Yeates Conwell

Risk factors for suicide in later life.

Suicide rates are higher in later life than in any other age group. The design of effective suicide prevention strategies hinges on the identification of specific, quantifiable risk factors. Methodological challenges include the lack of systematically applied terminology in suicide and risk factor research, the low base rate of suicide, and its complex, multidetermined nature. Although variables in mental, physical, and social domains have been correlated with completed suicide in older adults, controlled studies are necessary to test hypothesized risk factors. Prospective cohort and retrospective case control studies indicate that affective disorder is a powerful independent risk factor for suicide in elders. Other mental illnesses play less of a role. Physical illness and functional impairment increase risk, but their influence appears to be mediated by depression. Social ties and their disruption are significantly and independently associated with risk for suicide in later life, relationships between which may be moderated by a rigid, anxious, and obsessional personality style. Affective illness is a highly potent risk factor for suicide in later life with clear implications for the design of prevention strategies. Additional research is needed to define more precisely the interactions between emotional, physical, and social factors that determine risk for suicide in the older adult.

Validation of a Measure of Physical Illness Burden at Autopsy: The Cumulative Illness Rating Scale

Objective: To further validate an objective measure of physical illness burden, the Cumulative Illness Rating Scale (CIRS).

Risk Factors for Late-Life Suicide: A Prospective, Community-Based Study

Despite the fact that people age 65 and older have the highest rates of suicide of any age-group, late-life suicide has a low prevalence, making it difficult to conduct prospective studies. The authors examined risk factors for late-life suicide on the basis of general information collected directly from older subjects participating in a community-based prospective study of aging, the Established Populations for Epidemiologic Studies of the Elderly. Demographic variables, presence of a relative or friend to confide in, alcohol use, and sleep quality were assessed at baseline interview. Baseline and follow-up data were used to determine physical, cognitive, and affective functioning, as well as medical status. Of 14,456 people, 21 committed suicide over the 10-year observation period. Depressive symptoms, perceived health status, sleep quality, and absence of a relative or friend to confide in predicted late-life suicide. Suicide victims did not have greater alcohol use and did not report more medical illness or physical impairment. This study provided additional information about the context of late-life depression that also contributes to suicidal behavior: poor perceived health, poor sleep quality, and limited presence of a relative or friend to confide in.

Four Studies on How Past and Current Suicidality Relate Even When "Everything But the Kitchen Sink" Is Covaried.

T. E. Joiners (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.

Completed suicide among older patients in primary care practices: a controlled study.

OBJECTIVE: To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not.

Suicide and Aging I: Patterns of Psychiatric Diagnosis

Rates of suicide differ markedly as a function of age and gender. In a great majority of countries that report suicide statistics, rates are higher in the elderly than in younger age groups. Few data are available to determine whether this age-related pattern of rates is reflected in a differential prevalence of other factors known to be associated with increased suicide risk. Using the psychological autopsy method, researchers have established the distribution of psychiatric diagnoses in samples of adolescents, young adults, and elders who have committed suicide, and in victims across the life course in community-based populations. Review of those studies reveals that affective disorders, substance use disorders, and their comorbidity are common in completed suicides of all ages. Although methodologic issues and cohort and period effects limit the conclusions that can be drawn, comparison by age within and between studies further suggests that depressive illness is more common and substance abuse less prevalent in later-life victims. That the aging process itself (biological, psychological, and social) may account for the observed pattern has important implications for further research and the design of intervention strategies. There is a need for more coordinated and comprehensive study of psychopathological correlates of suicide across the life course in a broad range of cultures.

Age Differences in Behaviors Leading to Completed Suicide

The authors described retrospectively the premorbid self destructive behaviors of suicide victims to determine whether these behaviors differ with age. One hundred forty one suicide victims, age 21-92 years, were studied by psychological autopsy. Older age was significantly associated with more determined and planful self-destructive acts, less violent methods, and fewer warnings of suicidal intent. Age differences in the behaviors leading to suicide indicate that intervention in the midst of a suicidal crisis may be less effective in elderly persons than in younger people. Primary prevention should be the focus of efforts to decrease suicide rates in late life.

Suicide in Older Adults

This article makes the case that late-life suicide is a cause for great concern that warrants ongoing attention from researchers, health care providers, policy makers, and society at large. It reviews the evidence for factors that place older adults at risk for suicide, or protect them from it. The authors introduce the notion that suicide preventive interventions target individuals or groups at different levels of risk at different points on the developmental trajectory toward death by suicide, offering examples and recommending their strategic, combined application to create an effective, community-level response to the mounting problem of suicide in older adults.

Suicidal behavior in elders

Suicide is a major public health concern for older adults, who have higher rates of completed suicide than any other age group in most countries of the world. Older men are at greatest risk. Reduction of suicide-related morbidity and mortality in this age group hinges on systematic study at each point in the suicide preventive intervention research cycle. Improvements in systems for surveillance of late-life suicidal behavior, particularly attempted suicide, are needed to further develop the foundation on which to evaluate differences in the elderly subgroup, over time, and in different locations, and to better assess changes in response to interventions. This article provides an overview of suicide in later life and a foundation on which to base decisions about the design and implementation of preventive interventions.

Validity of the Patient Health Questionnaire 2 (PHQ-2) in Identifying Major Depression in Older People

OBJECTIVES: To determine the performance of the Patient Health Questionnaire 2 (PHQ‐2) against the criterion standard for diagnosing major depression, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV), and to examine its performance across age, sex, and racial/ethnic groups.