# Suicide risk among spouses of patients with dementia: a population-based cohort study

## TL;DR

Spouses of dementia patients face higher suicide risk, especially in low-income groups, possibly due to financial burdens from healthcare costs.

## Contribution

This study identifies socioeconomic factors and healthcare utilization patterns linked to increased suicide risk in dementia patient spouses.

## Key findings

- Spouses of dementia patients in the lowest insurance premium group had a 3.2-fold higher suicide risk.
- Suicide risk among dementia patient spouses rebounded 10 years after diagnosis.
- Patient hospitalization was associated with a 2.6-fold increase in suicide risk among spouses.

## Abstract

Caregiver burden among spouse caregivers is associated with mental health burdens, including suicide. However, longitudinal studies on suicide risk among spouses of dementia patients are limited. This study aimed to investigate suicide risk among spouses of patients with dementia and to examine how sociodemographic factors and healthcare service utilization influence this risk.

We conducted a population-based cohort study using the 2008–2021 National Health Insurance Research Database (28,696 dementia patient–spouse dyads and matched non-dementia patient–spouse dyads). Dementia and suicide behaviors were identified using diagnostic codes from the national registry. Incident rates of suicide among patients’ spouses were calculated following the diagnosis of dementia. A Cox proportional hazards model assessed suicide risk among spouses of dementia patients relative to spouses of non-dementia patients, stratified by sociodemographic characteristics. We also examined the association between healthcare service utilization by patients with dementia and suicide behavior among their spouses.

Overall suicide risk was similar between spouses of dementia patients and those of non-dementia patients. However, among those in the lowest insurance premium group, spouses of patients with dementia had a 3.2-fold higher (95% confidence interval [CI]: 1.3–8.0) risk of suicide compared to spouses of patients without dementia. The incidence rate ratio of suicide decreased following the diagnosis of dementia but rebounded 10 years after diagnosis. Healthcare utilization was higher among patients with dementia compared to those without dementia, and patient hospitalization was associated with a 2.6-fold increase (95% CI: 1.3–5.3) in suicide risk among their spouses.

The increased suicide risk among spouses of patients with dementia in the later stages of the disease may be related to the financial burden caused by healthcare service utilization. Affordable long-term care services for spouses of patients with dementia should be developed.