Physical, mental, and social wellbeing and their association with death by suicide and self-harm in older adults: A community-based cohort study

Objective
To assess associations between physical, mental, and social well‐being and suicide and self‐harm in a community‐based sample of older adults.
Methods
Using a cohort design, questionnaire data from 102,880 individuals aged 65 years or older living in New South Wales, Australia during 2006–2009 were linked to hospital and cause‐of‐death databases until 2017. Poisson regressions obtained adjusted incidence rate ratios (IRRs).
Results
One hundred nine suicides and 191 deliberate self‐harm (DSH) events occurred. Compared to those reporting excellent/good overall health, older adults reporting fair overall health had higher suicide rates (IRR = 2.8, 95% confidence interval: 1.8–4.4). Also, suffering from physical limitations was associated with higher rates of suicide. A fair versus excellent/good memory was associated with higher rates of suicide (IRR = 2.0, 1.3–3.3). Male erectile dysfunction was linked to self‐harm (IRR = 2.8, 1.0–7.7). Suicide rates were elevated with baseline Kessler‐10 scores of 20–50 versus 10–15 (IRR = 5.0, 2.9–8.9); the corresponding IRR for DSH was 2.9 (1.8–4.8). Elevated rates were observed for both self‐reported depression and anxiety. Poor versus excellent/good quality of life was associated with suicide (IRR = 4.3, 1.7–10.7) and achieving less than desired to due to emotional problems was linked to self‐harm (IRR = 1.8 1.3–2.4). Rates of suicide ande DSH were lower in those with ≥5 people to depend on versus one (suicide: IRR = 0.5, 0.3–0.9; DSH: IRR = 0.5, 0.3–0.7).
Conclusions
Older adults experiencing health problems, including those relating to overall health or memory, and those with psychological distress had elevated rates of suicidal behavior. Rates of subsequent self‐harm and/or death by suicide were elevated in participants with small social networks.