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Original research
Executive dysfunction and risk of suicide in older adults: a population-based prospective cohort study
  1. Dae Jong Oh1,2,
  2. Ji Won Han3,
  3. Jong Bin Bae3,
  4. Tae Hui Kim4,
  5. Kyung Phil Kwak5,
  6. Bong Jo Kim6,
  7. Shin Gyeom Kim7,
  8. Jeong Lan Kim8,
  9. Seok Woo Moon9,
  10. Joon Hyuk Park10,
  11. Seung-Ho Ryu11,
  12. Jong Chul Youn12,
  13. Dong Young Lee1,13,
  14. Dong Woo Lee14,
  15. Seok Bum Lee15,
  16. Jung Jae Lee15,
  17. Jin Hyeong Jhoo16,
  18. Ki Woong Kim1,3,17
  1. 1Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  2. 2Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea (the Republic of)
  3. 3Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  4. 4Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea (the Republic of)
  5. 5Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea (the Republic of)
  6. 6Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea (the Republic of)
  7. 7Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (the Republic of)
  8. 8Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea (the Republic of)
  9. 9Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea (the Republic of)
  10. 10Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea (the Republic of)
  11. 11Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea (the Republic of)
  12. 12Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea (the Republic of)
  13. 13Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea (the Republic of)
  14. 14Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea (the Republic of)
  15. 15Department of Psychiatry, Dankook University Hospital, Cheonan, Korea (the Republic of)
  16. 16Department of Psychiatry, Kangwon National University, School of Medicine, Chuncheon, Korea (the Republic of)
  17. 17Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea (the Republic of)
  1. Correspondence to Professor Ki Woong Kim, Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 463-707, Korea (the Republic of); kwkimmd{at}


Objective It is uncertain what factors increases the risk of suicide in older adults without depression, and it is unknown whether executive dysfunction (ED) is one of those factors. We aimed to examine the effect of ED on the risk of suicide in non-demented older adults without depression.

Methods In an ongoing population-based prospective cohort of Korean older adults, we identified suicide using the National Mortality Database and suicidal ideation or attempt (SIA) based on the Korean version of the Mini International Neuropsychiatric Interview. We defined ED as performing below −1.5 SD of age-adjusted, gender-adjusted and education-adjusted norms in any of following tests: Frontal Assessment Battery, Trail Making Test A, Digit Span Test or Verbal Fluency Test.

Results The mean age of the 4791 participants at baseline was 69.7 (SD 6.4) years, and 57.1% of them were women (mean follow-up duration=4.9 years). ED at baseline increased the risk of suicide by about seven times (HR 7.20, 95% CI 1.84 to 28.12, p=0.005) but did not change the risk of SIA. However, cognitive impairment without ED did not change the risks of suicide and SIA. In participants with ED, being aged 75 years or above, living alone, and having a low socioeconomic status were associated with the risk of suicide.

Conclusion ED is a strong risk factor of late life suicide independent from depression, particularly in very old adults living in disadvantaged environments.

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors DJO, JWH and KWK conceptualised and designed this work. All authors acquired and analyzed the data. DJO, JWH, JBB and KWK drafted manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This research was supported by a fund (grant no. 2019-ER6201-00) by Research of Korea Centers for Disease Control and Prevention. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Disclaimer The sponsor was not involved in the design and administration of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.