Factors associated with suicidal thoughts in a large community study of older adults

Osvaldo P. Almeida · Brian Draper · John A Snowdon · Nicola T. Lautenschlager · Jane Pirkis · Gerard J. Byrne +4 more

204 citations0/0 files storedThe British Journal of Psychiatry

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Suicide and Self-Harm Studies Mental Health Treatment and Access Homicide, Infanticide, and Child Abuse

Abstract

BACKGROUND: Thoughts about death and self-harm in old age have been commonly associated with the presence of depression, but other risk factors may also be important. AIMS: To determine the independent association between suicidal ideation in later life and demographic, lifestyle, socioeconomic, psychiatric and medical factors. METHOD: A cross-sectional study was conducted of a community-derived sample of 21 290 adults aged 60-101 years enrolled from Australian primary care practices. We considered that participants endorsing any of the four items of the Depressive Symptom Inventory -Suicidality Subscale were experiencing suicidal thoughts. We used standard procedures to collect demographic, lifestyle, psychosocial and clinical data. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. RESULTS: The 2-week prevalence of suicidal ideation was 4.8%. Male gender, higher education, current smoking, living alone, poor social support, no religious practice, financial strain, childhood physical abuse, history of suicide in the family, past depression, current anxiety, depression or comorbid anxiety and depression, past suicide attempt, pain, poor self-perceived health and current use of antidepressants were independently associated with suicidal ideation. Poor social support was associated with a population attributable fraction of 38.0%, followed by history of depression (23.6%), concurrent anxiety and depression (19.7%), prevalent anxiety (15.1%), pain (13.7%) and no religious practice (11.4%). CONCLUSIONS: Prevalent and past mood disorders seem to be valid targets for indicated interventions designed to reduce suicidal thoughts and behaviour. However, our data indicate that social disconnectedness and stress account for a larger proportion of cases than mood disorders. Should these associations prove to be causal, then interventions that succeeded in addressing these issues would contribute the most to reducing suicidal ideation and, possibly, suicidal behaviour in later life.

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References

1983The Hospital Anxiety and Depression Scale 2002The validity of the Hospital Anxiety and Depression Scale 2005Suicide Prevention Strategies 2010A Meta-Analysis of Interventions to Reduce Loneliness 2004Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients 2005Anxiety Disorders and Risk for Suicidal Ideation and Suicide Attempts 2011Suicide in Older Adults 2002Risk Factors for Late-Life Suicide: A Prospective, Community-Based Study

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2016Identifying a clinical signature of suicidality among patients with mood disorders: A pilot study using a machine learning approach 2016Smoking and Suicide: A Meta-Analysis 2014Predicting the Risk of Suicide by Analyzing the Text of Clinical Notes 2015In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide 2014Suicide Risk in Primary Care: Identification and Management in Older Adults 2017

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