People with dementia may be at higher risk of having suicidal thoughts

People with dementia are more likely to have suicidal thoughts but are not necessarily more likely to attempt or die by suicide than the general population, finds a new study led by UCL researchers.

The study, published in Ageing Research Reviews, analyzed 54 studies that investigated various aspects of mental health - including the prevalence and risk of suicide - in people with dementia, between 1991 and 2023.

Dementia is an escalating global health challenge, affecting an estimated 55 million people worldwide. Alongside impacting cognitive abilities, people with dementia often experience debilitating neurological and psychological symptoms such as depression, apathy, aggression and anxiety.

These symptoms can sometimes lead to heightened emotional distress and, in some cases, suicidal ideation.

The researchers pooled data from 20 studies that reported on suicidal thoughts in people with dementia, that involved more than 1.5 million people. They found that 10% of people with dementia had experienced suicidal thoughts compared to the World Health Organization's estimate of 2% for the general population.

Those with moderate dementia were more at risk of suicidal ideation than those with mild dementia.

However, after reviewing data from more than 3.7million people with dementia, the researchers found that the prevalence of attempted suicide or death by suicide was approximately the same as the prevalence found in the general population- with 0.8% of people with dementia attempting suicide within a two-year period.

The team found that 0.1% of people with dementia died by suicide, and younger people with dementia were about three times more likely to be affected than those who were older.

Even though men were less likely to report suicidal thoughts they were significantly more likely to attempt suicide and almost three times more likely to die by suicide than women.

Dementia is a growing global health issue as more people live long enough to develop it.

People with dementia may be at higher risk of having suicidal thoughts and in particular certain groups such as men and younger people with dementia may be more at risk of dying by suicide, but this field has not been well studied,  The current NICE guidelines for the assessment, management and support of people living with dementia do not mention suicidality in this population or address how to assess or manage this risk. This means that clinicians do not routinely assess or actively manage this risk.

This review highlights the importance of providing mental health support and suicide prevention in dementia care, with a focus on age, the severity of symptoms, and sex."

Dr. Roopal Desai, Lead Author, UCL Psychology & Language Sciences

In light of the study's findings, the researchers are now calling on clinicians and caregivers to be vigilant in assessing the emotional well-being of people with dementia, in order to ensure timely support and the safety of patients.

Senior author, Dr Amber John said: "It is often assumed that suicide is not an issue in people living with dementia. This study shows that people with dementia are no less likely to attempt or die by suicide than the general population - and indeed are more likely to experience suicidal ideation.

"This means that suicide risk needs to be taken just as seriously in people living with dementia as in the general population. "

The research was supported by the Welsh National Health Service.

Mental Health Medical Director of Betsi Cadwaladr University Health Board (BCUHB), Prof Alberto Salmoiraghi, who co-authored the paper, said: "These findings are truly important for clinicians and paramount to inform future service developments, particularly in regard to risk assessments and pathways of care."

Study limitations

The study examined various ways people expressed suicidal thoughts and involved both clinical and community samples, which can influence incidence rates.

The researchers were also unable to analyse all the risk factors for suicide due to a lack of information from the existing studies.

In addition, the findings do not consider different subtypes of dementia (i.e. frontotemporal dementia may pose a higher suicide risk due to behavioural changes and aggression).