Psychosomatics 43:434, October 2002
© 2002 The Academy of Psychosomatic Medicine
Suicide and Euthanasia in Older Adults: A Transcultural Journey
Edited by Diego De Leo, Toronto, Hogrefe & Huber Publishers, 2001, 228 pages, $24.95, ISBN 0-88937-251-9
Keven Hails, M.D.
Key Words: Book Reviewed
This book is a series of studies that closely examines data on suicides completed by the elderly in various countries. The majority of the studies are based on data provided to the World Health Organization. There are no data in this book from Africa, the Middle East, or from South and Central America in part because there are proportionally fewer elderly in these regions. The book seems to confirm that in many cultures, the rates of suicide often peak in the elderly. Although on first glance the book seems to be overburdened with graphs and charts, there are many points worth noting throughout the various sections.
The book attempts to combat the belief that the suicide of an older person is somehow less of a waste than that of a young person. It also points out numerous times that suicide prevention programs generally are not directed to the older adult. For example, one study cited noted that a 24-hour telephone service attracted callers in their 20s and generally not the elderly. Furthermore, there remains a bias in many cultures that indeed suicide is more understandable in the elderly because of the multiple losses we know are suffered by the aging population. However, not enough may be done to combat these losses. Even treatment may not be enough to prevent suicide in the elderly. One study noted that "the median interval between the first suicidal communication and the final act was only one month," and a Swedish study was cited that noted that 52% of those elderly patients who completed a suicide were taking an antidepressant or lithium at the time of the suicide.
The book can be confusing, since most of the chapters examine data from individual countries and the individual authors place emphasis on different aspects of the data. Furthermore, the differences between cultures are often difficult to ascertain, since the data are generally not compared between cultures. It may have been preferable to have chapters discussing various topics about suicide in the elderly, such as method of suicide or the presence of psychiatric illness, and then compare among the different countries for which data were available. Another confusing aspect was that some of the graphs did not have proper keys identifying the plots on a graph.
The book concludes with a chapter on physician-assisted suicide. Margaret Battin presents a thought-provoking essay on the possible cultural changes that could make physician-assisted suicide less rare than proponents assume it will be. Although an excellent work, it does not build on the chapters that preceded it and is not necessarily transcultural in its focus.
Overall, this book will appeal to the scholar who wants to know the statistical differences in suicide rates for the various countries reported within the text. It might also appeal to the clinician who, by reading the interpretations of the rates of suicide in the elderly in the various countries, learns of the challenges and failures to significantly alter the frighteningly high suicide rates in the elderly throughout the world.
FOOTNOTES
Dr. Hails is the Director of Consultation-Liaison Psychiatry at Albert Einstein Medical Center, Philadelphia
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