Risk Factor For Late-life Suicide Research Articles

Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75+

Objectives Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode. Method Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode. Results There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care. Conclusion The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.

348 - Increased White Matter Hyperintensity and Brain Resting-state fMRI Topology Changes in Suicide Attempters of Late-life Depression

Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee.Introduction:Suicide rate tends to peak in old age, and major depression is the most salient risk factor for late-life suicide. However, few studies have focused on the neuroscientific facet of suicide in the context of late-life depression (LLD).Methods:We recruited 114 participants of LLD (28 with history of suicide attempt and 86 without) and 47 elderly controls. They received MRI scanning and behavioral assessment. White matter hyperintensity (WMH) was quantified by an automated segmentation algorithm and graph theoretical analysis was applied to resting-state fMRI. We used ANCOVA to compare group difference in WMH loading and multivariate generalized linear model to compare global and local topological parameters in fMRI signals, controlling for demographics. Partial correlation was conducted between imaging parameters and behavioral data in group of suicide attempters.Results:We found significant higher WMH in suicide attempters than those of LLD without suicide attempts and elderly controls (F =7.091; p = 0.001). Suicide attempters also had increased betweenness centrality (BC) in right superior occipital gyrus (SOG) (Bonferroni corrected), right precuneus (False positive corrected) and right superior temporal gyrus (uncorrected) and decreased BC in left hippocampus (uncorrected). In suicide attempters, higher BC in right SOG correlated with higher WMH, higher depression severity, higher illness awareness and insight, and lower cognitive function (digit backward), while higher BC in right precuneus correlated with higher decrease awareness and insight and higher cognitive function (digit backward).Conclusion:Resonating with the vascular hypothesis in LLD, higher WMH was found in those having history of suicide attempts. However, the re-organized brain topology changes are related with divergent cognitive function and convergent heightened disease insight.

SUICIDE-RELATED OUTCOMES IN OLDER VETERANS: IMPLICATIONS FOR INTERVENTION AND PREVENTION OF SUICIDE: Session 301

This session will highlight the particular challenges of addressing suicide among older veterans in VHA care using epidemiological and novel statistical approaches, and offer a promising way forward for early identification and prevention of late-life suicide. The research presented here will highlight various unique factors in older veterans that may be missing from the suicide prevention conversation, including the saliency of physical health, pain, high-risk subpopulations, and psychosocial interventions. Drs. Byers and Morin will present findings on late life suicide in VHA using medical record data for novel investigations of administrative data. First, using her database of over 5 million veterans receiving VHA care, Dr. Byers will provide a big picture overview of nationally based estimates of the occurrence of suicide-related outcomes, including non-fatal attempts and death by suicide, in veterans over age 50. Additionally, she will discuss factors that influence risk of a first attempt in later life, as well as factors that further influence, among survivors, who goes on to repeat an attempt and who does not. Next, Dr. Morin will describe physical and mental health comorbidity profiles of 2,131 veterans over 65 who attempted suicide between 2012 and 2014, and last saw a primary care provider prior to their attempt. The relatively minimal depression prevalence as well as high incidence of chronic pain in more than half of these attempters, as well as higher rates of fatality using firearms among these individuals compared to those with multiple mental health comorbidities will be discussed. These findings raise awareness about possible points of intervention in a group that may otherwise not be considered to be as high-risk as a population with significant comorbid mental health concerns. Drs. Barry and Van Orden will speak about more specific subgroups of older veterans, with recommendations for possible intervention to reduce unintended death and suicide, emphasizing the importance of transition of care models for prevention of late-life suicide. Dr. Barry will provide an example of increased risk for suicide and unintended death among older veterans transitioning from prison to the community. Findings show that those re-entering society following a prison sentence are at significantly higher risk for suicide attempt by multiple means, with higher rates of fatality compared to matched controls. These results highlight the urgent need for assistance during this vulnerable period of transition. Finally, Dr. Van Orden will discuss transition of care models more specifically and their importance in combating loneliness, a major risk factor for late-life suicide. She will share compelling findings related to a novel intervention currently being studied on the benefits of volunteer-provided peer companionship for older veterans transitioning from community living center (CLC) stays back into the community. This intervention is targeted to support upstream suicide prevention.

Poster Number: NR 14 - Socially ENGAGE: Pilot Trial to Demonstrate Feasibility of an Intervention for Social Engagement

Introduction: Older adults who are socially isolated—defined as those with restricted social networks and/or loneliness—are at risk for numerous suicide risk factors, including reduced quality of life, physical illness, functional impairment, cognitive impairment, and depression, as well as suicide ideation, attempts, and suicide deaths. The premise of this work is that among depressed older adults, social disconnectedness is both a risk factor for late-life suicide and a potential intervention target. Despite the negative consequences for late-life mental health, little is known about how to reduce social isolation and increase social engagement. Here, we present the rationale and feasibility results of a project testing the use of the ENGAGE intervention (Alexopoulos & Areán, 2014; Alexopoulos, Raue, Kiosses, Seirup, Banerjee, & Areán, 2014) as a means of increasing social engagement, and thereby reducing risk factors for suicide. ENGAGE is designed to work primarily through “reward exposure,” which, in line with RDoC principles (e.g., Insel, 2014), targets the behavioral expression of positive valence systems' dysfunction by having patients re-engage with pleasant, physical, or social activities they may have stopped doing because of depression. For this trial, subjects were focused solely on social activities because the hypothesis of the study is, in line with the Interpersonal Theory of Suicide (Van Orden et al., 2010), that targeting social engagement will increase positive connections and contributions to others, thus reducing two proximal risk factors for suicide—thwarted belongingness and perceived burdensomeness, thereby reducing suicide risk. We report here the experience and outcomes of the first three subjects enrolled, with the objectives of demonstrating that these older adults would complete 10 sessions, develop action plans based exclusively on social engagement, and demonstrate reductions in thwarted belongingness, depression, and suicide risk. We hypothesized that the changes in thwarted belongingness would temporally precede changes in depression and suicide risk.

Journal Digest

Journal Digest

Suicide risk in primary care: identification and management in older adults.

The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior.

Geriatric Depression - Review for Primary Care

Late-life depression is the most common mood disorder in the geriatric population. Often encountered in the primary care setting, geriatric depression needs to be appropriately diagnosed and differentiated from medical conditions that can mimic it or present with mood symptoms. This review will help psychiatrists and primary care physicians to screen for, identify possible medical confounders, and treat depression in the elderly. Untreated major depression may lead to increased morbidity and mortality from medical illnesses, and is the strongest risk factor for late-life suicide. Pharmacological approaches should be used in combination with psychotherapies, several of which have solid evidence in geriatric depression.

Community‐based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females

The lack of social support is the most common risk factor for late-life suicide. Few previous community-based interventions against the lack of social relationships reduced suicide. This study aims to evaluate outcomes of a community-based prevention program against suicide amongst the elderly in rural Japan. During 1995-2002, the program based on population strategy including group activity, psychoeducation and self-assessment of depression but no screening for depression, was implemented for elderly residents in Yuri town, Japan (5-year average population 6817; 5-year average suicide rate [> or =65 years old] 291.4/10(5)). Changes in the relative risk of suicide for individuals (> or =65 years old) before and after the 8-year implementation were estimated by the incidence rate ratio (IRR), using a quasi-experimental design with a neighboring reference, Chokai town, Japan (5-year average population 8136; 5-year average suicide rate [> or =65 years old] 216.5/10(5)). The risk of elderly females in Yuri completing suicide was reduced by 76% (age-adjusted IRR, 0.24; 95% CI, 0.10-0.58), while there was no change in the risks for Yuri's elderly males and both Chokai's elderly males and females. General loglinear analysis estimated a ratio of the female IRR in Yuri to that in its Akita prefecture of 0.35 (95% CI, 0.14-0.84), showing that the reduction of the risk in the intervention area was greater than a historical trend. A community-based suicide prevention through a group intervention designed to increase knowledge and to cultivate social relationships would be effective for elderly females but not males.

Prostate Cancer: A Significant Risk Factor for Late-Life Suicide

The authors sought to determine the incidence of suicide and its relevant correlates among men with prostate cancer. This was a population-based, retrospective cohort review of men age 65 and older, residing in South Florida between 1983 and 1993. Average annual suicide rate was calculated for prostate cancer-related suicides and contrasted with age and gender-specific rates in the same geographic area. Of 667 completed suicides, 20 were prostate cancer-related (3% of the total male suicide sample). The average annual incidence of suicide for men was 55.32 per 100,000 persons, but for men with prostate cancer, the rate was 274.7 per 100,000. The risk of suicide in men with prostate cancer was 4.24 times that of an age- and gender-specific cohort. The clinical correlates included depression (70%), cancer diagnosis within 6 months of suicide (80%), physician visit within 1 month of suicide (60%), and being foreign-born (70%). The incidence of suicide among older men with prostate cancer is higher than previously recognized. Depression, recent diagnosis, pain, and being foreign-born are important clinical correlates. Screens for depression and suicide in older men with prostate cancer should be done after diagnosis and redone during the first 6 months regularly, particularly in the primary-care setting. Public education is needed to decrease the stigma associated with having a cancer diagnosis.

Prostate Cancer: A Significant Risk Factor for Late-Life Suicide

The authors sought to determine the incidence of suicide and its relevant correlates among men with prostate cancer.This was a population-based, retrospective cohort review of men age 65 and older, residing in South Florida between 1983 and 1993. Average annual suicide rate was calculated for prostate cancer-related suicides and contrasted with age and gender-specific rates in the same geographic area.Of 667 completed suicides, 20 were prostate cancer-related (3% of the total male suicide sample). The average annual incidence of suicide for men was 55.32 per 100,000 persons, but for men with prostate cancer, the rate was 274.7 per 100,000. The risk of suicide in men with prostate cancer was 4.24 times that of an age- and gender-specific cohort. The clinical correlates included depression (70%), cancer diagnosis within 6 months of suicide (80%), physician visit within 1 month of suicide (60%), and being foreign-born (70%).The incidence of suicide among older men with prostate cancer is higher than previously recognized. Depression, recent diagnosis, pain, and being foreign-born are important clinical correlates. Screens for depression and suicide in older men with prostate cancer should be done after diagnosis and redone during the first 6 months regularly, particularly in the primary-care setting. Public education is needed to decrease the stigma associated with having a cancer diagnosis.

Several Factors Mitigate Seniors’ High Suicide Risk

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessSeveral Factors Mitigate Seniors’ High Suicide RiskJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:16 Aug 2002https://doi.org/10.1176/pn.37.16.0018Older Americans, and especially older white men, are at greater risk of suicide than any other group. And now some of the factors that increase seniors’ suicide risk have been identified in two studies reported in the August American Journal of Geriatric Psychiatry.Those factors are depression, poor sleep quality, limited social support, and the possession of firearms.In the first study, Carolyn Turvey, Ph.D., of the University of Iowa College of Medicine, and her colleagues followed some 15,000 elderly subjects’ mental and physical health over a decade as part of the Established Populations for Epidemiological Studies of the Elderly.Of those subjects, 21 committed suicide during the study period. Baseline and follow-up data about these 21 subjects were then compared with baseline and follow-up data about the remaining subjects (controls) to identify suicide risk factors.Depression, poor sleep quality, and absence of a relative or friend to confide in turned out to be risk factors, whereas medical illness and alcohol use were not.Interestingly, depression, poor sleep quality, and limited social support have previously been identified as risk factors for death by natural causes, as well as for death by suicide. Or as Turvey and her team noted in their study report: “It appears that these variables erode a will to live that affects mortality even in the absence of suicidal tendencies.”In the second study, Yeates Conwell, M.D., of the University of Rochester School of Medicine, and his colleagues probed the role of firearms in senior suicide risk, since firearms are the most common method of suicide used by both men and women in later life.The subjects included 86 persons aged 50 or older who had committed suicide and 86 community control subjects individually matched on age, sex, race, and county of residence.The presence of a firearm in the home was found to be associated with an increased risk of suicide, even after controlling for psychiatric illness. Elevated risk was accounted for by access to handguns rather than to long guns and was more pronounced in men than in women.However, it is probably not the presence of a firearm in the home per se that constitutes a risk factor for senior suicides, but rather the recent purchase of a firearm, Conwell and his team contended. The reason, they explained in their study report, is that firearm suicide rates for the elderly have declined markedly in states that have instituted waiting periods or background checks, or both, for handgun purchases.Yet just as depression, poor sleep quality, limited social support, and the recent purchase of a handgun may put seniors at risk of suicide, social support and religious beliefs may help protect them against it. The reason to believe that this is the case comes from a third study published in the August American Journal of Geriatric Psychiatry.This study, headed by Joan Cook, Ph.D., of the University of Pennsylvania, focused on a senior group with a very low suicide risk—older African-American women. Indeed, compared with older white men, older African-American men, and older white women, senior African-American women have had the lowest suicide rate for decades.Cook and her colleagues interviewed 835 elderly African Americans, 77 percent of whom were women, in urban public housing developments to find out how many were having suicidal thoughts. They found that only 27 (about 3 percent) were. They then compared characteristics of the suicide-contemplation subjects with the subjects not contemplating suicide and found that the former were more likely to be experiencing depression and anxiety and to have less life satisfaction, fewer social supports, and fewer religious beliefs. In fact, some 90 percent of control subjects reported that they obtained a great deal of support and comfort from religion.The study reports “Risk Factors for Late-Life Suicide: A Prospective, Community-Based Study,” “Access to Firearms and Risk for Suicide in Middle-Aged and Older Adults,” and “Suicidality in Older Americans: Findings From the EPOCH Study” are posted on the Web at http://ajgp.psychiatryonline.org under the August issue. ▪ Am J Geriatr Psychiatry 2002 10 407 ISSUES NewArchived

Risk Factors for Late-Life Suicide: A Prospective, Community-Based Study

Despite the fact that people age 65 and older have the highest rates of suicide of any age-group, late-life suicide has a low prevalence, making it difficult to conduct prospective studies. The authors examined risk factors for late-life suicide on the basis of general information collected directly from older subjects participating in a community-based prospective study of aging, the Established Populations for Epidemiologic Studies of the Elderly. Demographic variables, presence of a relative or friend to confide in, alcohol use, and sleep quality were assessed at baseline interview. Baseline and follow-up data were used to determine physical, cognitive, and affective functioning, as well as medical status. Of 14,456 people, 21 committed suicide over the 10-year observation period. Depressive symptoms, perceived health status, sleep quality, and absence of a relative or friend to confide in predicted late-life suicide. Suicide victims did not have greater alcohol use and did not report more medical illness or physical impairment. This study provided additional information about the context of late-life depression that also contributes to suicidal behavior: poor perceived health, poor sleep quality, and limited presence of a relative or friend to confide in. Despite the fact that people age 65 and older have the highest rates of suicide of any age-group, late-life suicide has a low prevalence, making it difficult to conduct prospective studies. The authors examined risk factors for late-life suicide on the basis of general information collected directly from older subjects participating in a community-based prospective study of aging, the Established Populations for Epidemiologic Studies of the Elderly. Demographic variables, presence of a relative or friend to confide in, alcohol use, and sleep quality were assessed at baseline interview. Baseline and follow-up data were used to determine physical, cognitive, and affective functioning, as well as medical status. Of 14,456 people, 21 committed suicide over the 10-year observation period. Depressive symptoms, perceived health status, sleep quality, and absence of a relative or friend to confide in predicted late-life suicide. Suicide victims did not have greater alcohol use and did not report more medical illness or physical impairment. This study provided additional information about the context of late-life depression that also contributes to suicidal behavior: poor perceived health, poor sleep quality, and limited presence of a relative or friend to confide in.

Risk Factors for Late-Life Suicide: A Prospective, Community-Based Study

Despite the fact that people age 65 and older have the highest rates of suicide of any age-group, late-life suicide has a low prevalence, making it difficult to conduct prospective studies. The authors examined risk factors for late-life suicide on the basis of general information collected directly from older subjects participating in a community-based prospective study of aging, the Established Populations for Epidemiologic Studies of the Elderly. Demographic variables, presence of a relative or friend to confide in, alcohol use, and sleep quality were assessed at baseline interview. Baseline and follow-up data were used to determine physical, cognitive, and affective functioning, as well as medical status. Of 14,456 people, 21 committed suicide over the 10-year observation period. Depressive symptoms, perceived health status, sleep quality, and absence of a relative or friend to confide in predicted late-life suicide. Suicide victims did not have greater alcohol use and did not report more medical illness or physical impairment. This study provided additional information about the context of late-life depression that also contributes to suicidal behavior: poor perceived health, poor sleep quality, and limited presence of a relative or friend to confide in.

Suicide, life course, and life story.

This article explores how a life-course perspective and narrative methodology can be used to study risk factors for late-life suicide. A life-course approach to aging and suicide requires consideration of age as both social and personal construction. "On-" and "off-time" events and their impact on adjustment are used to illustrate these social and personal constructions. Cohort, period, and historical events have potentially profound effects on risk for suicide, yet the study of these effects is difficult because they are so often confounded in longitudinal study. Lifelong personality characteristics that are not life-threatening in earlier life may be of greater risk in later life depending on life circumstances such as physical dependencies. A life-story or narrative approach offers an alternative method for incorporating these complicated factors when studying late-life suicide. The psychological autopsy can be considered a type of "narrative" used by various individuals to gain understanding about a suicide.