A recent cross-national study reported that elderly suicide rates in both sexes were significantly negatively correlated with household size and the percentage of extended households and positively correlated with the percentage of single-person households (Shah, Reference Shah2009). Speculative explanations for these findings were based on cultural factors, including (i) a mismatch between the traditional dependence of elderly relatives on their children for emotional and financial support and their children's ability to provide this support (Yip et al., Reference Yip, Chi and Yu1998, Reference Yip, Callanan and Yuen2000; Liu et al., Reference Liu, Wang and Yang2006); (ii) the unmet traditional expectation of the elderly person being able to live with their children or grandchildren (Yip et al., Reference Yip, Callanan and Yuen2000; Liu et al., Reference Liu, Wang and Yang2006); (iii) the effect on the elderly of their children's negative attitudes (Yip et al., Reference Yip, Callanan and Yuen2000); (iv) the migration of children to urban areas or to other countries (Yip and Tan, Reference Yip and Tan1998; Yip et al., Reference Yip, Callanan and Yuen2000); and, (v) the number of available caregivers, household size and family size (Kua et al., Reference Kua, Ko and Ng2003). Countries with larger household sizes and a greater number of extended households potentially have a greater number of people available within the household and within close geographical proximity who can contribute positively to these cultural issues, and this may ultimately lead to a reduction in elderly suicide rates – the “emotional proximity” explanation. However, there may also be other explanations for these findings (Shah, Reference Shah2009). Having more people in a household implies that there are more people to identify suicidal ideation and support the suicidal individual in seeking approprate help. Also, in larger households elderly people are likely to be alone for shorter periods of time, which would reduce the opportunity to implement any suicidal plans. Both these possibilities form part of the “geographical proximity” explanation.

If “emotional proximity” is important then elderly suicide rates should decline not only with larger household size but also with a greater density of people per household room, but not with greater general population density. If “geographical proximity” is important then elderly suicide rates should decline not only with larger household size but also with greater general population density and greater density of people per household room. Therefore, a study with two components was conducted: (i) an examination of the relationship between elderly suicide rates and data on household size from a different source than that used in an earlier study (Shah, Reference Shah2009); and (ii) the relationship between elderly suicide rates and general population density and density of people per household room.

Data on elderly suicide rates for both sexes in two age-bands – 65–74 years and 75+ years – were ascertained from the World Health Organization website (www.who.int/whosis/mort/table1.cfm). The median (range) of the latest available year for this data from different countries was 2000 (1985–2003). Data on the average number of people living in a household, density of people per room and general population density were ascertained from the following United Nations websites: household size – www.unstats.un.org/unsd/demographic/sconcerns/housing/housing2.htm (median year for these data from different countries was 1991); density per room – www.unstats.un.org/unsd/demographic/products/socind/housing.htm; and general population density – www.unstats.un.org/unsd/demographic/products/dyb/dyb2006/Table03.pdf. Spearman's correlation coefficient (ρ) was used to examine the relationship between elderly suicide rates and the household size, the general population density and the density of the number of people per room.

There were significant negative correlations between the average number of people living in a household and suicide rates in males aged 65–74 years (ρ = −0.39, P = 0.006), males aged 75+ years (ρ = −0.46, P = 0.001), females aged 65–74 years (ρ = −0.53, P;< 0.00001) and females aged 75+ years (ρ = −0.51, P < 0.00001) for 47 countries. There were no significant correlations between elderly suicide rates and general population density (data for 78 countries) and the density of people per household room (data for 36 countries).

The negative correlation between elderly suicide rates and household size confirms the findings of a recent study (Shah, Reference Shah2009), which used a different data source for household size. However, the negative findings do not allow further clarification of the relative contribution of emotional and geographical proximity explanations to elderly suicide rates. The negative findings may be the result of the well-described methdological issues in ecological studies of elderly suicides (Shah, Reference Shah2009). The emotional and geographical proximity explanations are both likely to contribute simultaneously to elderly suicides rather than be “either/or” explanations.

Conflict of interest

None.