Suicidal Ideation and Suicide-Attempt-Related Hospitalizations among People with Alzheimer’s Disease (AD) and AD-Related Dementias in the United States during 2016–2018
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Frequency of Suicidal-Behavior-Related Hospitalizations in Dementia Subtypes
3.2. Demographic and Clinical Characteristics
3.3. Associations between Patient Factors and Suicidal-Behavior-Related Hospitalizations
3.4. Modes of Harm in Suicide Attempts
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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AD | VaD | LBD | FTD | Mixed | ||||||
---|---|---|---|---|---|---|---|---|---|---|
ADRD population with suicidal behavior | N = 5592 | N = 5035 | N = 578 | N = 370 | N = 963 | |||||
Age, mean (SD) | 77.0 | 0.3 | 71.7 | 0.4 | 71.9 | 0.9 | 68.3 | 1.0 | 77.4 | 0.6 |
Female sex, n (%) | 3190 | 57.0% | 2502 | 49.7% | 230 | 39.8% | 173 | 46.8% | 525 | 54.5% |
Median household income, n (%) | ||||||||||
Q1 (lowest income) | 1671 | 29.9% | 1594 | 31.7% | 146 | 25.3% | 82 | 22.2% | 284 | 29.5% |
Q2 | 1493 | 26.7% | 1332 | 26.5% | 146 | 25.3% | 96 | 26.0% | 256 | 26.6% |
Q3 | 1274 | 22.8% | 1087 | 21.6% | 145 | 25.1% | 102 | 27.6% | 211 | 21.9% |
Q4 (highest income) | 1076 | 19.2% | 947 | 18.8% | 132 | 22.8% | 82 | 22.2% | 199 | 20.7% |
Mental health conditions, n (%) | ||||||||||
Depression | 3836 | 68.6% | 3525 | 70.0% | 387 | 67.0% | 247 | 66.8% | 680 | 70.6% |
Anxiety | 2238 | 40.0% | 2107 | 41.8% | 235 | 40.7% | 164 | 44.3% | 436 | 45.3% |
Psychotic disorders | 1526 | 27.3% | 1392 | 27.6% | 196 | 33.9% | 116 | 31.4% | 284 | 29.5% |
Bipolar disorder | 709 | 12.7% | 772 | 15.3% | 98 | 17.0% | 70 | 18.9% | 126 | 13.1% |
Personality disorder | 207 | 3.7% | 247 | 4.9% | 25 | 4.3% | 27 | 7.3% | 227 | 23.6% |
PTSD | 146 | 2.6% | 210 | 4.2% | 17 | 2.9% | 20 | 5.4% | 21 | 2.2% |
ADHD | 119 | 2.1% | 145 | 2.9% | 16 | 2.8% | 17 | 4.6% | 24 | 2.5% |
Other comorbidities, n (%) | ||||||||||
Hypertension | 4219 | 75.4% | 3935 | 78.2% | 418 | 72.3% | 239 | 64.6% | 783 | 81.3% |
Hyperlipidemia | 2727 | 48.8% | 2571 | 51.1% | 255 | 44.1% | 152 | 41.1% | 539 | 56.0% |
Diabetes | 1695 | 30.3% | 1779 | 35.3% | 158 | 27.3% | 96 | 25.9% | 286 | 29.7% |
Chronic kidney disease | 1591 | 28.5% | 1628 | 32.3% | 161 | 27.9% | 76 | 20.5% | 685 | 71.1% |
Ischemic heart disease | 1468 | 26.3% | 1536 | 30.5% | 137 | 23.7% | 64 | 17.3% | 297 | 30.8% |
Thyroid disease | 1333 | 23.8% | 1072 | 21.3% | 128 | 22.1% | 87 | 23.5% | 224 | 23.3% |
Chronic pulmonary disease | 1089 | 19.5% | 1054 | 20.9% | 71 | 12.3% | 55 | 14.9% | 160 | 16.6% |
Rheumatoid or osteoarthritis | 1070 | 19.1% | 818 | 16.2% | 57 | 9.9% | 42 | 11.4% | 180 | 18.7% |
Atrial fibrillation | 878 | 15.7% | 882 | 17.5% | 76 | 13.1% | 40 | 10.8% | 187 | 19.4% |
Congestive heart failure | 721 | 12.9% | 788 | 15.7% | 57 | 9.9% | 32 | 8.6% | 120 | 12.5% |
Substance-use disorder | 321 | 5.7% | 558 | 11.1% | 38 | 6.6% | 35 | 9.5% | 193 | 20.0% |
Alcohol-use disorder | 320 | 5.7% | 480 | 9.5% | 27 | 4.7% | 24 | 6.5% | 50 | 5.2% |
Asthma | 271 | 4.8% | 250 | 5.0% | 32 | 5.5% | 21 | 5.7% | 51 | 5.3% |
Mobility Disorder | 222 | 4.0% | 462 | 9.2% | 43 | 7.4% | 13 | 3.5% | 37 | 3.8% |
Liver disorders | 122 | 2.2% | 161 | 3.2% | 21 | 3.6% | ** | ** | 66 | 6.9% |
Covariate | OR | 95% CI |
---|---|---|
Dementia subtype | ||
Alzheimer’s disease | Reference | Reference |
Vascular | 1.85 | 1.69–2.01 |
Lewy body | 0.97 | 0.85–1.10 |
Frontotemporal | 1.35 | 1.13–1.62 |
Mixed | 2.27 | 2.02–2.54 |
Age (per 5 years) | 0.85 | 0.85–0.87 |
Female sex | 0.77 | 0.73–0.81 |
Median household income, n (%) | ||
Q1 (lowest income) | Reference | |
Q2 | 1.02 | 0.94–1.11 |
Q3 | 1.02 | 0.94–1.11 |
Q4 (highest income) | 1.00 | 0.88–1.36 |
Mental health conditions, n (%) | ||
Depression | 6.80 | 6.35–7.30 |
Psychotic disorders | 2.77 | 2.56–3.00 |
Bipolar disorder | 2.72 | 2.52–2.94 |
Personality disorder | 2.47 | 2.12–2.90 |
ADHD | 1.63 | 1.32–2.94 |
Anxiety | 1.55 | 1.44–1.66 |
PTSD | 1.43 | 1.23–1.67 |
Other comorbidities, n (%) | ||
Substance-use disorders | 2.17 | 1.95–2.41 |
Alcohol-use disorder | 1.78 | 1.61–1.98 |
Diabetes | 1.03 | 0.98–1.08 |
Hypertension | 1.02 | 0.96–1.08 |
Thyroid disease | 1.06 | 0.99–1.12 |
Asthma | 1.03 | 0.92–1.15 |
Hyperlipidemia | 0.97 | 0.92–1.02 |
Atrial fibrillation | 0.85 | 0.78–0.93 |
Ischemic heart disease | 1.03 | 0.97–1.09 |
Rheumatoid or osteoarthritis | 0.96 | 0.89–1.02 |
Chronic pulmonary disease | 0.95 | 0.89–1.01 |
Liver disorders | 0.70 | 0.60–0.82 |
Chronic kidney disease | 0.65 | 0.62–0.69 |
Congestive heart failure | 0.68 | 0.63–0.74 |
Mobility Disorder | 0.52 | 0.47–0.58 |
Method of Harm | N | % |
---|---|---|
Medications or drugs | 1166 | 89.2% |
Weapons (knives, firearms, etc.) | 231 | 17.7% |
Asphyxiation (hanging, carbon monoxide) | 33 | 2.5% |
Mechanical harms (falling, vehicles) | 28 | 2.1% |
Alcohol or other harmful substances | 20 | 1.5% |
Detailed Method of Harm Descriptions | N | % |
---|---|---|
Poisoning by benzodiazepines | 233 | 17.8% |
Suicide attempt (not specified) | 224 | 17.1% |
Self-harm by other specified means | 160 | 12.2% |
Poisoning by 4-aminophenol (acetaminophen) | 102 | 7.8% |
Poisoning by other opioids | 91 | 7.0% |
Intentional self-harm by knife | 85 | 6.5% |
Poisoning by other antiepileptic and sedative-hypnotic drugs | 79 | 6.0% |
Intentional self-harm by other sharp objects | 60 | 4.6% |
Intentional self-harm by unspecified sharp objects | 56 | 4.3% |
Poisoning by unspecified drugs, medicaments, and biological substances | 54 | 4.1% |
Poisoning by other antipsychotics and neuroleptics | 52 | 4.0% |
Poisoning by selective serotonin reuptake inhibitors | 48 | 3.7% |
Poisoning by selective serotonin and norepinephrine reuptake inhibitors | 40 | 3.1% |
Poisoning by beta-adrenoreceptor antagonists | 39 | 3.0% |
Poisoning by aspirin | 31 | 2.4% |
Poisoning by other drugs, medicaments, and biological substances | 27 | 2.1% |
Poisoning by other antihypertensive drugs | 25 | 1.9% |
Toxic effect of ethanol | 23 | 1.8% |
Poisoning by other synthetic narcotics | 22 | 1.7% |
Poisoning by antiallergic and antiemetic drugs | 22 | 1.7% |
Poisoning by tricyclic antidepressants | 20 | 1.5% |
Poisoning by propionic acid derivatives | 19 | 1.5% |
Poisoning by calcium-channel blockers | 19 | 1.5% |
Poisoning by angiotensin-converting-enzyme inhibitors | 19 | 1.5% |
Poisoning by other parasympathomimetics [cholinergics] | 18 | 1.4% |
Poisoning by other antidepressants | 16 | 1.2% |
Poisoning by tetracycline antidepressants | 15 | 1.1% |
Asphyxiation due to hanging | 15 | 1.1% |
Intentional self-harm by jumping from a high place | 15 | 1.1% |
Poisoning by antithyroid drugs | 14 | 1.1% |
Poisoning by unspecified synthetic narcotics | 14 | 1.1% |
Poisoning by antiparkinsonism drugs | 13 | 1.0% |
Poisoning by antihyperlipidemic and antiarteriosclerotic drugs | 13 | 1.0% |
Poisoning by thyroid hormones | 12 | 0.9% |
Other causes | 273 | 20.9% |
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Alipour-Haris, G.; Armstrong, M.J.; Sullivan, J.L.; Suryadevara, U.; Rouhizadeh, M.; Brown, J.D. Suicidal Ideation and Suicide-Attempt-Related Hospitalizations among People with Alzheimer’s Disease (AD) and AD-Related Dementias in the United States during 2016–2018. J. Clin. Med. 2022, 11, 943. https://doi.org/10.3390/jcm11040943
Alipour-Haris G, Armstrong MJ, Sullivan JL, Suryadevara U, Rouhizadeh M, Brown JD. Suicidal Ideation and Suicide-Attempt-Related Hospitalizations among People with Alzheimer’s Disease (AD) and AD-Related Dementias in the United States during 2016–2018. Journal of Clinical Medicine. 2022; 11(4):943. https://doi.org/10.3390/jcm11040943
Chicago/Turabian StyleAlipour-Haris, Golnoosh, Melissa J. Armstrong, Jennifer L. Sullivan, Uma Suryadevara, Masoud Rouhizadeh, and Joshua D. Brown. 2022. "Suicidal Ideation and Suicide-Attempt-Related Hospitalizations among People with Alzheimer’s Disease (AD) and AD-Related Dementias in the United States during 2016–2018" Journal of Clinical Medicine 11, no. 4: 943. https://doi.org/10.3390/jcm11040943