threatening behavior among military veterans who have transitioned to college were examined, controlling for demographic factors, religiousness, combat-related physical injury, combat exposure, depressive symptoms, and posttraumatic stress symptoms. Findings suggest that comprehensibility (having “made sense” of a stressor) is uniquely associated with lower suicide risk and a lower likelihood of driving under the influence of drugs or alcohol and engaging in self-mutilating behaviors.

Differential effect of lithium on spermidine/spermine N1-acetyltransferase expression in suicidal behaviour

An altered polyamine system has been suggested to play a key role in mood disorders and suicide, a hypothesis corroborated by the evidence that lithium inhibits the polyamine mediated stress response in the rat brain. Recent post-mortem studies have shown that spermidine/spermine N1-acetyltransferase (SAT1), the key regulator of cellular polyamine content, is under-expressed in brains from suicide victims compared to controls. In our study we tested the effect of in vitro lithium treatment on SAT1 gene and protein expression in B lymphoblastoid cell lines (BLCLs) from bipolar disorder (BD) patients who committed suicide (and for which BLCLs were collected prior to their death), BD patients with high and low risk of suicide and a sample of non-psychiatric controls. Baseline mRNA levels were similar in the four groups of subjects (p > 0.05). Lithium had no effect in suicide completers (p > 0.05) while it significantly increased SAT1 expression in the high risk (p < 0.001) and low risk (p < 0.01) groups as well as in controls (p < 0.001). Protein and mRNA levels were not correlated; lithium significantly reduced protein levels only in the control sample (p < 0.05). Our findings suggest that SAT1 transcription is influenced by lithium and that this effect is altered in BD patients who completed suicide, further supporting a role for polyamines in suicide.

Suicide mortality in second-generation migrants, Australia, 2001–2008

Generally, due to limited availability of official statistics on the topic, little is known about suicide mortality in second-generation migrants. A recent study from Sweden showed that these people could be at a high suicide risk. In a generalised phenomenon, this aspect would represent an important issue in suicide prevention. This paper aims to report the profile of second-generation migrants who died by suicide and the suicide risk differentials of second-generation migrants with other Australians. Official suicide data from 2001 to 2008 were linked with State/Territory registries to collect information about the birthplace of the deceased’s parents to differentiate migration status (first, second or third-plus generation). The profile and suicide risk of second-generation migrants were compared with other generations by logistic and Poisson regression. Suicide in second-generation migrants accounted for 811 cases (14.6%). These tended to be represented by younger subjects, more often never married, as compared to the other cases. Second-generation males aged 25–39 years tended to have a higher suicide risk than first generation migrants, but the risk was lower when compared with the third-plus generation. Second-generation migrants aged 60? tended to have a lower suicide risk than first generation migrants. In Australia, second-generation migrants are not at a higher suicide risk as compared to first-generation migrants or locals (third-plus-generation). In males aged 25–39, a lower suicide risk was found in second-generations as compared to Australian-born third generation,which may be explained by their more advantageous socioeconomic status and the flexibility and resources rendered by having grown up in a bicultural environment.The higher suicide rates found amongst older first-generation migrants require further examination.

Medication and suicide risk in schizophrenia: A nested case–control study

IntroductionPatients with schizophrenia are at increased risk of suicide, but data from controlled studies of pharmacotherapy in relation to suicide risk is limited. AimTo explore suicide risk in schizophrenia in relation to medication with antipsychotics, antidepressants, and lithium. MethodsOf all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n=4000), patients who died by suicide within five years from diagnosis were defined as cases (n=84; 54% male). Individually matched controls were identified from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Adjusted odds ratios [OR] of the association between medication and suicide were calculated by conditional logistic regression. ResultsLower suicide risk was found in patients who had been prescribed a second generation antipsychotic (clozapine, olanzapine, risperidone, or ziprasidone; 12 cases and 20 controls): OR 0.29 (95% confidence interval [CI], 0.09–0.97). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.23 (95% CI 0.06–0.89). No significant association was observed between suicide and prescription of any antipsychotic, depot injection antipsychotics, antidepressants, SSRI, or lithium. ConclusionsLower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these drugs, to differences in adherence, or to differences in other patient characteristics associated with lower suicide risk.

Antipsychotics and mortality in first-onset schizophrenia: Prospective Finnish register study with 5-year follow-up

ObjectiveOur aim was to assess the impact of the most commonly used typical and atypical antipsychotics on mortality of patients with first-onset schizophrenia. MethodWe conducted a nationwide, register-based, five-year follow-up study of all patients presenting with first-onset of schizophrenia between 1998 and 2003. Details of reimbursed medicines were obtained from the register of Social Insurance Institution. ResultsAfter adjusting for age, gender, comorbid physical diseases and patient group, the use of second generation antipsychotics (SGAs), especially clozapine, olanzapine and quetiapine, was associated with reduced risk of all-cause mortality in patients with schizophrenia, while clozapine associated with lower suicide risk. First generation antipsychotics (FGAs), specifically levomepromazine, thioridazine or clorprothixene, were associated with increased risk of all-cause mortality. The FGAs, particularly clorprothixene, were associated with decreased suicide mortality. An increased likelihood for cardiovascular deaths was found among users of levomepromazine. In antidepressants, the use of mirtazapine associated with increased risk of suicide. ConclusionsDifferences exist between FGAs' and SGAs' use in relation to mortality. These differences remain even when the patient's physical illness are taken into account when prescribing antipsychotic medication.

Coffee, caffeine, and risk of completed suicide: Results from three prospective cohorts of American adults

Objective.To evaluate the association between coffee and caffeine consumption and suicide risk in three large-scale cohorts of US men and women. Methods. We accessed data of 43,599 men enrolled in the Health Professionals Follow-up Study (HPFS, 1988–2008), 73,820 women in the Nurses’ Health Study (NHS, 1992–2008), and 91,005 women in the NHS II (1993–2007). Consumption of caffeine, coffee, and decaffeinated coffee, was assessed every 4 years by validated food-frequency questionnaires. Deaths from suicide were determined by physician review of death certificates. Multivariate adjusted relative risks (RRs) were estimated with Cox proportional hazard models. Cohort specific RRs were pooled using random-effect models. Results. We documented 277 deaths from suicide. Compared to those consuming ≤ 1 cup/week of caffeinated coffee (< 8 oz/237 ml), the pooled multivariate RR (95% confidence interval [CI]) of suicide was 0.55 (0.38–0.78) for those consuming 2–3 cups/day and 0.47 (0.27–0.81) for those consuming ≥ 4 cups/day (P trend < 0.001). The pooled multivariate RR (95% CI) for suicide was 0.75 (0.63–0.90) for each increment of 2 cups/day of caffeinated coffee and 0.77 (0.63–0.93) for each increment of 300 mg/day of caffeine. Conclusions. These results from three large cohorts support an association between caffeine consumption and lower risk of suicide.

Opposite Effective Connectivity in the Posterior Cingulate and Medial Prefrontal Cortex between First-Episode Schizophrenic Patients with Suicide Risk and Healthy Controls

ObjectiveThe schizophrenic patients with high suicide risk are characterized by depression, better cognitive function, and prominent positive symptoms. However, the neurobiological basis of suicide attempts in schizophrenia is not clear. The suicide in schizophrenia is implicated in the defects in emotional process and decision-making, which are associated with prefrontal-cingulate circuit. In order to explore the possible neurobiological basis of suicide in schizophrenia, we investigated the correlation of prefrontal-cingulate circuit with suicide risk in schizophrenia via dynamic casual modelling.MethodParticipants were 33 first-episode schizophrenic patients comprising of a high suicide risk group (N = 14) and a low suicide risk group (N = 19). A comparison group of healthy controls (N = 15) were matched for age, gender and education. N-back tasking functional magnetic resonance imaging data was collected.ResultsCompared with healthy controls group, the two patients groups showed decreased task-related suppression during 2-back task state versus baseline state in the left posterior cingulate and medial prefrontal cortex; the hyper-connectivity from the left posterior cingulate cortex to the left medial prefrontal cortex existed in both schizophrenic patients groups, but hypo-connectivity in the opposite direction only existed in the schizophrenic patients group with high suicide risk.ConclusionsThe hyper-connectivity from the left posterior cingulate cortex to the left medial prefrontal cortex may suggest that the abnormal effective connectivity was associated with risk for schizophrenia. The hypo-connectivity in the opposite direction may represent a possible correlate of increased vulnerability to suicide attempt.

Preventing Patient Suicide: Clinical Assessment and Management

Back to table of contents Next article Book ReviewsFull AccessPreventing Patient Suicide: Clinical Assessment and ManagementJeffrey L. Geller, M.D., M.P.H., and Jeffrey L. Geller, M.D., M.P.H., Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., and Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., EditorPublished Online:1 Apr 2013https://doi.org/10.1176/appi.ps.640404AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by SimonRobert I., M.D.; Washington, D.C., American Psychiatric Publishing, 2011, 235 pages, $57Robert Simon and American Psychiatric Publishing have compiled Simon’s writings on suicide prevention with high heuristic value. All but three of the 13 chapters are previously published articles or chapters by Simon, which contributes to the major weakness of the book—it’s quite repetitive.Each chapter in Preventing Patient Suicide is organized for easy learning. Chapters include tables and figures that capture the essence of the material quite well. Illustrative case examples are included that put a face on the clinical material. Each chapter concludes with a summary of the contents, and each chapter ends with “key clinical concepts” that are the chapter’s take-home messages. The key clinical concepts sections are filled with fundamental truisms we all tend to forget—for example, “The severity of suicide risk is dimensional and dynamic, constantly governed by changing risk and protective factors. Thus, suicide risk assessment is a process, not an event.”The book is also filled with clinical pearls not included in the key clinical concepts sections, so skimming through the book for just the key clinical concepts deprives the reader of much practical information that can influence one’s practice. Simon stresses that the transition from chronic suicide risk to acute suicide risk can be “gradual and nuanced or alarmingly rapid.” He reminds us that the assessment of a guarded suicidal patient needs to include collateral contacts if possible. Simon points out that patients on one-to-one observation or 15-minute checks should not be discharged from these statuses but should be given a trial period after suicide precautions have been discontinued.Simon has a humanistic view of doctors, nurses, and others who deal regularly with suicidal patients. He highlights that “Distinguishing suicidal patients whose improvement is illusory from patients who are actually improving is one of the most difficult evaluations that psychiatrists must undertake.” He recognizes that “high-volume admissions of acutely suicidal patients place a heavy burden on inpatient staffs.” And he admonishes the clinician to “not worry alone”—get a consultation.Simon addresses the controversial “suicide prevention contract.” He reminds the reader that such contracts can never take the place of adequate suicide risk assessments and that one can never rely on such a contract with a new, unknown patient. And in much the same vein, he cautions against the use of unaided assessment forms and checklists.Simon homes in on myths about suicide. Perhaps one of the more dangerous myths is that “passive suicide is a subset of suicidal ideation that is less severe and thus reflects a lower risk of suicide.” Much the same warning is provided for “fleeting” suicidal ideation.Simon provides all manner of useful tips concerning risk management. One of particular note is his warning against using “true emergency” messages on an answering machine. Simon opines that this is “worse than useless; it is irrelevant and gratuitous.” And finally, “The royal road to therapeutic risk management passes through good patient care, not veering off into a detour of self-defeating defensive practices.”So, first purchase this book. Second, keep it handy in your office. Don’t read it cover to cover, but read a chapter here and there. Consult this book when confronted by a suicidal patient. In fairly short order, your copy of Preventing Patient Suicide should be ragged and dog-eared from frequent use.Dr. Geller, who is the book review editor, is facility medical director, Worcester Recovery Center and Hospital, and professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited ByNone Volume 64Issue 4 April 2013Pages e01-e01 Metrics The reviewer reports no competing interests.PDF download History Published online 1 April 2013 Published in print 1 April 2013

The Impact of Exercise on Suicide Risk: Examining Pathways through Depression, PTSD, and Sleep in an Inpatient Sample of Veterans

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.

C-Reactive Protein Level and its Relationship with Suicide Risk and Alexithymia among Newly Diagnosed, Drug-Naïve Patients with Non-Affective Psychosis

The aim of the present study was to evaluate C-Reactive Protein (CRP) levels in newly diagnosed drug-naïve patients with non-affective psychosis, testing the hypotheses that in such patients serum CRP levels would be higher than in healthy controls and related to more severe psychopathology, suicide risk and alexithymia. CRP levels of 30 adult patients and 30 sex- and age-matched healthy controls were evaluated. Patients were tested with the Scale of Suicide Ideation (SSI), the Toronto Alexithymia Scale (TAS-20), the Scale for the Assessment of Positive and Negative Symptoms (SAPS and SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). Higher suicide risk patients showed higher CRP levels than lower suicide risk patients and healthy controls. Moreover, such patients showed higher SAPS, SANS and CDSS scores than lower suicide risk patients. In linear regression model, CRP was significantly associated with higher SSI and TAS-20 scores. The results of the present study support the notion that CRP, suicide risk and alexithymia are strictly linked in newly diagnosed, drug-naïve patients with non-affective psychosis, independently of depressive symptoms or general psychopathology. Limitations are discussed.

‘In two minds’ – socially motivated self-harm is perceived as less serious than internally motivated: A qualitative study of youth justice staff

Community-based young offenders are at high risk of self-harm and unlikely to be in contact with mental health services. Semi-structured interviews with community youth justice staff and a content analysis of 50 records of self-harm not only revealed staff concerns about the impact of stigma on disclosure and service use, but also found dismissive attitudes towards socially motivated self-harm, which was equated with lower suicide risk and less emotional distress. Efforts to improve identification of self-harm will need to address the perceived - and false - distinction between 'genuine' and socially motivated self-harm.

Teaching medical professionals and trainees about adolescent suicide prevention: five key problems

Predicting and preventing suicide represent very difficult challenges for clinicians. The awareness of adolescent suicide as a major social and medical problem has increased over the past years. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Suicide prevention efforts among adolescents are restricted by the fact that there are five key problems related to the evaluation and management of suicidality in adolescents: 1. Many clinicians underestimate the importance of the problem of adolescent suicidal behavior and underestimate its prevalence. 2. There is a misconception that direct questioning of adolescents about suicidality is sufficient to evaluate suicide risk. 3. Another misconception is that adolescents with non-psychiatric illnesses do not need to be evaluated for suicidality. 4. Many clinicians do not know about or underestimate the role of contagion in adolescent suicidal behavior. 5. There is a mistaken belief that adolescent males are at lower suicide risk than adolescent females. Educating medical professionals and trainees about the warning signs and symptoms of adolescent suicide and providing them with tools to recognize, evaluate, and manage suicidal patients represent a promising approach to adolescent suicide prevention.

Suicide Among Veterans in 16 States, 2005 to 2008: Comparisons Between Utilizers and Nonutilizers of Veterans Health Administration (VHA) Services Based on Data From the National Death Index, the National Violent Death Reporting System, and VHA Administrative Records

We sought to compare suicide rates among veterans utilizing Veterans Health Administration (VHA) services versus those who did not. Suicide rates from 2005 to 2008 were estimated for veterans in the 16 states that fully participated in the National Violent Death Reporting System (NVDRS), using data from the National Death Index, NVDRS, and VHA records. Between 2005 and 2008, veteran suicide rates differed by age and VHA utilization status. Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. The higher rates of suicide for utilizers of VHA among veteran men aged 30 and older were consistent with previous reports about which veterans utilize VHA services. The increasing rates of mental health conditions in utilizers younger than 30 years suggested that the decreasing relative rates in this group were related to the care provided, rather than to selective enrollment of those at lower risk for suicide.

AS07-02 - Brain imaging: help for the understanding of suicidal vulnerability

Suicidal behaviour may be best understood within a stress-vulnerability model. The vulnerability is a key element that differentiates psychiatric patients who are at high risk versus those at lower risk of suicide. Neurobiological studies have strongly influenced the concept of a vulnerability to suicidal behaviour. Moreover neuropsychological studies have reported dysfunctional cognitive processes in suicide attempters. Brain imaging is a helpful tool to better understand in vivo their neuroanatomical basis. Neuroimaging studies mainly showed the involvement of ventrolateral orbital, dorsomedial and dorsolateralprefrontal cortices and the anterior cingulate gyrus. In addition, alterations in white matter connections have been suggested. We will propose a neurocognitive model of suicidal act and will discuss the strengths and limitations of the neuroimaging approach of the pathophysiology and prediction of such complex human behaviours.

Predictors of suicide in patients with dementia.

Assessing predictors of suicide and means of completion in patients with dementia may aid the development of interventions to reduce risk of suicide among the growing population of individuals with dementia. This national, retrospective, cohort study used data from the Department of Veterans Affairs (fiscal years 2001-2005). The sample included patients ≥60 years old diagnosed with dementia (N = 294,952), of which 241 committed suicide. Potential predictors of suicide were identified using logistic regression. Suicide methods are also reported. Increased risk of suicide was associated with white race (OR: 2.4, 95% CI: 1.2, 4.8), depression (OR: 2.0, 95% CI: 1.5, 2.9), a history of inpatient psychiatric hospitalizations (OR: 2.3, 95% CI: 1.5, 3.5), and prescription fills of antidepressants (OR: 2.1, 95% CI: 1.6, 2.8) or anxiolytics (OR: 2.0, 95% CI: 1.5, 2.7). Nursing home admission was associated with lower suicide risk (OR: 0.3, 95% CI: 0.1, 0.8). Severity of medical comorbidity did not affect risk of suicide. Sensitivity analysis indicated that the majority of suicides occurred in those who were newly diagnosed with dementia. Firearms were the most common method of suicide (73%) used. Given the higher rate of suicide in those receiving treatment for psychiatric symptoms and the high proportion that died using firearms, closer monitoring and assessment of gun access may be an important part of initial treatment planning for older male patients with dementia, particularly those with symptoms of depression or anxiety.