Late-life suicide: Insight on motives and contributors derived from suicide notes

•41.5% of older New Zealanders who committed suicide left a suicide note; and Caucasians and females were more likely to do so.•33.3% of those who left a suicide note gave health-related reasons for their suicide and about three-quarter of them (73.3%) had genuine underlying medical conditions.•Not all established suicide risk factors in the literature are necessarily reflected in a person's suicide note. The findings of suicide note research should be interpreted in conjunction with research using other methodologies e.g. psychological autopsies and case-control study.•The progression from physical illness to suicidal behavior is currently not well understood and should be further researched, e.g. using qualitative methodology in older people presenting with death wish/suicidal ideation/suicide attempt and significant physical comorbidities.

ObjectivesThe aims of this study were: (i) to investigate the proportion of older people writing suicide notes in New Zealand; (ii) to compare the socio-demographic and clinical variables of older suicide note writers and non-note writers; and (iii) to perform a thematic analysis of the content of suicide notes.MethodsThe Coronial Services provided records of all suicide cases aged 65 years and over (n=225) between July 2007 and December 2012. We were able to determine whether there was a suicide note written in 212 cases. The content of 39 coroners/medical examiners' excerpts and 5 suicide notes was available for thematic analysis using a general inductive approach.Findings88 (41.5%) older people left a suicide note. Logistic regression showed that female gender (OR=2.8, 95% CI=1.4−5.7, p=0.005) and Caucasian ethnicity (OR=13.7, 95% CI=1.7−111.0, p=0.014) are significantly associated with older people writing suicide notes. 33.3% of those who left a suicide note gave health-related reasons for their suicide and a significant proportion (73.3%) of them had underlying medical conditions. Another common theme is around people leaving specific instructions and wishes.ConclusionsApart from gender and ethnicity, suicide note writers are similar to non-writers on broad socio-demographic and clinical factors. Suicide notes indicated free will in and reasons for their suicide and emotional/farewell messages to their loved ones. Many documented poor quality of life or physical illness but the progression of these factors to suicide in older people should be further researched.