Suicide among older adults: Interactions among key risk factors

Abstract

Objective The present study aimed to understand how key risk factors of older adult suicide interact to ultimately lead to death by suicide using data collected post-mortem. Method A psychological autopsy was used to gather detailed information about psychiatric diagnosis, medical problems, social isolation, and negative attitudes expressed by the individual during the six months prior to their death. Interviews with next-of-kin, medical and psychiatric records, and the Cumulative Illness Rating Scale for Geriatrics were used. Subjects included 32 older adults who died by suicide and 45 older adults who died by natural causes. Results Hopelessness, depression, and negative health attitudes were strongly correlated with suicide. Older age was associated with social isolation, suggesting an indirect relationship with suicide via hopelessness, depression, and negative health attitudes. Physical illness did not increase risk. Multivariate analyses suggested that hopelessness fully mediated the effects of social isolation, negative health attitudes, and depression on suicide. Conclusions Psychological factors played the largest role in suicide deaths compared to social isolation and physical illness. Suicide interventions aimed at older adults should ensure hopelessness, depression, and negative health attitudes are primary targets.

Dinâmica temporal e espacial e fatores relacionados à mortalidade por suicídio entre idosos

“…Foi observado ainda que à medida em que a taxa de envelhecimento aumenta, a mortalidade por suicídio entre idosos também se eleva na mesma proporção. Diante do exposto, reflete-se que o aumento do número de pessoas com idade avançada pode aumentar o risco de suicídio nessa faixa etária, tanto pelas situações de risco e eventos estressantes que a velhice traz à tona como devido a morte de pessoas queridas, surgimento de doenças e comprometimento cognitivo 10,26 . Além disso, na velhice se tornam mais comuns a diminuição das atividades de lazer, o aumento da solidão, isolamento social e sentimentos de inutilidade e peso para a família do idoso 7,27 .…”

“…Estudos apontam várias situações que justificam taxas de suicídio tão expressivas na população idosa, tais como o declínio progressivo das reservas fisiológicas e da capacidade orgânica e funcional e o aparecimento de diversos tipos de doenças crônicas secundárias ao processo de envelhecimento 7,8 . Quando essas situações se somam à diminuição do autocuidado, à perda da autonomia e ao surgimento de crises existenciais, podem emergir percepções negativas para a pessoa idosa, as quais são determinantes na ocorrência de pensamentos suicidas e tentativas e concretização do ato de suicidar-se 7,9,10 .…”

The protective effect of self‐esteem on suicidal ideation among nursing home residents with limited social support in China: A cross‐sectional study

“…During past decades, clinicians and researchers have tended to treat suicide using the "problem-solving" instead of the "strengthbuilding" approach (Hernandez et al, 2020;Johnson et al, 2011).…”

“…During past decades, clinicians and researchers have tended to treat suicide using the “problem‐solving” instead of the “strength‐building” approach (Hernandez et al., 2020 ; Johnson et al., 2011 ). In the former approach, risk factors of suicide were the foci and targets of interventions and treatment, which has advantages in terms of preventing the occurrence of suicide but may not be effective at overcoming the innermost vulnerability, leading to the recurrence of suicide attempt or related psychosocial problems.…”

The Risk for Food Insecurity and Suicide Ideation among Young Adults in the United States: The Mediating Roles of Perceived Stress and Social Isolation

“…In his seminal work on suicide, Durkheim ([1897] 1951) ascertained a connection between social isolation and “egoistic” suicide, and his theory still serves as the foundation for research on social disconnectedness and suicide. A robust body of literature indicates that facets of social isolation such as dissonant social relationships (Bearman and Moody 2004), limited social interactions (Beautrais 2002; Calati et al 2019; Trout 1980), lack of social ties (Hall-Lande et al 2007; Trout 1980), and lack of social support (Endo et al 2017; Hall-Lande et al 2007; Hernandez et al 2021; Heuser and Howe 2019) contribute to suicidality and suicide mortality. Given that food insecurity can lead to feelings of social isolation and the clear indication that social isolation is a risk factor for suicidal thoughts, we anticipate that perceived social isolation will mediate the association between the risk for food insecurity and suicide ideation.…”