Skip to main content
    • Aa
    • Aa

Dementia and suicidal behavior: a review of the literature

  • Camilla Haw (a1), Daniel Harwood (a2) and Keith Hawton (a3)

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.

Corresponding author
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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G. S. Alexopoulos (1991). Psychological autopsy of an elderly suicide. International Journal of Geriatric Psychiatry, 6, 4550.

D. Ashby , D. Ames , C. R. West , A. MacDonald , N. Graham and A. H. Mann (1991). Psychiatric morbidity as predictor of mortality for residents of local authority homes for the elderly. International Journal of Geriatric Psychiatry, 6, 567575.

L. Baliko , B. Csala and J. Czopf (2004). Suicide in Hungarian Huntington's disease patients. Neuroepidemiology, 23, 258260.

C. Ballard , C. Bannister , M. Solis , F. Oyebode and G. Wilcock (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135144.

C. Bamford , S. Lamont , M. Eccles , L. Robinson , C. May and J. Bond (2004). Disclosing a diagnosis of dementia: a systematic review. International Journal of Geriatric Psychiatry, 19, 151169.

Y. Barak and D. Aizenberg (2002). Suicide amongst Alzheimer's disease patients: a 10-year survey. Dementia and Geriatric Cognitive Disorders, 14, 101103.

A. L. Beautrais (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32, 19.

T. D. Bird (1999). Outrageous fortune: the risk of suicide in genetic testing for Huntington disease. American Journal of Human Genetics, 64, 12891292.

M. Broadstock , S. Michie and T. Marteau (2000). Psychological consequences of predictive genetic testing: a systematic review. European Journal of Human Genetics, 8, 731738.

C. M. Callahan , H. C. Hendrie , N. A. Nienaber and W. M. Tierney (1996). Suicidal ideation among older primary care patients. Journal of the American Geriatrics Society, 44, 12051209.

S. S. Carney , C. L. Rich , P. A. Burke and R. C. Fowler (1994). Suicide over 60: the San Diego study. Journal of the American Geriatrics Society, 42, 174180.

H. F. K. Chiu , L. C. W. Lam , A. H. T. Pang , C. M. Leung and C. K. Wong (1996). Attempted suicide by Chinese elderly in Hong Kong. General Hospital Psychiatry, 18, 444447.

A. M. Codori , P. R. Slavney , A. Rosenblatt and J. Brandt (2004). Prevalence of major depression one year after predictive testing for Huntington's disease. Genetic Testing, 8, 114119.

A. P. de Jonghe-Rouleau , A. M. Pot and J. F. M. de Jonghe (2005). Self-injurious behavior in nursing home residents with dementia. International Journal of Geriatric Psychiatry, 20, 651657.

M. Decruyenaere (2003). Psychological distress in the 5-year period after predictive testing for Huntington's disease. European Journal of Human Genetics, 11, 3038.

L. Di Maio , F. Squitieri , G. Napolitano , G. Campanella , J. A. Trofatter and P. M. Conneally (1993). Suicide risk in Huntington's disease. Journal of Medical Genetics, 30, 293295.

N. J. Donovan , D. L. Kendall , S. C. Heaton , S. Kwon , C. A. Velozo and P. W. Duncan (2008). Conceptualizing functional cognition in stroke. Neurorehabilitation and Neural Repair, 22, 122135.

P. K. Doshi , N. Chhaya and M. H. Bhatt (2002). Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson's disease. Movement Disorders, 17, 10841085.

B. Draper , C. Maccuspie-Moore and H. Brodaty (1998). Suicidal ideation and the “wish to die” in dementia patients: the role of depression. Age and Ageing, 27, 503507.

B. Draper , H. Brodaty and L. F. Low (2002). Types of nursing home residents with self-destructive behaviours: analysis of the harmful behaviours scale. International Journal of Geriatric Psychiatry, 17, 670675.

A. Erlangsen , S. H. Zarit , X. Tu and Y. Conwell (2006). Suicide among older psychiatric inpatients: an evidence-based study of a high-risk group. American Journal of Geriatric Psychiatry, 14, 734741.

R. A. Faber (2003). Suicide in neurological disorders. Neuroepidemiology, 22, 103105.

L. A. Farrer (1986). Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. American Journal of Medical Genetics, 24, 305311.

Y. Forsell , A. F. Jorm and B. Winblad (1997). Suicidal thoughts and associated factors in an elderly population. Acta Psychiatrica Scandinavica, 95, 108111.

A. Funkiewiez (2004). Long term of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 75, 834839.

L. Grabbe , A. Demi , M. A. Camann and L. Potter (1997). The health status of elderly persons in the last year of life: a comparison of deaths by suicide, injury, and natural causes. American Journal of Public Health, 87, 434437.

E. C. Harris and B. Barraclough (1994). Suicide as an outcome for medical disorders. Medicine, 73, 281296.

E. C. Harris and B. Barraclough (1997). Suicide as an outcome for mental disorders: a meta-analysis. British Journal of Psychiatry, 170, 205228.

D. G. Harwood and D. L. Sultzer (2002). “Life is not worth living”: hopelessness in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 15, 3843.

J. Hepple and C. Quinton (1997). One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry, 171, 4246.

U. Hiroeh , L. Appleby , P. B. Mortensen and G. Dunn (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet, 358, 21102112.

A. F. Jorm , A. S. Henderson , R. Scott , A. E. Korten , H. Christensen and A. J. MacKinnon (1995). Factors associated with the wish to die in elderly people. Age and Ageing, 24, 389392.

D. N. Juurlink , N. Herrmann , J. P. Szalai , A. Kopp and D. A. Redelmeier (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine, 164, 11791184.

K. Kaye , J. Grigsby , L. J. Robbins and B. Korzun (1990). Prediction of independent functioning and behavior problems in geriatric patients. Journal of the American Geriatrics Society, 38, 13041310.

J. Keene , T. Hope , C. G. Fairburn and R. Jacoby (2001). Death and dementia. International Journal of Geriatric Psychiatry, 16, 969974.

D. A. King , Y. Conwell , C. Cox , R. E. Henderson , D. G. Denning and E. D. Caine (2000). A neuropsychological comparison of depressed suicide attempters and nonattempters. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 6470.

Y. Kishikawa , R. P. Friedland , H. Ueda , Y. Kitabayashi and K. Fukui (2007). Socio-psychological factors in suicide with Alzheimer's disease: comparative case studies of two patients in the USA and Japan. Psychogeriatrics, 7, 3739.

D. S. Knopman , J. Kitto , S. Deinard and J. Heiring (1988). Longitudinal study of death and institutionalization in patients with primary degenerative dementia. Journal of the American Geriatrics Society, 36, 108112.

M. U. Larsson , M. A. Luszcz , T. H. Bui and T. B. R. Wahlin (2006). Depression and suicidal ideation after predictive testing for Huntington's disease: a two-year follow-up study. Journal of Genetic Counseling, 15, 361374.

D. Lawrence , O. P. Almeida , G. K. Hulse , A. V. Jablensky and C. D. J. Holman (2000). Suicide and attempted suicide among older adults in Western Australia. Psychological Medicine, 30, 813821.

S. Lebret , E. Perret-Vaille , A. Mulliez , L. Gerbaud and I. Jalenques (2006). Elderly suicide attempters: characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 10521059.

A. Lieberman (2006). Are dementia and depression in Parkinson's disease related? Journal of the Neurological Sciences, 248, 138142.

W. S. Lim , E. H. Rubin , M. Coats and J. C. Morris (2005). Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages. Alzheimer Disease and Associated Disorders, 19, 214219.

A. J. D. MacDonald and G. Dunn (1982). Death and the expressed wish to die in the elderly: an outcome study. Age and Ageing, 11, 189195.

J. J. Mann (2003). Neurobiology of suicidal behaviour. Nature Reviews Neuroscience, 4, 819828.

C. C. Meltzer (1998). Serotonin in aging, late-life depression, and Alzheimer's disease: the emerging role of functional imaging. Neuropsychopharmacology, 18, 407430.

F. L. Nelson and N. L. Farberow (1980). Indirect self-destructive behavior in the elderly nursing home patient. Journals of Gerontology, 35, 949957.

M. Nowers (1993). Deliberate self-harm in the elderly: a survey of one London borough. International Journal of Geriatric Psychiatry, 8, 609614.

C. Peisah , J. Snowdon , C. Gorrie , J. Kril and M. Rodriguez (2007). Investigation of Alzheimer's disease-related pathology in community dwelling older subjects who committed suicide. Journal of Affective Disorders, 99, 127132.

D. Pierce (1987). Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 2, 105110.

D. W. Pierce (1996). Repeated deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 11, 983986.

M. Préville , R. Hébert , R. Boyer , G. Bravo and M. Seguin (2005). Physical health and mental disorder in elderly suicide: a case-control study. Aging and Mental Health, 9, 576584.

R. Rao , T. Dening , C. Brayne and F. A. Huppert (1997). Suicidal thinking in community residents over eighty. International Journal of Geriatric Psychiatry, 12, 337343.

M. A. Rapp (2006). Increased hippocampal plaques and tangles in patients with Alzheimer's disease with a lifetime history of major depression. Archives of General Psychiatry, 63, 161167.

T. B. Robins Wahlin (2007). To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington's disease. Patient Education and Counseling, 65, 279287.

T. B. Robins Wahlin , L. Bäckman , A. Lundin , A. Haegermark , B. Winblad and M. Anvret (2000). High suicidal ideation in persons testing for Huntington's disease. Acta Neurologica Scandinavica, 102, 150161.

K. Rohde , E. R. Peskind and M. A. Raskind (1995). Suicide in two patients with Alzheimer's disease. Journal of the American Geriatrics Society, 43, 187189.

A. Rubio , A. L. Vestner , J. M. Stewart , N. T. Forbes , Y. Conwell and C. Cox (2001). Suicide and Alzheimer's pathology in the elderly: a case-control study. Biological Psychiatry, 49, 137145.

F. A. Ruths , R. I. Tobiansky and M. Blanchard (2005). Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London. International Journal of Geriatric Psychiatry, 20, 106112.

B. Schneider , K. Maurer and L. Frölich (2001). Dementia and suicide. Fortschritte der Neurologie Psychiatrie, 69, 164169.

P. Scocco (2006). Suicidal behaviour in nursing homes: a survey in a region of north-east Italy. International Journal of Geriatric Psychiatry, 21, 307311.

J. Snowdon and P. Baume (2002). A study of suicides of older people in Sydney. International Journal of Geriatric Psychiatry, 17, 261269.

E. J. Steinbart , C. O. Smith , P. Poorkaj and T. D. Bird (2001). Impact of DNA testing for early-onset familial Alzheimer disease and frontotemporal dementia. Archives of Neurology, 58, 18281831.

E. N. Stenager , L. Wermuth , E. Stenager and J. Boldsen (1994). Suicide in patients with Parkinson's disease: an epidemiological study. Acta Psychiatrica Scandinavica, 90, 7072.

K. Suominen , M. Henriksson , E. Isometsä , Y. Conwell , H. Heilä and J. Lönnqvist (2003). Nursing home suicides: a psychological autopsy study. International Journal of Geriatric Psychiatry, 18, 10951101.

L. Teri , L. C. Baer and B. V. Reifler (1991). Depression in Alzheimer's patients: investigation of symptom patterns and frequency. Clinical Gerontologist, 11, 4758.

C. F. Tsai , S. J. Tsai , C. H. Yang and J. P. Hwang (2007). Chinese demented inpatients admitted following a suicide attempt: a case series. International Journal of Geriatric Psychiatry, 22, 11061109.

A. K. Upadhyaya , Y. Conwell , P. R. Duberstein , D. Denning and C. Cox (1999). Attempted suicide in older depressed patients: Effect of cognitive functioning. American Journal of Geriatric Psychiatry, 7, 317320.

U. Vega , Y. Kishikawa , E. Ricanati and R. P. Friedland (2002). Suicide and Alzheimer disease. American Journal of Geriatric Psychiatry, 10, 484485.

M. Waern , E. Rubenowitz , B. Runeson , I. Skoog , K. Wilhelmsson and P. Allebeck (2002a). Burden of illness and suicide in elderly people: case-control study. BMJ, 324, 13551357.

M. Waern (2002b). Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry, 159, 450455.

M. Waern , E. Rubenowitz and K. Wilhelmson (2003). Predictors of suicide in the old elderly. Gerontology, 49, 328334.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 67 *
Loading metrics...

Abstract views

Total abstract views: 306 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd June 2017. This data will be updated every 24 hours.