Suicidal behaviour and suicide prevention in later life

Abstract

Despite a general decline in late life suicide rates over the last 30 years, older people have the highest rates of suicide in most countries. In contrast, non-fatal suicidal behaviour declines with age and more closely resembles suicide than in younger age groups. There are difficulties in the detection and determination of pathological suicidal ideation in older people. Multiple factors increase suicide risk ranging from distal early and mid-life issues such as child abuse, parental death, substance misuse and traumatic life experiences to proximal precipitants in late life such as social isolation and health-related concerns. Clinical depression is the most frequently identified proximal mental health concern and in many cases is a first episode of major depression. Recent studies have identified changes on neuroimaging and neurocognitive factors that might distinguish suicidal from non-suicidal depression in older people. Strategies for suicide prevention need to be 'whole of life' and, as no single prevention strategy is likely to be successful alone, a multi-faceted, multi-layered approach is required. This should include optimal detection and management of depression and of high risk individuals as available evidence indicates that this can reduce suicidal behaviour. How best to improve the quality of depression management in primary and secondary care requires further research.

In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide

“…ACE (e.g., early abusive or neglectful parenting, high family conflict, parental loss, and other maltreatment) have also been found to impact cognitive performance in older adulthood (Luecken, 2006). Draper (2014) further suggests that cognitive difficulties associated with aging may contribute to perceived burdensomeness, a component of the interpersonal-psychological theory of suicide.…”

“…functional impairment in older age is associated with death by suicide (Conwell et al, 2011b;Draper et al, 2008;Draper, 2014). Several studies have found a strong association between physical, emotional, and sexual abuse and health problems in adulthood (Norman et al, 2012;Sachs-Ericsson et al, 2005;Springer, Sheridan, Kuo, & Carnes, 2007).…”

“…Conwell et al (2002) point out that suicidal ideation among seriously ill people was extremely rare in the absence of clinically significant mood disturbance. Nonetheless Draper (2014) has pointed out that among older adults there are several specific health problems that exacerbate suicidal risk including medical illness related to depression, as well as severe and uncontrollable pain. Draper (2014) also noted that older adults with poor health are physically more vulnerable and, thus, more likely to succumb to a suicide attempt.…”

Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults

“…Research has identified many factors associated with older adult suicidal ideation and behavior. One of the most salient is psychopathology, particularly major depression . Research in the United States, South Korean, Brazilian, and Australian older adults suggests that psychological distress generally and major depression specifically account for the most variance in models examining suicidal ideation.…”

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

“…It is well known that 90% of older people who take their lives suffered from a psychiatric disorder[6] with depressive disorders being the most common psychiatric diagnoses of elderly suicide victims[7]. Furthermore, late life suicidal ideation is a risk factor for suicide [4, 8, 9], and executive dysfunction[10, 11], in particular impulsivity [12-14], and impairments in risk-sensitive decision making[14, 15] are associated with greater suicidal ideation in older adults. Given that these deficits in executive function (ED) are common in depressed older adults[16] and is related to suicidal ideation[11, 17], identifying older adults with depression and ED and providing them with interventions that target executive deficits may be one way to correct the trends in death by suicide in those over the age of 65.…”