A diagnosis of dementia more than doubles the risk of suicide in the first three months after a patient is told the news, according to the latest research.
The study, which followed nearly 600,000 English people for 18 years, found patients who already had a psychiatric condition, or who were younger than age 65 at the time of diagnosis, were at a similar risk. The risk was highest during the first three months after learning the news for people younger than 65: They were 6.5 times more likely to die by suicide.
“A dementia diagnosis can be devastating, but the immediate period after diagnosis is often the period of greatest distress,” said lead study author Dr. Charles Marshall, clinical senior lecturer and honourary consultant neurologist at the Wolfson Institute of Population Health at Queen Mary University of London.
“Receiving a diagnosis of Alzheimer’s at an early age is rare, unexpected and overwhelming, making it very difficult to accept,” said Beth Kallmyer, vice president of care and support for the Alzheimer’s Association, who was not involved in the study.
“One of the most important things you could tell someone facing an Alzheimer’s diagnosis is that they are not alone and support is available,” she said.
SMALL BUT SIGNIFICANT
Prior research has established a distinct connection between dementia and suicide, including a 2021 study by Yale University scientists. “Adults over the age of 65 who were diagnosed with Alzheimer’s disease were twice as likely to die from suicide than older adults who did not suffer from dementia,” Kallmyer said.
Most cases of dementia are in the elderly, but chronic conditions and behavioural choices can play a role, according to Kallmyer. “Obesity, diabetes and sedentary lifestyles in younger people are rising quickly, and these are risk factors for dementia,” she said.
In the new study, published Monday in the journal JAMA Neurology, the actual number of people — 95 patients — who died by suicide after finding out they had dementia was small. However, that did not diminish the study’s value in identifying the most vulnerable subgroups and three-month timing, Marshall said.
Past studies have also found a relationship between a diagnosis of dementia and suicide in people diagnosed at an earlier age. While the new study was unable to determine why this would be so, Marshall pointed to the interpersonal theory of suicide as a possible answer.
“Perceived burdensomeness is a critical pillar for suicidal behaviour,” Marshall said. “That perception of burdensomeness may be higher in younger patients with dementia who are more likely to be in their work-productive years as well as have family-caring responsibilities.”
Results from studies like these suggest that physicians should conduct a “robust risk assessment” for signs of suicide at the time of diagnosis, Marshall and his coauthors wrote in the latest study.
“We know that early Alzheimer’s disease can cause low mood, anxiety and social isolation. These symptoms might be both causes and signs of suicide risk,” Marshall said in an email.
SUPPORTING A LOVED ONE
Becoming educated about dementia “and in particular, younger onset Alzheimer’s disease, is an important first step in supporting someone who receives a younger onset diagnosis,” Kallmyer said.
Health and financial plans should be put in place early so that the person living with dementia can participate in those decisions, she suggested.
“If the person is still working, it’s critical that they investigate employment benefits that could help them — and it’s essential that they do this before they leave their jobs. Employer benefits might include short- and long-term disability insurance, which can be very helpful while they are applying for Social Security disability,” Kallmyer said.
Signs of depression and suicidal warning signs mimic those of dementia, making it extremely difficult for caregivers, according to the Alzheimer’s Association.
“Because of the complexities involved with diagnosing depression with dementia, it may be helpful to consult a geriatric psychiatrist who specializes in recognizing, diagnosing, and treating depression in older adults,” the association noted.
MENTAL HEALTH RESOURCES IN CANADA
If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the National Suicide Prevention Lifeline at 800-273-8255 (or 988 beginning July 16, 2022) or Canada’s Talk Suicide 1-833-456-4566. The following resources are also available to support people in crisis:
Hope for Wellness Helpline: (English, French, Cree, Ojibway and Inuktitut): 1-855-242-3310
Embrace Life Council hotline: 1-800-265-3333
Trans Lifeline: 1-877-330-6366
Kids Help Phone: 1-800-668-6868