First nonfatal suicide attempt risk factors differ significantly by age

Risk factors for first nonfatal suicide attempt likely differ by age, according to results of a nationally representative study published in Journal of Clinical Psychiatry.

“[Although] the prevalence of most psychiatric disorders is lower in older than in younger adults, psychiatric disorders are among the strongest predictors of suicide attempt and completion across all ages,” Nicolas Hoertel, MD, MPH, PhD, of the department of psychiatry and addictions at Paris University, and colleagues wrote. “Prior studies have suggested age differences in the strength of associations between psychiatric disorders and suicide risk. For example, major depression may be associated with a stronger risk [for] suicide in older than in younger adults, whereas substance use disorders may play a lesser role in later-life suicide risk.”

According to the investigators, research is sparse regarding similarities or differences between adults who first attempted suicide at a younger or older age. Because a significant proportion of older adults who attempt suicide have a history of suicide attempt, studying suicide risk by age group may help researchers identify risk factors related to emerging suicide risk in later life, as well as improve understanding of suicidal behavior across the life span, Hoertel and colleagues wrote. Research in this area also may aid in suicide prevention by informing identification of adults at greater suicide-attempt risk according to their age, and it also may allow for refinement of specific assessment and service provision according to age at first suicide attempt.

The researchers analyzed data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions — a nationally representative sample of 34,629 U.S. adults. Specifically, they compared characteristics of four different suicide attempter groups according to first attempt occurrence:

• before age 18 years;

• from ages 18 to 34 years;

• from ages 35 to 49 years; and

• at age 50 years or older.

They examined DSM-IV psychiatric disorders that occurred before the first suicide attempt, parental history of psychiatric disorders, sociodemographic characteristics and childhood maltreatment experiences.

Results showed 85.3% of first nonfatal suicide attempts occurred before age 35 years. Compared with attempts that occurred from ages 18 to 34 years, those that occurred before age 18 years had a stronger association with childhood maltreatment and a weaker association with lifetime prior psychiatric disorders. First suicide attempts that occurred at age 35 years and older were more strongly associated with a prior lifetime history of substance use disorders, including nicotine dependence and alcohol use disorder, as well as mood disorders, including dysthymic disorder and mania/hypomania between ages 35 and 49 years and major depressive episode at age 50 years and older.

“Improving early detection and treatment of psychiatric disorders and preventing childhood maltreatment may have broad benefits to reduce the burden of suicidal behavior at all ages,” the researchers wrote. – by Joe Gramigna

Disclosures: Hoertel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.