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Rather death

Fears of dementia and the life which may follow its diagnosis have been found to be associated with an increased incidence of suicide. More reasons for us to know more about dementia and to do what we can to make living with dementia something other than a monster: People with recent dementia diagnosis found to have higher suicide risk | Dementia | The Guardian

This is a worrying and challenging piece of information.

When I studied deaths amongst patients known to the Salford Psychiatric Case Register with David Baxter we found that suicide rates were higher than for the local community for all diagnoses other than dementia or organic brain syndromes Life expectation in organic brain disease | Advances in Psychiatric Treatment | Cambridge Core

There were relatively few people with dementia known to mental health services in the years covered by our study – and those captured by the Case Register were very likely to be inpatients and to stay in hospital or in care until their death. Awareness of dementia has been raised by efforts over the past three decades and diagnosis rates have risen. So too has awareness of the symptoms and lived experience of life after a diagnosis of dementia. So studies now are able to take account of people with much earlier evidence of dementia, still to spend months and years within the community and living as normal a life as is possible.

Much of the publicity about dementia has dwelt on the horrors of the condition and the impact on families. A disproportionate amount of publicity relates to people with Early Onset Dementia.

The study from Charles Marshall of the Wolfson Institute at Queen Mary’s University, and others is a detailed analysis from records linked and drawn from Primary Care, Secondary Care and the ONS. People over 15 years were included January 2001- December 2019. Of 594,674 people, 4,490 had received a diagnosis of dementia. 95 (2%) of these had died with a registered cause of death of suicide or an open verdict. Overall this is not different from people who were not diagnosed with dementia (matched from the Primary Care component of the study). Excess of deaths by suicide were concentrated amongst people with dementia aged less than 65 years and for all ages, in the 3 months following diagnosis.

Other studies have not found this association – but it feels to make sense of what we see in practice. It will be important to explore the finding by an analysis of details of the social and medical aspects of the cases where suicide followed so close on diagnosis. The presence of another mental health condition also increased the likelihood of suicide.

All this cautions us all to be careful of the hazards of our interventions, however well intended.

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