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.
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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.
Patient consent for publication Not required.
Ethics approval This study was approved by the Institutional Review Board of the Seoul National University Bundang Hospital.
Data availability statement Data are available on reasonable request.
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