Risk of suicide in people living with dementia and comorbid mental health conditions: A systematic review and meta-analysis

Abstract

Background: People with dementia (PwD) are more vulnerable to experiencing suicidal ideation than the general population. Within this group, certain risk factors such as being younger and male increase risk of death by suicide. However, currently little is known on whether comorbid mental health conditions in this population also elevate the risk of suicide outcomes. We aimed to determine if comorbid mental health conditions increased the risk of suicidal ideation, suicide attempts and death by suicide in PwD.

Methods: Five databases were searched from inception to July 2023. Peer-reviewed publications reporting data for suicide outcomes in PwD with a comorbid mental health condition were included. Random effects meta-analyses models were used to calculate the pooled effect sizes.

Results: 22 relevant studies were identified for inclusion 14 of which reported sufficient data to be included in the meta-analyses. In PwD, those with a general psychiatric comorbidity were at increased risk of death by suicide (OR = 2.61, [95%CI: 1.47; 4.63]). Those with comorbid depression or anxiety were at increased risk of all suicide outcomes (depression: ideation OR = 5.11, [95%CI:1.73;15.07], attempt OR = 7.75, [95%CI:2.68;22.41], death OR = 3.44 [95%CI:1.65;7.18]; anxiety: ideation OR = 3.69, [95%CI:1.41;9.66]; attempt OR = 2.27, [95%CI:1.08;4.78]; death OR = 2.36, [95%CI:2.02;2.75]). PwD and comorbid personality disorder and substance use were at increased risk of suicide attempt (OR = 4.60, [95%CI:1.36;15.55] and death by suicide (OR = 2.19, [95%CI:1.80;2.66] respectively.

Conclusion: Comorbid mental health conditions put PwD at increased risk of suicide outcomes. There is an urgent need for the assessment and monitoring of mental health in PwD in routine care to mitigate suicide risk.

Keywords: Comorbid mental health conditions; Death by suicide; Dementia; Suicidal ideation; Suicide attempts.