Practitioner's Column Facts on Elderly Suicide

Jane L. Pearson

 

National Institute of Mental Health

In the U.S. and nearly every other industrialized nation, older age and male gender are the most consistent demographic factors related to suicide patterns. In the U.S., older white males have the highest rates of any age, gender or racial group; White males aged 80 and older have 6 times the overall national rate.

Research focused on risk factors for elderly suicide has been slowing developing. We have learned that almost all people who have committed suicide have at least on diagnosable mental or substance abuse disorder. We know this from data gathered through the psychological autopsy method, which is comparable to physical autopsy, where organ systems are examined to establish diagnoses or failures of systems. In psychological autopsy studies, interviews from family, friends, co-workers, and classmates, along with health professionals, are used to establish diagnoses of mental disorders. Among the elderly, depression is the most common diagnosis, and it is typically uncomplicated by other mental disorders, and is of recent onset. This is in contrast to younger- and middle-aged groups, where substance use and other mental disorders are more common (see Conwell, 1996).

A second finding is that most elderly suicide victims have seen a primary are provider within a month of the suicide. Too frequently, their depression was not recognized or treated. They typically have had little or no consultation with mental health professionals. Elderly persons rarely seek help from telephone hotlines.

Two other findings challenge myths that elderly suicides are due primarily to isolation and physical illness: Most elderly suicide victims either live with family members or are in frequent contact with family or friends. Although physical illness is more common among older suicides compared to younger suicides, there is little evidence to suggest that physical illness, in the absence of depression, is a risk factor for suicide (see Clark, 1992).

In addition to these findings on psychiatric diagnosis and service use patterns, there is some suggestion that older suicides, in contrast to younger suicide victims, have some personality traits that may also place them at risk. A lack of openness to new experience and the inability or willingness to adapt to anticipated or actual physical limitations may contribute to suicide risk in late life (see Duberstein, 1995); Clark, 1993). Assessment of hopelessness and perfectionism may also be useful ways of exploring risk for suicidal ideation among the depressed elderly. Associations between alterations in the serotonin system and completed suicide violent suicide attempts, and impulsive disorders and depression would suggest that there may also be biological vulnerabilities to be explored.

An ongoing Program Announcement, "Studies of Suicide and Suicidal Behavior," updated in 1995, describes a broad range of topics in suicide research on interest to NIMH.

 

References

Clark, D. C. (1993). Narcissistic crises of aging and suicidal despair. Suicide and Life Threatening Behavior, 23, 21-26.

Clark D. C. (1992). "Rational" suicide and people with terminal conditions or disabilities. Issues in Law & Medicine, 8, 147-166.

Conwell, Y., Duberstein, P. R., Cox, C, Herrmann J. H., Forbes, N. T., & Caine, E. D. (1966). Relationships of age and Axis I diagnoses in victims of completed suicide: A psychological autopsy study. American Journal of Psychiatry, 153, 1001-1008.

Duberstein, P. R. (1995). Openness to experience and completed suicide across the second half of life. International Psychogeriatrics, 7, 183-198.

Richman, J. (1993). Preventing elderly suicide: Overcoming personal despair, professional neglect, and social bias. New York: Springer.

 

Remember Suicide IS NOT an option

 

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