Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study

Abstract

BackgroundSuicide is a global issue among the elderly, but few studies have explored the experiences of suicide ideation in older Asian psychiatric outpatients.MethodOlder psychiatric outpatients (N = 24) were recruited by convenience from one medical centre and one regional hospital in northern Taiwan. Participants were recruited if they met these inclusion criteria: 1) ≥65 years old, 2) without severe cognitive deficit, 3) outpatients in the psychiatric clinics at the selected hospitals, and 4) self-reported first episode of suicidal ideation within the previous year. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis.ResultsSuicide ideation was triggered by illness and physical discomfort, conflicts with family members/friends, illness of family members, death of family members/friends, and loneliness. Participants’ reasons for not executing suicide were family members’ and friends’ support, receiving treatment, finding a way to shift their attention, fear of increasing pressure on one’s children, religious beliefs, and not knowing how to execute suicide.ConclusionUnderstanding these identified triggers of suicide ideation may help psychiatrists open a channel for conversation with their elderly clients and more readily make their diagnosis. Understanding these identified protective factors against executing suicide can help psychiatrists not only treat depression, but also enhance protective factors for their clients.

Influencing and protective factors of suicidal ideation among older adults

“…The present study expands the findings of Lee et al () on suicidal ideation and protective factors of suicide in older adults. Adaptive factors are coping strategies, which can inhibit or diminish continued suicidal ideation: support from family and friends, pharmacological therapy, refocussing emotions, and religious beliefs.…”

“…Religious activities reduced anxiety, because participants did not feel a need to be in control of their emotions. Other studies have shown religious beliefs can function as protective factors for the elderly and reduce suicidal ideation (Chen et al , Lee et al ; McClain et al ; Wu et al ).…”

“…Suicidal ideation is a key predictive factor and clinical indicator of suicide (Hultén et al ; WHO ). Lee et al () found that 91.7% of older adults in Taiwan with suicidal thoughts are diagnosed with depression, rather than suicidal ideation. Rarely do they mention the presence of suicidal thoughts, and they do not seek help from others.…”

Development and psychometric testing of the triggers of Suicidal Ideation Inventory for assessing older outpatients in primary care settings

“…The TSII does not include some triggers of suicidal ideation reported by other older people, such as illness in oneself or family members (Lee et al ., ), death of family members/friends (Lee et al ., ), loneliness (Rurup et al ., ; Lee et al , ), and perceived burden to others (Cukrowicz et al , ). All these items were included in the initial TSII but excluded after pre‐testing in 200 older outpatients because of low item total Pearson's correlation, low internal consistency (Cronbach's α value), or ambiguous factor loading in factor analysis.…”

“…Because depression is an important predictor of suicide among older people (Conwell and Thompson , ), construct validity was evaluated by comparing differences between TSII scores of participants with and without depressive tendency using the independent t ‐test. Based on loneliness being an important factor associated with suicide among older Taiwanese people (Lee et al ., ), criterion validity of the TSII was examined by testing the correlation coefficients of its scores with scores on both the BSSI and UCLA Loneliness Scale. Internal consistency of the TSII was assessed by estimating Cronbach's α coefficients.…”