Pathways to Late-Life Suicidal Behavior

Abstract

Objective Clinical heterogeneity is a key challenge to understanding suicidal risk, as different pathways to suicidal behavior are likely to exist. We aimed to identify such pathways by uncovering latent classes of late-life depression cases and relating them to prior and future suicidal behavior. Methods Data was collected from 09/2011-09/2015. We examined distinct associations of clinical and cognitive/decision-making factors with suicidal behavior in 194 older (50+) non-demented, depressed, elderly; 57 non-psychiatric controls provided benchmark data. The DSM-IV was used to establish diagnostic criteria. We identified multivariate patterns of risk factors defining clusters based on personality traits, perceived social support, cognitive performance and decision-making in an analysis blind to participants' history of suicidal behavior. We validated these clusters using past and prospective suicidal ideation and behavior. Results Of five clusters identified, three were associated with high risk for suicidal behavior: (1) cognitive deficits, dysfunctional personality, low social support, high willingness to delay future rewards, overrepresentation of high-lethality attempters; (2) high-personality-pathology (i.e. low self-esteem), minimal or no cognitive deficits, overrepresentation of low-lethality attempters and ideators; (3)cognitive deficits and inability to delay future rewards, similar distribution of high- and low-lethality attempters. There were significant between-cluster differences in number (p<0.001) and lethality (p=0.002) of past suicide attempts, as well as in the likelihood of future suicide attempts (p=0.010, 30 attempts by 22 participants, two fatal) and emergency psychiatric hospitalizations to prevent suicide (p=0.005, 31 participants). Conclusions Three pathways to suicidal behavior in old age were found, marked by (1) very high levels of cognitive and dispositional risk factors suggesting a dementia prodrome, (2) dysfunctional personality traits, (3) impulsive decision-making and cognitive deficits.

Sociodemographic and gender determinants of late-life suicide in users and non-users of antidepressants

“… 2 ‘Late-life’ studies tend to include a wide age range, in some cases starting at age 50. 3 , 4 Also, older people are more likely than younger persons to die on their first suicide attempt, 5 and prospective studies that focus on suicide outcomes in the 75+ age group are sorely needed.…”

Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population

“…Moreover, self-esteem has been shown to be associated with geriatric depression symptoms [15] and prognosis [17]. Numerous studies have documented a strong positive correlation between CM and low self-esteem [36][37][38].…”

“…Moreover, self-esteem is associated with the clinical symptomatology and prognosis in geriatric depression. Indeed, firstly, it has been found that low self-esteem significantly increases the risk of suicidal behaviour [ 15 ]. Secondly, depressive symptoms are negatively correlated with self-esteem in this population [ 16 ].…”

Personality of late‐ and early‐onset elderly suicide attempters

“…To explain high suicide rates in old age, 1 researchers typically invoke stressors of aging such as illness, disability, loss, and cognitive impairment. 2,3 By contrast, relatively little is known about the role of personality in late-life suicide. In younger people, personality traits are among the strongest predictors of suicidal behavior.…”