Life-Satisfaction, Engagement and Social Support: Do they Predict Depression Severity, Suicide Ideation, and History of Attempt in Late-life Depression?

Abstract

<h3>Introduction</h3> Older adults are at the highest risk for death by suicide in almost all countries in the world. Certain protective factors, such as objective and subjective social support, have long been stated as protective factors for suicidal behavior in the elderly. Trait-level mindfulness, and life satisfaction and engagement have also been stated to be protective factors against suicide, however, their relationship with risk for suicide in late life has yet to be examined. We examined the effects of a combination of these protective factors in late life in a high suicide risk sample of depressed older adults. Specifically, we examined the effects of these protective factors on depression severity, presence and severity of suicidal ideation, and history of suicidal behavior. <h3>Methods</h3> Participants included 297 adults aged 55+ (mean age: 64.2, range: 55-90, 56.6% female, 84.5% White). We contrasted depressed participants (unipolar non-psychotic major depression as diagnosed by the Structured Clinical Interview for DSM Disorders) who had a history of suicide attempt (N=92) with depressed non-attempters (N=138) who had no history of suicidal behavior but may or may not have had ideation. In addition, 67 healthy controls (no lifetime history of psychiatric illness) served as a benchmark comparison group. We used the Beck Scale for Suicidal Ideation to measure the severity of suicidal ideation, and the Hamilton Depression Rating Scale to measure depression severity. We used a combination of 6 self-report scales (Flourishing Scale, Interpersonal Support Evaluation List [Tangible, Belonging, Self-esteem, and Appraisal support subscores], Mindfulness Attention Awareness Scale, Satisfaction with Life Survey, Life Engagement Test and the Social Network Index [network diversity, number of people in social networks, embedded networks subscores]). All variables were scaled and then averaged to calculate one overall protective factor value to represent levels of mindfulness, satisfaction and engagement with life, objective and subjective social support, and subjective well-being. We used this protective factor as the predictor variable and conducted binomial logistic regression to assess its relationship with presence of ideation and past attempt, and linear regression models for its relationship with depression and ideation severity. <h3>Results</h3> The overall protective factor value significantly predicted depression severity (p=0.003) and likelihood of ideation (p=0.030) but did not predict ideation severity (p=0.136) or likelihood of past suicide attempt (p=0.954). <h3>Conclusions</h3> Previously identified factors that have been associated with psychological resilience in late life may, in fact, be more predictive of depression severity and presence of ideation than severity of ideation or suicide attempt. Thus, interventions to decrease suicidal behavior in late-life depression may need to go beyond focusing on traditionally stated social support or life-satisfaction/engagement measures and consider other factors such as personality and cognitive capacity. <h3>This research was funded by</h3> NIMH R01-MH085651-10