Suicidal Ideation in Dementia: Associations with Neuropsychiatric Symptoms and Subtype Diagnosis

Objectives To investigate factors associated with suicidal ideation around the time of dementia diagnosis. We hypothesised that relatively preserved cognition, co-occurring physical and psychiatric disorders, functional impairments and dementia diagnosis subtype would be associated with higher risk of suicidal ideation. Design Cross-sectional study using routinely collected electronic mental healthcare records. Setting National Health Service secondary mental healthcare services in South London, United Kingdom, which serve a population of over 1.36 million residents. Participants Patients who received a diagnosis of dementia (Alzheimer’s, vascular, mixed Alzheimer’s/vascular or dementia with Lewy bodies) between 1/1/2007-30/6/2016. 11,787 people with dementia were identified during the observation period. Measurements A natural language processing algorithm was used to identify recorded clinician statements about suicidal ideation around the time of dementia diagnosis. Sociodemographic and clinical characteristics were also measured around the time of diagnosis. We compared people diagnosed with non-Alzheimer’s dementia to those with Alzheimer’s and used statistical models to adjust for putative confounders. Results 4.8% of patients identified with dementia had recorded suicidal ideation. Recorded suicidal ideation was almost twice as common in dementia with Lewy bodies compared to other dementia diagnoses studied. After adjusting for sociodemographic and clinical factors, dementia with Lewy bodies, physical illnesses or disability and neuropsychiatric symptoms were significantly associated with suicidal ideation. Mini-Mental State Examination score at diagnosis was not associated with suicidal ideation. Conclusions Although completed suicide is rare, suicidal ideation is present in sufficient proportions of people with dementia to justify treatment of potentially modifiable risk factors within dementia care pathways.