Yes, dementia or mild cognitive impairment can increase suicide risk, but our research indicates it depends upon certain factors.
The number of individuals with dementia is expected to triple by 2050 worldwide. The Lancet Commission has called dementia one of the greatest challenges for social care and healthcare of the 21st century. Further adding to this burden is mild cognitive impairment (MCI). MCI represents a grey area in which an individual does not have entirely intact cognitive function, but also does not meet criteria for a dementia diagnosis. It is characterized by cognitive impairment while daily functioning is maintained.
Both MCI and dementia may have various implications, and as we discovered, attempting suicide is one of them. In approximately 150,000 U.S. veterans, ages 50 and older, we found that risk of attempting suicide is increased in those with MCI or dementia compared to veterans without either.
Importantly, timing of the MCI or dementia diagnosis played a critical role. The increased risk of suicide attempt occurred only soon after having received an MCI or dementia diagnosis. Veterans with a prior diagnosis were not at increased risk for attempting suicide.
Even in light of individual differences in demographic characteristics including age, gender, ethnicity or presence of medical or psychiatric comorbidities, recent diagnoses of MCI or dementia consistently resulted in an increased risk of attempting suicide.
Psychiatric comorbidities including depression, posttraumatic stress disorder and generalized anxiety disorder also were more often prevalent in veterans with MCI or dementia compared to those without. Additional research in this area would be beneficial, but for now, these findings suggest that mental well-being, on average, may be more impaired in individuals with MCI or dementia than it is in those without either diagnosis.
Interestingly, our study indicated that risk of death by suicide is not increased in veterans with MCI or dementia. In fact, risk of death by suicide was found to be decreased in those with a prior diagnosis of dementia.
‘Increased risk of suicide attempt occurred only soon after having received an MCI or dementia diagnosis.’
These findings about timing of diagnosis and suicide attempt and death may not be so surprising. Receiving a diagnosis of dementia or MCI is often extremely distressing. Particularly around the time of diagnosis, individuals affected may still have insight into what it means to have MCI or dementia, anticipating gradual decline of their abilities. Patients may worry about losing autonomy and becoming a burden to their significant others.
Additionally, individuals still may be able to plan and implement a suicide attempt soon after diagnosis, whereas (they may fear) they will not be able to as MCI or dementia progresses. This could also explain why individuals with a prior diagnosis of dementia are at decreased risk to die from suicide. That is, more severe dementia may “protect” an individual from death by suicide. Individuals with prior diagnoses of MCI or dementia may also choose or use less lethal means, such as something other than firearms, as well as have restricted access to firearms.
The more frequent presence of psychiatric comorbidities in veterans with MCI or dementia may also partly explain why they have an increased wish to end their lives.
What Can Be Done?
Our findings suggest that individuals who have been recently diagnosed with MCI or dementia should be viewed as a high-risk group for suicide attempt. These findings underline the importance of supportive services in the care of individuals with a recent diagnosis of MCI or dementia.
Being diagnosed with MCI or dementia is a profound life-changing event for which no disease-modifying treatment exists. Post-diagnostic support such as social events to reduce isolation, education about the disease, and opportunities to plan ahead may be helpful. It is strongly recommended to offer advance care planning early on so that individuals affected can decide for themselves their future medical care. This can ensure that choices match individual’s values, respecting their autonomy as well as preserving their dignity. Yet, access to advance care planning has been poor due to lack of skills and delegation of responsibility among healthcare providers, and stigmatization.
Supportive services are critical in the care of individuals with a recent diagnosis of MCI or dementia.
Such services should be offered to all individuals affected by MCI or dementia. Early detection and treatment of psychiatric comorbidities is necessary. Unfortunately, people with dementia are commonly denied access to mental health services as it is often erroneously believed that patients’ mental health condition will not improve. Moreover, restricting lethal means access such as firearms and addictive medications also is essential—not only when cognitive impairment has progressed but very soon after diagnosis.
For veterans, the Department of Veterans Affairs (VA) offers several resources that help patients to cope with an MCI or dementia diagnosis, including remaining healthy and active, planning ahead for one’s safety at home and in the community, later living arrangements and care (such as in-home aide, adult day-care services or residential care), planning medical choices as well as negotiating financial and legal issues. Doing these things when individuals affected still are able to take part in required discussions will provide them with a feeling of being listened to rather than labeling them as being too ill or severely impaired to have a say, at best, preventing or enhancing a sense of hopelessness.
The VA also provides resources for caregivers to prepare for caring for people with dementia, including helping with daily life, learning new ways to communicate, and seeking support in a network of other caregivers. It is important to offer such options early on so that individuals with dementia are aware of them and are cognizant that their caregivers will be supported. People with dementia often are afraid they will become a burden to others. Thus, knowledge that their caregivers will be supported will likely be reassuring and ease such concerns.
The wish to attempt suicide appears to be greatest soon after receiving a diagnosis of MCI or dementia. Healthcare providers and caregivers should be aware and act accordingly by providing support, listening to individual’s concerns and needs, and maintaining their autonomy—as much and as early as possible.
Where to Get Help:
The Lifeline provides support for people in crises and emotional distress for oneself or someone else. National Suicide Prevention Lifeline: 1-800-273-8255, free and confidential, available every day, 24/7.
For Veterans in crisis or when concerned about one: Veterans Crisis Line: 1-800-273-8255 # Press 1 or Text 838255, free and confidential, available every day, 24/7.
Mia Maria Günak, MSc, is a trainee clinical psychologist at the Ludwig Maximilian University of Munich, Germany. Amy L. Byers, PhD, MPH, is a professor and research health science specialist at the San Francisco Veterans Administration Department of Psychiatry and Behavioral Sciences, Department of Medicine, Division of Geriatrics, University of California, San Francisco.
