Elderly suicide with and without a history of suicidal behavior: implications for suicide prevention and management.

This study examined the impact of a history of suicidal behavior on suicide among elderly people in Singapore. In this coroner register-based study, characteristics of 409 elderly people who died of suicide in Singapore between 2000 and 2004 were examined. Sixty-five people were classified with a history of previous suicidal behavior and 344 people without a history of suicidal behavior. Elderly people who died of suicide and had a past history of suicidal behavior were more likely to suffer from major psychiatric disorders (26.2% vs 10.2%, p = 0.001), encounter social problems in life (33.9% vs 21.5%, p = 0.038), have alcohol detected in the blood toxicology report at autopsy (23.1% vs. 12.8%, p = 0.036), receive psychiatric treatment in the past (60% vs. 37.5%, p < 0.001), have antidepressant detected in the blood toxicology report at autopsy (16.9% vs. 8.1%, p = 0.037), and be admitted to a mental hospital under the mental health legislation (36.9% vs. 11.6%, p < 0.001). Conversely, those without a past history of suicidal behavior were more likely to have a pre-suicidal plan for the fatal suicide act (11.1% vs. 1.5%, p = 0.011) and have received medical or surgical treatment in the past (22.1% vs. 9.2%, p = 0.018). For suicide prevention in Asians, psychiatrists should aggressively treat major psychiatric disorders, engage social services to resolve social problems in elderly people with a history of suicidal behavior, and reduce access to alcohol. Clinicians working in medical or surgical departments should routinely screen for suicide plans in elderly patients without a past history of suicidal behavior.