Older Women Who Died By Suicide: Suicide Means, Sociodemographic and Psychiatric Risk Factors, and Other Precipitating Circumstances

Background and Purpose: Over the past decade, suicide rates among older women in the United States have increased. Contributors include mental disorders (especially depression), substance abuse, intimate partner and family relationship problems, physical health problems, and many other factors. While most older men choose firearms as suicide means, older women choose drug overdose, firearms, hanging/suffocation, and other means in approximately equal proportions. To better understand suicide among older women, we examined potential differences in sociodemographic and risk/precipitating factors among those who died by different means and postmortem toxicology results by means. Given prior studies, we hypothesized that women who used drug overdose rather than other means will have been younger and not married; had higher rates of prior suicide attempts and alcohol, drug, mental/physical health problems; and lower rates of other precipitating factors (e.g., interpersonal, job/financial, legal problems).

Methods: Data are from the 2005-2015 U.S. National Violent Death Reporting System (N=12,401 female decedents aged 50+). We used three logistic regression models, with overdose versus firearms, hanging/suffocation, and “other” means as the dependent variables, to examine associations between suicide means and sociodemographic characteristics (age, race/ethnicity, marital status, education, Census region) and risk/precipitating factors (physical health, mental health, alcohol/drug, relationship, job/finance/housing, legal problems; suicide attempt history/intent disclosure; mental health/substance abuse treatment; family/friends’ recent suicides/other deaths; any recent crisis). To examine positive toxicology of prescription/illicit drugs by suicide means, χ² tests were used.

Results: Nearly 92% of decedents were non-Hispanic White. Hispanics and Asians were overrepresented among those who use hanging/suffocation. Nearly 42% exhibited warning signs (e.g., suicide attempt/intent disclosure), and nearly one third had physical health problems that reportedly contributed to their suicide. As hypothesized, compared to firearm users, overdose users were younger and had higher odds of previous suicide attempts/intent disclosures (AOR=1.37, 95% CI=1.25-1.51), mental disorders (e.g., depression/dysthymia: AOR=1.18, 95% CI=1.05-1.34), physical health problems (AOR=1.15, 95% CI=1.03-1.27), and substance abuse (AOR=2.68, 95% CI=2.29-3.15) other than alcohol, but lower odds of relationship problems and crisis. Compared to hanging/suffocation, overdose declined (AOR=0.95, 95% CI=0.93-0.97) during the study period and was less prevalent among Hispanic and Asian women and those with job/finance/housing problems. Toxicology reports showed that 47%, 43%, and 45% of overdose users were antidepressant, opioids, and benzodiazepine positive, respectively. Firearm users had the lowest rates of positive toxicology results for these drugs.

Conclusions and Implications: Results indicate that more emphasis is needed on educating formal (e.g., healthcare) and informal (e.g., family) support systems to identify and monitor warning signs. The opioid overdose rate implicates pain as a significant suicide precipitant. To prevent overdose, healthcare providers must employ risk reduction strategies (e.g., drug monitoring, prescribe in quantities that limit overdose potential), and obtain education on pain management and addiction treatment. Restricting firearms and adding barriers at jumping/hanging sites are also needed. Assistance with developing safety plans, managing chronic conditions and pain, and resolving interpersonal problems should be readily accessible Research to identify more effective prevention approaches is needed, including those targeting non-Hispanic White women, given their overrepresentation among older suicide decedents.