Social Inequalities in the Occurrence of Suicidal Ideation Among Older Primary Care Patients

Abstract

Objectives-To examine whether there is an association between area socioeconomic status and the experience of suicidal ideation among older adults.Design-Secondary analyses of data from a prospective study of naturalistic outcomes of depressive symptoms Setting-Monroe County, NYParticipants-A cohort of older adults (≥65 years, N=515) attending primary care settings Measurements-Area socioeconomic status was based on the median household incomes of the census tracts in which participants lived. At six and twelve month follow-ups, the Longitudinal Interval Follow-up Evaluation was used to assess weekly depressive symptom status over the previous 6 months, which was used to construct a measure of any suicidal ideation during the study.Results-Residents of census tracts with median household incomes of less than $30,000/per year were more likely to experience suicidal ideation than residents of higher income census tracts (unadjusted odds ratio (OR), 4.60; 95%CI, 1.64-12.86). Adjustment for demographic and baseline clinical factors did not eliminate the association (OR, 5.44; 95%CI,). Subsequent NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript models that adjusted for medical, functional, and psychosocial variables did not explain this association, either.Conclusions-There is a robust association between lower census tract income and the occurrence over one year of suicidal ideation in a primary care cohort of older adults. These findings indicate the need for more research into how social worlds come to influence the emotional well-being of older adults, and whether social factors such as census tract income can be used to identify individuals at elevated risk for suicidal behavior.Keywords suicidal ideation; socioeconomic status; neighborhood effects; older adults OBJECTIVEAn estimated 5-10% of older adults (≥65 years) experience suicidal ideation (1), with the rate rising to as high as 30% among those individuals diagnosed with major depression (2). Two factors make suicidal ideation an issue of concern in primary care. First, it is a predictor of suicide attempts in late-life. Thus, it is reasonable to assume that detecting suicidal ideation, and addressing the clinical issues that are associated with it -depression, anxiety, feelings of guilt and worthlessness, poor social support, and bereavement, history of prior suicide attempts (3-5) -will reduce suicidal behaviors in older adults (2,6). Second, most at-risk older adults come into contact with a primary care physician, but few are seen in specialty mental health services (7). Detection could facilitate appropriate referrals.Much of the research about suicidal ideation in older adults has focused on psychopathology (2,3,6,(8)(9)(10). However, for more than a century suicide has been recognized as a social phenomenon, too (11). Support for this comes from evidence demonstrating that high rates of suicide in general populations are, for example, related to low socioeconomic status (7), or associated with political violence (12...

Prevalence of Depressive Symptoms and Associated Factors in Older Adult Public Housing Residents

“…Financial strain is one of the social risk factors of depression in older adults, and a robust association between lower income and the occurrence of suicidal ideation in a primary care cohort of older adults over 1 year has been reported (Cohen et al, 2010). The relationship between financial worries and depressive symptoms is in line with findings of previous studies (Kamiya et al, 2013; Rautio et al, 2013).…”

“…Financial strain has also been reported as a social risk factor for depressive symptoms among older adults (Cohen et al, 2010) and may be associated with depressive symptoms among older adult women living in public housing.…”

Suicide Risk in Primary Care: Identification and Management in Older Adults

“…In a large primary care sample of older adults in Australia [28], Almeida and colleagues found independent associations between suicidal ideation and smoking, living alone, limited social support, not practicing religion, and use of antidepressants. And in a secondary analysis of older primary care patients, those living in census tracts in the lowest quartile of family income for the area were almost 5 times more likely to report recurrent thoughts of death or recurrent suicidal ideation than those from the highest income tracts [29]. Similarly, in the PROSPECT study both depression severity and rates of suicidal ideation were significantly greater in those with annual incomes below $20,000 and those reporting financial strain [30].…”

Economic Inequalities in the Effectiveness of a Primary Care Intervention for Depression and Suicidal Ideation

“…However, much of this evidence does not separate pre-existing depression severity from differential treatment outcomes. For example, Cohen and colleagues have reported a relatively unfavorable course of depression treatment outcomes among older adults residing in lower-income census tracts, 1,35,36 and data from primary-care clinics demonstrate social inequalities in the receipt of depression treatment, adequacy of depression treatment, and outcomes of depression treatment. 10,12,37-40 Friedman et al reported that lower educational attainment and minority race/ethnicity were associated with worsened depression during the course of antidepressant treatment.…”