Depression and Suicide in the Geriatric Patient

Abstract

A survey was made of 200 elderly male patients in a VA hospital; 100 (Group A) had depression of the psychoneurotic or psychosomatic type with no evidence of suicidal potential, and 100 (Group B) had a psychotic depressive reaction with suicidal tendencies. The behavioral features of each group are described.In Group A the symptoms of depression were related to "loss" (of physical health, of independence, of social status, of a spouse or close relative) or "failure." These patients were of the passive-dependent type. In Group B, the symptoms of depression were related to compulsivity (work, ambition, perfection). These patients "introjected" their hostile feelings. Eighty per cent had suicidal tendencies.It is very important to differentiate these types of depression because the proper treatment, and the fairly good prognosis, are based upon understanding the psychodynamics.Issues of the dynamics, prognosis and treatment of the depressed geriatric patient are far from resolved. Prediction of suicidal attempts is still unreliable. Most studies unfortunately continue to treat depression and its suicidal aspects as an encapsulated experience. BACKGROUND

Suicide in the elderly

“…Who is vulnerable? Evidence is limited, but studies of depression and attempted suicide in old age indicate that lifelong traits are important, for example an incapacity for close relationships (Murphy, I982), a tendency to be helpless and hopeless (Send-buehler, 1977) and an inability to tolerate change or loss of control (Wolff, 1969;Hedlin, 1982).…”

Attempted Suicide Among the Aged

“…Also, suicidal behavior occurs much more frequently when there is a history of organic brain syndrome (OBS). On the other hand, Jones and Kaplan [as cited by Wolff (3)] believe that suicide attempts are not typical of OBS patients; rather, the loss of a loved one or escape from physical illness often prompts suicide attempts. The importance of physical illness as a factor in suicide among the elderly has been noted by several observers (4, 5, 7, 10, 11).…”

Recent research on suicide in the elderly

“…Other community-based studies have estimated lower attempt to completion ratios for older, compared with younger adults [31][32][33][34]. Stenback [35] estimated that the attempt to completion ratio among older adults was four-to-one compared with estimates of eight-and 20-toone for the US population as a whole [36,37].…”