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

AISRAP Comments 13-2-13

Main findings: While often hidden or disguised, suicidal thoughts are shown to precede suicide in older adults and the elderly(1). In an effort to address this, suicide prevention strategies for older populations have mainly focussed on detecting and managing depression and anxiety. Although depression and anxiety are correlated with suicidal thoughts, collaborative care strategies aimed at reducing the severity of depression and the prevalence of suicidal ideation in older populations have reported only moderate success in decreasing suicide. In addition to psychiatric and clinical factors, this study explored independent socio-demographic and lifestyle factors that predicted suicidal ideation in older adults in Australia. Significant predictors of suicidal ideation included living alone, poor social support, financial stress, physical abuse during childhood, suicide in the family, but also pain, use of anti-depressants, anxiety and depression and past suicide attempt. Older adults with suicidal ideation were more likely to be educated non-religious males. These results were derived from an Australian cross-sectional study where a questionnaire was sent to all participants over 60 years old in primary care practices located in New South Wales, Queensland, South Australia, Victoria, and Western Australia. A total of 21 290 questionnaires were returned out of the 35 099 that were tracked. To date this is the most indepth study to explore the demographic, lifestyle, socioeconomic and clinical factors associated with older persons’ suicidal ideation.

Implications: This large community-based Australian study has important implications to suicide prevention in older populations, who have shown high suicide rates, especially males aged 75 years and over (25.2 per 100 000 compared to the total age-standardised male rate of 16.3 in 2010 preliminary data)(2). As indicated by the authors, while many of the older adults who experienced suicidal ideation had a history of anxiety or depression and a past suicide attempt; social factors, such as poor perceived social support and living alone, were also independently associated with suicidal ideation. Consequently, focussing older population suicide prevention strategies on mood disorders may have only limited impact on the overall prevalence of suicide ideation. Providing more social support for older populations by telephone support and befriending, could contribute to the reduction of high suicide rates of older people in Australia(3). Also, gender-specific interventions for older populations need to be considered as men are less likely to seek help and may prefer interventions programs that emphasize problem solving, rather than expressing emotions or building new realtionships(4).

Furthermore, this study highlights the importance of independent social factors and emphasises that future research must address the prevalence of suicidal ideation by targeting people with symptoms of risk, including mental factors as well as demographic, lifestyle and socioeconomic characteristics.

Endnotes

1. Scocco P, De Leo D (2002). One-year prevalence of death thoughts, suicide ideation and behaviours in an elderly population. International Journal of Geriatric Psychiatry, 17, 842-846. 2. Australian Bureau of Statistics (2001-2010). Suicide in Australia: Suicide Summary Statistics, Australia, (2001-2010). Canberra, Australia: Australian Bureau of Statistics. 3. De Leo D, Dello Buono M, Dwyer J (2002). Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. British Journal of Psychiatry, 181, 226-9. 4. Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, Gallo J, Szanto K, Conwell Y, Draper B, Quinnett P (2011). A systematic review of elderly suicide prevention programs. Crisis, 32, 88-98.