Determinants of death wishes and the impact of considering life completed in geriatric-psychiatric outpatients

BACKGROUND: Death wishes are common in later life and multifactorial. This study aims to examine prevalence and correlates of death wishes in older people referred to specialized mental health care.

METHOD: A cross-sectional study, 1784 patients aged ≥60 years referred to specialized mental health care for a functional psychiatric disorder. Participants answered questions related to death wishes, were assessed with the Mini International Neuropsychiatric Interview, the Montreal Cognitive Assessment test, and psychiatric symptom severity scales. Death wish was assessed by a single question about wanting to continue living. Determinants of death wishes were studied by hierarchical logistic regression analysis with entrance of 1) suicidality, 2) psychopathology, 3) considering life completed as potential determinants, controlling for age and sex.

RESULTS: A total of 302/1784 (16.9 %) participants had a death wish; either ambivalent (n = 218, 12.2 %) or decisive (n = 84, 4.7 %). In order of decreasing predictive value, suicide risk, feeling life completed, depressive symptom severity, and having a depressive disorder distinguished patients with any thoughts of wanting to die from those who want to live (with unique generalized R 2 changes of 0.098, 0.071, 0.017, and 0.003, respectively). Only considering life completed differentiated between a decisive wish to die or being ambivalent towards life (unique generalized R 2 changes of 0.170).

CONCLUSION: Death wishes are highly prevalent among older patients with psychiatric disorders. Considering one's life completed contributes independently to death wishes in this population, beyond suicidality and severity of psychopathology. These findings argue for in-depth exploration of death wishes beyond psychopathology.