SUICIDE RISK AND IDEATION IN ELDERLY PATIENTS RECEIVING HOMECARE NURSING

Abstract

Background: In the authors' first 100 interviews of patients newly receiving homecare nursing from a regional Visiting Nurse Services, 2 (2%) were at imminent suicidal risk requiring an intervention protocol that involves breaking subject confidentiality and resulted, in one case, in the patient being immediately hospitalized. This high event rate prompted closer investigation of suicide risk and ideation in this population. Aims & Methods: This study reports preliminary findings on the prevalence and correlates of suicidal ideation in a random sample (N=120) of elderly homecare nursing patients (age>65). Suicidal ideation was assessed using items from the SCID and the HDRS. Depression was diagnosed using etiologic (DSM-IV) criteria with the SCID. Results: Among our first set of interviews (mean age=77.8, SD=7.1; 68.3% female; 15.1% nonwhite), 21.7% (26/120) of the homecare patients reported suicidal ideation. The factor most strongly associated with suicidal ideation was depression: 63.6% (14/22) of patients with major depression and 60.0% (6/10) of patients with minor depression reported suicidal ideation compared to 6/88 (6.8%) of nondepressed patients (P<0.001). Among the 20 depressed patients with suicidal ideation, 2 reported both an impulse to self-harm and a plan, 16 reported frequent suicidal thoughts but no plan, and 2 strongly wanted to die but were not contemplating suicide. Among the 6 nondepressed patients with suicidal ideation, 5 reported frequent suicidal thoughts but no plan, and 1 strongly wanted to die only. Controlling for major (P<0.0001) and minor depression (P<0.001), other factors associated with suicidal ideation included being female (P<0.02) and having very poor physical health (P<0.04). The associations of gender and health status with suicidal ideation were found in both depressed and nondepressed patients. Conclusions: Suicidal ideation is widespread in elderly homecare nursing patients. As more than 75% of the patients expressing suicidal ideation have major or minor depression and depression itself is highly prevalent, identifying and treating depression in this population may be the most effective approach to reducing suicidal risk. Additionally, the severely compromised health status characterizing many homecare patients contributes an independent risk to suicidal ideation, so that ongoing monitoring of suicidal ideation in this population is also recommended. P53