Objectives
Using the Interpersonal Theory of Suicide as a guiding framework, we investigated older adults' causal attributions for suicidal behavior. We hypothesized that older adults who attributed their suicidal behavior to thwarted belongingness or perceived burdensomeness would be more likely to use more immediately lethal means and to re-attempt suicide during the 12-month follow-up.
Design
Prospective cohort study in western Sweden.
Participants
A total of 101 older adults who presented to medical emergency rooms for suicide attempts.
Measurements
Participants were asked why they attempted suicide.
Results
Attributions included: a desire to escape (n=29), reduced functioning and autonomy (n=24), psychological problems, including depression (n=24), somatic problems and physical pain (n=16), perceived burdensomeness (n=13), social problems that reflected either thwarted belongingness or family conflict (n=13) and lack of meaning in life (n=8); 41 participants provided more than one reason. No specific reason was given by 28 participants, 15 of whom reported not understanding or remembering why they attempted suicide and 13 reported simply wanting to die (or go to sleep and not wake up). As hypothesized, patients who attributed the attempt to thwarted belongingness were more likely to use more immediately lethal means for their index attempt and were more likely to re-attempt during follow-up. This was not the case for those reporting burdensomeness.
Conclusions
People who attribute suicide attempts to thwarted belongingness use more lethal methods and have a poorer prognosis. Replications across diverse cultural settings are needed to determine whether attributing suicide attempts to thwarted belongingness may warrant increased monitoring.
A number of social variables were independently related to SOC in elderly suicide attempters. Prospective studies are needed in order to determine whether SOC-strengthening interventions can reduce the risk of suicidal behavior in seniors.
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