On the Distinction of Suicide Ideation Versus Attempt in Elderly Psychiatric Inpatients

Abstract

A study of selected elderly psychiatric inpatients admitted for depression suggests that suicidal ideation may initiate a process of smoldering when the patient, family, and professionals interact in such a way as to dampen apparent distress. Suicidal thoughts and mood may be masked by affective or cognitive constriction, camouflaged by anxiety and external agitation, and "tranquilized" by anti-anxiety agents. Depression may go undetected. Distinguishing factors between attempters and ideators are presented.

Editorial Review. Attempted suicide in old age

“…These findings contrast with rates for suicide in old age, where the male to female ratio is around 4-6 : 1 (McIntosh, 1992). The majority of attempters were not married (Pierce, 1987;Upadhyaya et al, 1989;Merrill and Owens, 1990;Frierson, 1991;Nieto et al, 1992;Lyness et al, 1992;Nowers, 1993;Draper, 1994b;Schmid et al, 1994), with at least 45% of those aged 65 years and over being widowed. The divorcedlseparated account for 4-13% of attempts and have been reported to have the highest population rates (Hawton and Fagg, 1990).…”

“…None included data from general practice, which is relevant as a recent Belgian study found that only 70% of attempted suicides across all ages who were seen by general practitioners were referred to hospital (Van Casteren et al, 1993). Other sample biases noted were the restriction to self-poisoning attempts (Merrill and Owens, 1990), the inclusion of only 'serious' attempts (Nieto et al, 1992), the exclusion of near fatal attempts (Schmid et al, 1994) and the limitation to those requiring psychiatric admission (Lyness et al, 1992;Rifai et al, 1993) or assessment (Upadhyaya et al, 1989;Draper, 1994b).…”

“…Employment status has been found to be a significant factor in the 55-64-year age group, with annual rates (per 100000) of 562 in the unemployed and 48 in the employed (Hawton and Fagg, 1990). The role of religion has also been considered, with some studies suggesting that there are lower rates in Roman Catholics (DeLeo et al, 1994;Schmid et al, 1994) and higher rates in Protestants (Schmid et al, 1994).…”

“…Some studies included all identified illnesses (Rifai et al, 1993;Schmid et al, 1994), others only those felt to be relevant by the clinician/researcher (Draper, 1994b). Although some studies have included a comparison group of older psychiatric patients (Rifai et al, 1993;Zweig and Hinrichsen, 1993;Schmid et al, 1994), none have included control groups matched for other suicide risk factors.…”

“…Studies that did not distinguish between acute and chronic illnesses reported 4676% had significant physical illnesses (Pierce, 1987;Upadhyaya et al, 1989;Merrill and Owens, 1990;Schmid et al, 1994). Chronic physical illness was common, occurring in 49-54% of patients (Frierson, 1991;Nieto et al, 1992;Nowers, 1993;Draper, 1994b).…”