Older veterans with recent mild cognitive impairment (MCI) or dementia diagnoses were at increased risk of attempting suicide, researchers found in a nationwide cohort study published in JAMA Psychiatry.
Researchers examined these associations using national data from the Veterans Affairs (VA) National Patient Care Database, Centers for Medicare & Medicaid Services, the National Suicide Prevention Applications Network, the Mortality Data Repository, and the VA’s Pharmacy Managerial Cost Accounting National Data Extract. They identified patients aged ≥50 years who used VA healthcare services at least once from fiscal years 2012-2013 (baseline) and at least once from fiscal years 2007-2011. They compared patients who were diagnosed with either any form of dementia or MCI with patients who were not. The researchers assigned patients who had both dementia and MCI to the dementia group.
The final cohort included 147,595 patients (21,085 with MCI; 63,255 with dementia; and 63,255 without MCI or dementia). Prevalence of psychiatric conditions was higher in both the MCI (10,807) and dementia (34,289) groups compared with the group without either condition (18,988) and consistently highest in patients with dementia.
After adjusting for demographic characteristics and Charlson Comorbidity Index (CCI), risk for suicide attempt was 1.2 to 1.3 times higher in patients with MCI (hazard ratio (HR) 1.34 [95% CI, 1.09-1.65]; P =.005) or dementia diagnoses (HR 1.23 [95% CI, 1.05-1.44]; P =.01) compared with the group with neither condition.
After adjusting for demographic details, CCI, and any psychiatric comorbidity, the risk for suicide attempt was 73% and 44% greater in patients with a recent diagnosis in the MCI and dementia groups, respectively (HR for MCI 1.73 [95% CI, 1.34-2.22]; P <.001; HR for dementia 1.44 [95% CI, 1.17-1.77]; P =.001) but not in patients with a prior diagnosis (HR for MCI 1.03 [95% CI, 0.78-1.36]; P =.84; HR for dementia 1.14 [95% CI, 0.95-1.36]; P =.15) relative to the comparison group.
Firearms were the most common method across all groups’ members who committed suicide (26 of 38 patients with MCI; 66 of 88 with dementia; and 89 of 110 in the comparison group; P =.26). The dementia group had a 29% lower risk for death by suicide than the comparison sample (HR 0.71 [95% CI, 0.53-0.94]; P =.02). The reduced risk for death by suicide in patients with dementia (36%) was restricted to patients with a prior diagnosis (HR 0.64 [95% CI, 0.46-0.89]; P =.007).
Limitations of the study included the inability to infer causation and that immortal time bias may limit interpretability of the nonrecent MCI and dementia categories since they were defined before baseline. Anyone who died by suicide before baseline would not have been included. The study also investigated timing of the diagnosis — not course or stage of the illness — in relation to suicide attempts and events.
“Additional supportive services in the care of patients with MCI or dementia are imperative, especially around the time of initial diagnosis,” the study authors said.
They also said screening and possibly restricting firearms access earlier in the progression of dementia may be helpful.
Günak MM, Barnes DE, Yaffe K, Li Y, Byers AL. Risk of suicide attempt in patients with recent diagnosis of mild cognitive impairment or dementia. JAMA Psychiatry. Published online March 24, 2021. doi: 10.1001/jamapsychiatry.2021.0150