At this year’s congress of the Swiss Society for Psychiatry and Psychotherapy (SGPP, August 2016, Basel), the motto was “Mental health from a generational perspective”. A problem that cuts across generations is suicide and, especially among older people, increasingly assisted suicide. This is legal in Switzerland, unlike most European countries. In a symposium, experts presented an overview of the current figures and strategies for prevention.
Nicole Steck, Institute for Social and Preventive Medicine at the University of Bern, provided information on the development of suicide figures in recent years. Various studies show that the suicide rate in Switzerland (and in other European countries) has declined since the 1990s. At the same time, membership of the euthanasia organizations EXIT and Dignitas is rising sharply, and so are assisted suicides. This development was investigated in more detail as part of a study [1].
Many more assisted suicides among the elderly
The analysis was based on the Swiss National Cohort, a longitudinal study of the entire Swiss population resulting from linking the 1990 and 2000 censuses with cause-of-death statistics through 2008. The Federal Statistical Office has used a separate code for (suspected) assisted suicides since 1998.
In the period studied between 1991 and 2008, there were a total of around 24,400 suicides (17,400 men, 7000 women), of which around 2300 are presumed to have been assisted (1000 men, 1300 women) in the period from 1998 alone. Among men, the suicide rate fell slightly in all age groups; in particular, suicides by firearms fell significantly, which can be attributed to army reform and the downsizing of the army – and thus the reduced availability of firearms. In contrast, the suicide rate among women remained stable. Among women over 65, the rate actually increased, especially for poisonings, most of which are assisted suicides.
Within a few years, the number of assisted suicides tripled among women over 64, and doubled among men in the same age category. “In order for this trend to be monitored, there needs to be a registry of all assisted suicides,” the speaker urged.
Suicides and suicide prevention in old age
In 2013, 786 men and 284 women died by suicide in Switzerland – four times the number of traffic deaths. Each year, about 10,000 people are estimated to receive medical care after suicide attempts, and the direct cost of a suicide attempt is at least 19,000 Swiss francs, explained Prof. Gabriela Stoppe, MD, executive director of MentAge and head of the Mental Health and Aging WG of Swiss Public Health. Among men in particular, the suicide rate increases significantly in the age groups over 70; the methods practiced are mainly shooting (more than a third) and hanging (about a quarter). Among women, firearms hardly play a role, while poisoning and hanging are the most common ways of death.
The most important risk factors for suicide are mental illness, especially unrecognized and untreated depression, and a previous suicide attempt. However, there are other significant risk factors, including a new serious illness and the death of the partner or. of the partner. For the prevention of suicide, protective factors are most important (Table 1).
The topic of “suicide in old age” was addressed comprehensively for the first time in 2009 as part of an interdisciplinary roundtable. Since 2011, the annual Suicide Prevention Forum has been held in Rüschlikon each fall (this year on the topic of “Prevention of Assisted Suicide”, program at www.ipsilon.ch). The speaker’s conclusion: suicide in old age is a serious health problem, all the more so because in many cases there are causes that need to be treated or treated. could be eliminated.
Suicide Prevention Action Plan of the Confederation, Cantons and Health Promotion Switzerland
Esther Walter, Project Manager Suicide Prevention, Federal Office of Public Health, presented the Suicide Prevention Action Plan. In 2014, the Swiss parliament mandated the Federal Council to strengthen suicide prevention throughout Switzerland. Specifically, the federal government is mandated to present and implement an action plan for suicide prevention. The draft was written in collaboration with 100 experts, and 130 stakeholders from inside and outside the healthcare system participated in the consultation.
The draft action plan envisages a whole range of measures, e.g. mental health promotion, raising public awareness, early detection, early intervention and health care, but also in the aftercare of survivors or occupationally involved persons. The goal of the action plan is to further and sustainably reduce the rate of non-assisted suicide during stressful crises or mental illness. Suicide rates have already decreased significantly since 1995. The action plan aims to reduce the rate further and sustainably.
Source: Congress of the Swiss Society for Psychiatry and Psychotherapy (SGPP), August 17-19, Basel.
Literature:
- Steck N, et al: Time-trends in assisted and non-assisted suicides completed with different methods: Swiss National Cohort. Swiss Med Wkly 2015; 145: w14153.
InFo NEUROLOGY & PSYCHIATRY 2016; 14(5): 43-44.
