Alone? Perceived social support and chronic interpersonal difficulties in suicidal elders

Causal associations between digital device use and suicide risk: A bidirectional Mendelian randomization study

BACKGROUND

The popularity of digital devices seems to provide a new observational variable for early identification and prevention of suicide with the development of the information technology era. Nevertheless, whether it is the use of digital devices that alters suicide risk or suicide risk manifests itself through change digital device use needs to be further explored.

METHODS

Bidirectional Mendelian randomization (MR) analysis was used to explore potential causal relationships in the perspective of genetic prediction. We collected publicly available digital device use and suicide risk summary statistics genome-wide association data from UK Biobank, Neale Lab and FinnGen genetic databases. We used inverse variance weighting methods to assess MR estimates. For robustness of the results, we performed further tests of heterogeneity and pleiotropy.

RESULTS

In the Phase 1 results, we did not observe any effect of the length of digital device use on the suicide risk, while the results of Phase 2 suggested a significant positive association between suicide risk and the length of mobile phone use (IVW OR, 1.04; 95%CI, 1.01-1.06; P = 0.002), but this significance disappeared after adjusting for confounders of mental and affective disorders.

CONCLUSIONS

In this bidirectional MR analysis, we observed that People at high risk of suicide may be more addicted to digital device use, but more detailed GWAS data and research methods to validate this finding are required.

A 50-state survey study of thoughts of suicide and social isolation among older adults in the United States

BACKGROUND

We aimed to characterize the prevalence of social disconnection and thoughts of suicide among older adults in the United States, and examine the association between them in a large naturalistic study.

METHODS

We analyzed data from 6 waves of a fifty-state non-probability survey among US adults conducted between February and December 2021. The internet-based survey collected the PHQ-9, as well as multiple measures of social connectedness. We applied multiple logistic regression to analyze the association between presence of thoughts of suicide and social disconnection. Exploratory analysis, using generalized random forests, examined heterogeneity of effects across sociodemographic groups.

RESULTS

Of 16,164 survey respondents age 65 and older, mean age was 70.9 (SD 5.0); the cohort was 61.4 % female and 29.6 % male; 2.0 % Asian, 6.7 % Black, 2.2 % Hispanic, and 86.8 % White. A total of 1144 (7.1 %) reported thoughts of suicide at least several days in the prior 2 week period. In models adjusted for sociodemographic features, households with 3 or more additional members (adjusted OR 1.73, 95 % CI 1.28-2.33) and lack of social supports, particularly emotional supports (adjusted OR 2.60, 95 % CI 2.09-3.23), were independently associated with greater likelihood of reporting such thoughts, as was greater reported loneliness (adjusted OR 1.75, 95 % CI 1.64-1.87). The effects of emotional support varied significantly across sociodemographic groups.

CONCLUSIONS

Thoughts of suicide are common among older adults in the US, and associated with lack of social support, but not with living alone.

TRIAL REGISTRATION

NA.

Physical Health Problems as a Suicide Precipitant: Associations With Other Risk Factors and Suicide Methods in Three Age Groups of Older Decedents

Background and Objectives

Physical health problems are a significant late-life suicide precipitant. This study's purpose was to examine differences in (i) other suicide precipitants and psychiatric/substance use problems, and (ii) suicide methods (firearms, hanging/suffocation, and poisoning) in 3 age groups (55-64, 65-74, and 75+) of older suicide decedents who had physical health problems as a suicide precipitant.

Research Design and Methods

Data came from the 2017-2019 U.S. National Violent Death Reporting System (N = 34,912; 27,761 males [79.5%] and 7,151 females [20.5%]). Generalized linear models for a Poisson distribution with a log link were used to examine the study questions.

Results

Physical health problems were a suicide precipitant for 25.8%, 41.9%, and 57.7% of the 55-64, 65-74, and 75+ age groups, respectively, and were associated with a higher likelihood of having had depressed mood (IRR = 1.38, 95% CI: 1.33-1.43) and other substance use problems (IRR = 1.22, 95% CI: 1.13-1.31). Interaction effects showed that when job/finance/housing problems, depressed mood, or any psychiatric disorders were co-present with physical health problems, the age group differences in the predicted rates of physical health problems were diminished. Physical health problems were also positively associated with firearm and poisoning use, but negatively associated with hanging/suffocation. Interaction effects indicated that the predicted rates of firearm and poisoning use significantly increased among those aged 55-64 with than without physical health problems.

Discussion and Implications

In all 3 age groups of older suicide decedents, physical health problems were the predominant suicide precipitant, and those with physical health problems had elevated depressed mood. Assessment of suicide risk, affordable and accessible health, and mental health services, restriction of access to lethal suicide methods, and policy-based suicide prevention approaches for older adults with physical health problems are needed.

Suicide Risk Help-Seeking Among Middle- to Old-Age Adults: A Systematic Review

Background and Objectives

Suicide has become a major public health concern worldwide and in the United States. Rates of suicide increase during the life course and are highest among middle- to old-age adults. Help-seeking represents a crucial coping mechanism that can mitigate suicide risk. Yet, less is known about suicide risk help-seeking, especially among these age groups. To address this knowledge gap, a systematic review of existing literature was performed to obtain a refined understanding of help-seeking for suicide risk among middle- to old-age adults.

Research Design and Methods

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic databases and key journals with suicide and/or gerontology focuses were searched to identify peer-reviewed publications in English between 2010 and 2020. A total of 4 732 unduplicated publications were screened for relevance based on titles and abstracts, of which 52 were reviewed in full text.

Results

Twenty-four articles met inclusion criteria and were included in the qualitative synthesis. These articles discussed a range of topics, including the prevalence of service utilization, service use prior to a suicide death, and correlates of help-seeking. In general, the prevalence of service utilization was low and varied by suicidal history (eg, higher prevalence among individuals with a history of suicide attempts than those with suicide ideation only). Key facilitators (eg, current or history of suicidal thoughts, plans, or attempts) and barriers (eg, stigma) for service use and help-seeking were also identified.

Discussion and Implications

Findings highlight the need for future studies and tailored services to improve age-appropriate and culturally responsive suicide prevention and intervention strategies for middle- to old-age adults.

Different Effects of Perceived Social Support on the Relationship between Perceived Stress and Depression among University Students with Borderline Personality Disorder Symptoms: A Multigroup Mediation Analysis

Background: While perceived social support can mediate the relationship between perceived stress and depression, little is known about the differences between individuals with high and low borderline personality disorder symptoms (BPDS). This study aimed to investigate the associations among perceived stress, perceived social support, and depression, and compare low and high levels of BPDS. Methods. This cross-sectional analysis was a secondary analysis of data from the SI-Bord study. University students across Thailand completed a screening instrument for borderline personality disorder, the Perceived Stress Scale (PSS), the Revised Thai Multi-dimensional Scales of Perceived Social Support (MSPSS), and the Patient-Health Questionnaire (PHQ)-9. Mediation analysis using PROCESS was applied to test the direct and indirect effects of perceived stress on depression. Multigroup mediational analysis was adopted to compare low and high levels of BPDS. Results. The mean age of the 330 participants was 20.27 (SD, 1.4) and 80% were female. Significant correlations were observed between the PSS, MSPSS, and PHQ scores, with greater magnitude among the high-level BPDS group (p < 0.001). A significant direct effect on perceived stress and a significant indirect effect on depression through perceived social support were noted. Of all the sources of social support, only the significant others variable significantly differed between the two groups (p < 0.05). Conclusion. Perception of social support had a significant mediating role in perceived stress and depression. The magnitude of associations was remarkably high for individuals with high BPDS compared to those with low BPDS. Unlike those with low BPDS, all sources of social support were significant mediators between the two groups.

Working With a Psychopath: Is There Light at the End of the Tunnel?

Having a supervisor with psychopathic characteristics is related to being bullied, poorer job satisfaction, work/family life conflict, financial instability, and distress. To date, all research on corporate psychopathy victims considers how they are negatively impacted rather than potential positive outcomes. In response, this study examined how working with a psychopath impacts posttraumatic growth (PTG). Utilizing a mixed-methods approach, this study draws upon the experiences of 285 individuals who have worked with a colleague or supervisor with alleged psychopathic characteristics. Results indicated that approach coping and psychopathic characteristics predicted PTG. Qualitative analyses revealed that the majority of participants used various coping strategies (e.g., emotion-focused), received support (e.g., emotional), and underwent post-experiential growth or learning (e.g., positive personal growth); not all growth/learning was positive, however (e.g., less trusting). Results suggest that cultivating approach-focused coping strategies may enhance PTG following a traumatic event.

What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis

Those making suicide attempts with highly lethal medical consequences are arguably the best proxy for those who die by suicide and represent a qualitatively different population from those making lower lethality attempts. Different factors influence the likelihood of a suicide attempt occurring and the lethality of that attempt. Both are important dimensions of risk. Older adults represent a distinct group in suicide research with unique risk factors that influence the lethality of their suicide attempts. This systematic review and meta-analysis summarises factors distinguishing those making high and low-lethality suicide attempts in older adulthood. Databases PsycINFO, PubMed (MEDLINE), Embase and CINAHL were systematically searched with seven of 1182 unique records included. Random effects meta-analyses were conducted on 18 variables in addition to a narrative synthesis regarding executive function. Only increased suicidal intent and planning meaningfully distinguished high from low-lethality attempters in meta-analyses. A large effect size was additionally observed for white ethnicity. Diminished alcohol use disorder prevalence and depression severity, and greater cognitive impairment, may be associated with high lethality attempters but further research is needed. Age and gender were not associated with lethality, contrary to adult populations. A narrative synthesis of studies exploring differences in executive functioning suggested high-lethality attempters were less likely to impulsively act on suicidal urges, allowing them to better plan suicide attempts that are more lethal, and are less likely to alter suicidal plans. Key limitations were that meta-analyses were underpowered to detect small effect sizes, and samples were largely white and limited to the USA.

Diversify Your Emotional Assets: The Association Between the Variety of Sources of Emotional Support and Thoughts of Death or Self-harm Among US Older Adults

Using data from a nationally representative sample of community-dwelling older adults (age ≥ 65) (NHANES: n = 3,114), we examined the association between the variety in sources of emotional support and thoughts of death or self-harm in the past two weeks among US older adults and if such association is modified by gender and race/ethnicity. Overall, an additional category of source of emotional support was associated with the 0.36-fold lower odds of endorsing thoughts of death or self-harm in the past two weeks (WAOR: 0.64, 95% CI: 0.46-0.89), after controlling for demographic, socioeconomic, and health-related characteristics. The magnitudes of such association varied across different gender and racial/ethnic subgroups. While among older women and non-Hispanic Black older men, increase in the variety of sources of emotional support was associated with decrease in the odds of endorsing thoughts of death or self-harm in the past two weeks, for non-Hispanic White older men and Hispanic older men, increase in the variety of sources of emotional support was associated with increase in the odds of endorsing thoughts of death or self-harm in the past two weeks. Our findings highlight the importance of considering gender and race/ethnicity when designing and implementing successful interventions for reducing suicide ideation among diverse elderly persons.

Choosing Death Over Survival: A Need to Identify Evolutionary Mechanisms Underlying Human Suicide

The act of killing self contradicts the central purpose of human evolution, that is, survival and propagation of one’s genetic material. Yet, it continues to be one of the leading causes of human death. A handful of theories in the realm of evolutionary psychology have attempted to explain human suicide. The current article analyses the major components of certain prominent viewpoints, namely, Inclusive fitness, Bargaining model, Pain-Brain model, Psychological aposematism, and few other perspectives. The article argues that relatively more weightage has been given to understanding ultimate (the “why”) rather than proximate (the “how”) functionality of suicidal acts. Evolutionary theorists have consistently pointed out that to comprehensively understand a trait or behavior, one needs to delineate not only how it supports survival but also the evolution of the mechanisms underlying the trait or behavior. Existing theories on suicide have primarily focused on its fitness benefits on surviving kin instead of providing evolutionary explanations of the more complex mechanisms leading up to such self-destructive motivations. Thus, the current paper attempts to highlight this gap in theorizing while suggesting probable proximate explanations of suicide which stresses the need to diffuse attention paid to fitness consequences of the act alone. We speculate that such explorations are needed in order to build a robust and comprehensive evolutionary theory of human suicide.

A Pilot Randomized Trial of Engage Psychotherapy to Increase Social Connection and Reduce Suicide Risk in Later Life

BACKGROUND

Targeting social connection to prevent suicide in later life shows promise but requires additional study to identify the most effective and acceptable interventions. This study examines acceptability, feasibility, and efficacy of Engage Psychotherapy to improve subjective disconnection (target mechanisms: low belonging and perceived burden), and improve clinical and functional outcomes (depression, suicide ideation, quality of life).

METHODS

Pilot randomized trial with adults age 60 and older who reported feeling lonely and/or like a burden. Participants were randomly assigned to 10 sessions of 'Social Engage' (S-ENG; n = 32) or care-as-usual (CAU; n = 30), with follow-up assessments at 3 weeks, 6 weeks, and 10 weeks.

RESULTS

S-ENG is feasible to deliver over 10 sessions and acceptable to older adults who report social disconnection-a population at risk for suicide. Participants were willing and able to focus each session on social engagement and demonstrated high levels of compliance. Social Engage did not show preliminary evidence of impact on belonging or perceived burden but was effective in reducing depressive symptoms and improving social-emotional quality of life.

DISCUSSION

S-ENG holds promise for improving social-emotional quality of life and depressive symptoms. Future research is needed to identify and measure target mechanisms that account for clinical and functional improvement.

The Relationship Between Maladaptive Personality and Social Role Impairment in Depressed Older Adults in Primary Care

Objective: Personality pathology is associated with impaired social functioning in adults, though further evidence is needed to examine the individual contributions of personality traits and processes to social functioning in depressed older adults. This study is a secondary analysis examining the relationship between maladaptive personality traits and processes and social role impairment in depressed older adults in primary care. Methods: Participants (N = 56) were 77% female and ranged in age between 55-89 (M = 66.82, SD = 8.75). Personality pathology was measured by maladaptive traits (NEO-FFI) and processes (Inventory of Interpersonal Problems; IIP-PD-15). Individual variable as well as combined predictive models of social role impairment were examined. Results: Higher neuroticism (β = 0.30, p < .05), lower agreeableness (β = -0.35 p < .001) and higher IIP-PD-15 (β = 0.28, p < .01) scores predicted greater impairment in social role functioning. A combined predictive model of neuroticism and IIP-PD-15 scores predicted unique variance in social role impairment (R² = .71). Conclusion: These results link select personality traits and interpersonal processes to social role impairment, suggesting that these are indicators of personality pathology in older adults. Clinical Implications: These findings lend preliminary support for clinical screening of personality pathology in depressed older adults utilizing both personality trait and process measures.

Motives for deliberate self-harm in a South African tertiary hospital

Background

Although there is a growing body of literature on the epidemiology of deliberate self-harm (DSH) in South Africa, comparatively few studies have investigated the motives for self-harm. No studies have investigated the motives for DSH in Cape Town.

Aim

The objective of the study was to identify the range of motives for DSH in Cape Town, and how these motives are associated with different socio-demographic factors, the severity of self-injury and levels of suicidal intent.

Setting

Groote Schuur Hospital in Cape Town, South Africa.

Methods

Data were collected from 238 consecutive patients presenting with DSH to the emergency department. The data were analysed by using bivariate and multivariate analyses.

Results

Patients engaged in DSH for a range of motives. Interpersonal issues were the most common motive (70%), followed by financial concerns (22%). Male patients were twice as likely as female patients to report interpersonal motives for their self-harm. Patients who reported interpersonal issues were more likely to engage in methods of DSH that involved damage to body tissues. Patients without tertiary education were more likely to report academic concerns as a motive, and patients who reported psychiatric illness as motive for DSH were more likely to require medical interventions than those who did not.

Conclusion

This study contributes novel insights into the motives for DSH in the Cape Town context and provides the foundation for continued research on the subject. The study also gives impetus to the development of therapeutic interventions focussed on the motives for self-harm.

Attachment anxiety, depression, and perceived social support: a moderated mediation model of suicide ideation among the elderly

OBJECTIVES

Issues concerning the association among attachment anxiety, depression and suicidal ideation among the elderly have rarely been explored. The present study investigated the relationship among attachment anxiety, depression and perceived support concerning suicidal ideation among older people.

DESIGN

Cross-sectional study.

SETTING

Tertiary care settings.

PARTICIPANTS

The authors recruited 191 elderly patients from 10 tertiary care settings in Thailand.

MEASUREMENTS

Participants provided data on their suicidal ideation and suicidal attempt using Module C of the Mini-International Neuropsychiatric Interview. Their attachment anxiety was assessed using the revised Experience of Close Relationship questionnaire (ECR-R-18), while their level of depression was investigated using the Geriatric Depression Scale. In addition, their perception of being supported was ascertained using the Multidimensional Scale of Perceived Social Support. We performed two mediation analyses and moderation analyses separately using the product of coefficients approach. First, we created a mediation model to examine the role of attachment anxiety and depression on suicidal ideation. Second, a moderated mediation model was created to explore the relationship of perceived social support as a moderator of depression.

RESULTS

We found that depression significantly mediated the association between attachment anxiety and suicidal ideation. The association between depression and suicidal ideation was moderated by the level of perceived social support.

CONCLUSION

Findings of this study may broaden our understanding of how suicidal ideation develops among the elderly and further stimulate future research exploring the interaction of positive and negative factors of suicidality among the elderly. Implications of the findings were also discussed.

The role of family absolute and relative income in suicide among Chinese rural young adults: mediation effects of social support and coping strain

BACKGROUND

suicide is a major public health issue in China. However, research on the impact of absolute and relative economic stats on suicide is scarce among the Chinese population, particularly rural young adults. Using a case-control psychological autopsy study design, we aimed to investigate the effect of family absolute and relative income on suicide among Chinese rural young adults and to further explore the potential mediating mechanism under these associations.

METHOD

the information of 393 suicide cases and 416 community living controls were collected for this study. A Binary Choice Model was used to analyze the association between family absolute and relative income and suicide risk, as well as potential mediating factors for these associations.

RESULTS

a much stronger association was found between relative income and suicide than between absolute income and suicide. Social support was a dominant mediator for the association between family relative income and suicide among both female and male young adults. Coping strain emerged as a mediating factor within the link between absolute income and suicide for males.

CONCLUSIONS

public health interventions to reduce suicide should pay more attention to relative income in addition to absolute income as potential targets for intervention, and how social support and coping strain act as mediating factors.

Domains of Functional Impairment and Their Associations with Thwarted Belonging and Perceived Burden in Older Adults

Objectives: Functional impairment and social disconnection are risk factors for suicide in later life. This paper examines associations between domains of functional impairment and two forms of social disconnection that are empirically linked to suicide in later life - low (or thwarted) belonging and perceived burden on others.Methods: Participants are 62 older primary care patients (67.68% female, mean age = 72.05) who endorsed feeling lonely or like a burden. Participants completed self-report measures of low belonging and perceived burden (INQ-R) and domains of functional impairment (WHODAS 2.0) at a single time point.Results: Greater perceived burden was associated with greater impairment in activities of daily living ("self-care"), while greater thwarted belonging was associated with greater impairment in social functioning, when controlling for depressive symptoms and age. Domains of mobility, cognition and social participation were not associated with either belonging or perceived burden.Conclusions: Impairment in self-care (ADLs) and social functioning may be more strongly associated with perceived burden and thwarted belonging than other domains of functional impairment.Clinical Implications: Considering specific domains of functional impairment - rather than functioning more broadly - may facilitate tailored interventions to target suicide risk.

Validation by experts of Risk of suicide Nursing Diagnosis in the elderly

OBJECTIVE

to validate the conceptual and operational definitions content of factors for Risk of suicide Nursing Diagnosis in the elderly.

METHOD

this is validation of the conceptual and operational definitions content of factors for Risk of suicide in the elderly, performed by 15 experts, from November 2015 to March 2016. Risk factors were classified into three hierarchical chuncks. The data were analyzed by descriptive statistics and binomial test.

RESULTS

of the 54 validated risk factors, only eight presented problems regarding clarity, simplicity and accuracy: chronic pain, vision problems, retirement, frustration, medication neglect and depression. Only rigidity was not validated as relevant for the study diagnosis.

CONCLUSION

content validation of the risk factors for Nursing Diagnosis can guide the clinical practice of the nurse in the early detection of risk of suicide in the elderly.

Behavioral empathy failures and suicidal behavior

Impaired decision-making has recently gained recognition as a component of the suicidal diathesis. Yet, although precipitants and particularly deterrents to suicidal behavior are often interpersonal, little is known about social decision-making in suicidal individuals. This study employed a novel version of the Ultimatum Game to investigate how empathy moderates responses to social conflict in 149 older adults, comprising groups of suicide attempters (n = 49), suicide ideators (n = 32), non-suicidal depressed controls (n = 33), and a non-psychiatric control group (n = 35). Participants acted as responder to a series of single-shot financial offers that varied in fairness. Some offers were paired with social context information on the proposer, designed to evoke either empathy or punishment. Offer acceptance was sensitive to Fairness and Social Context, such that participants accepted more offers in the empathy condition and fewer offers in the punishment condition. A Group * Context interaction was observed, wherein the suicide attempters adjusted their acceptance rates less in the empathy condition than the non-psychiatric controls. Thus, older adults with a history of suicide attempt were less influenced by empathy scenarios, indicating that a failure to integrate others' emotions into decisions may undermine social deterrents to suicide.

The role of social support in suicidal ideation: a comparison of employed vs. unemployed people

Background: With the financial crisis, the number of unemployed has grown up, and so has suicidal ideation in these individuals. Although extensive research has been done about the factors associated with it, studies about protective factors are also necessary.Aims: To examine the relationship between unemployment and suicidal ideation, and the protective effect of social support.Methods: Participants were 149 people in full-time employment (age M = 41.63, SD = 10.37), 55 unemployed (M = 42.25, SD = 10.23 years), and 32.72 months average unemployment time (SD = 26.13). Instruments were a sociodemographic questionnaire, the Suicide Ideation Questionnaire (SIQ) and the Social Support Appraisal (SSA). Results: Suicidal ideation was significantly higher in the unemployed group, and positively associated with duration of unemployment. Social support, both from family and friends, was found to be a protective factor in suicidal ideation, particularly in long-term unemployment.Limitations: Cross-sectional study, convenience sample.Conclusions: Suicidal ideation is markedly present in unemployed individuals, particularly those unemployed for a year or more, and social support from family and friends may act as a significant protective factor.

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

BACKGROUND

Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.

METHODS

A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.

RESULTS

SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56-2.98), item 4 (inferiority) (OR = 1.62, 1.23-2.13), item 5 (insomnia) (OR = 1.52, 1.13-2.05), and physical domain of WHOQOL (OR = 0.84, 0.72-0.99). QOL15 (mobility) (OR = 0.64, 0.46-0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44-0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24-15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15-0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20-0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.

CONCLUSION

To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

Social Relationships and Suicidal Ideation Among the Elderly Who Live Alone in Republic of Korea: A Logistic Model

With population aging and change in family structure, the number of the elderly who live alone is rapidly increasing in Korea. The aim of this study was to explore the association between social relationships—especially newly formed formal social relationships (FSRs)—and suicidal ideation among Korean elderly who live alone. The elderly who live alone (N = 2509) from the 2014 Survey of Living Conditions and Welfare Needs of Older Koreans were analyzed using logistic regression. This study found that informal social relationships (ISRs) (eg, children, friends and neighbors) of the elderly who live alone had statistically significant association with suicidal ideation, whereas FSRs (eg, formal helper and social participation) did not have significant association with suicidal ideation. The findings of this study suggest that the Korean Government needs to strengthen public system for alleviating social isolation of the elderly living alone. Therefore, this study proposed 2 strategic approaches to maintain and strengthen ISRs and to develop different types of FSRs (eg, the measures to combine FSRs with ISRs, gatekeepers, etc).

Personality and Suicidal Behavior in Old Age: A Systematic Literature Review

BACKGROUND

Suicide rates generally peak in the second half of life and are particularly high in older men; however, little is known about the contribution of dispositional factors to late-life suicide. Maladaptive personality traits have been strongly implicated in suicide among younger adults, but the extent to which they continue to play a role in late-life suicidal behavior is unclear. We also do not know whether specific personality profiles interact with the stressors of aging to cause suicidal behavior.

METHODS

We sought to synthesize the data on personality pathology in late-life suicidal ideation and behavior via a systematic review using the PubMed, Google Scholar, PsycInfo, Scopus, Ovid, Web of Science, Embase, and Cochrane search engines. The included key words related to three descriptors: "personality," "suicide," and "elderly." Included articles evaluated personality based on the Five-Factor Model (FFM) or ICD/DSM diagnostic criteria in older samples with minimum age cutoffs of 50 years or older. Our original search identified 1,183 articles, of which 31 were retained.

RESULTS

Included studies were heterogeneous in their design and personality measurements. Studies of categorical personality disorders were particularly scarce and suggested a stronger association with late-life suicidal ideation than with death by suicide. Only obsessive-compulsive and avoidant personality traits were associated with death by suicide in old age, but only in studies that did not control for depression. All personality constructs were positively linked to suicidal ideation, except for histrionic personality, which emerged as a negative predictor. Studies employing the FFM also indicated that older adults who died by suicide were less likely to display a maladaptive personality profile than elderly suicide attempters and younger suicide victims, having both lower levels of neuroticism and higher levels of conscientiousness than these comparison groups. Nevertheless, older suicide victims displayed lower levels of openness to experience than younger victims in two samples.

CONCLUSION

Maladaptive personality manifests in milder, subthreshold, and more heterogeneous forms in late-life vs. early-life suicide. An inability to adapt to the changes occurring in late life may help explain the association between suicide in old age and higher conscientiousness as well as obsessive-compulsive and avoidant personality disorders.

Suicide in older adults: current perspectives

Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.

Suicide Risk Factors Among Older Adults: Exploring Thwarted Belongingness and Perceived Burdensomeness in Relation to Personality and Self-Esteem

The objective of this study was to explore the role of personality and self-esteem in later life within two established risk factors for suicidal ideation (SI)—Thwarted Belongingness (TB) and Perceived Burdensomeness (PB). The data about personality (i.e., Five Factor Model [FFM] and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Personality Disorders [PD]), self-esteem, TB, PB, and SI were collected from 102 community-dwelling older adults and analyzed using bivariate and multivariate techniques. All FFM domains and most PD traits were significantly correlated with SI, TB, and PB. Furthermore, FFM and PD traits explained a significant and meaningful amount of variance of SI, TB, and PB. Self-esteem demonstrated strong negative relationships with SI, TB, and PB. Personality features and self-esteem are important associated features for SI, TB, and PB. Clinicians should consider this information when assessing and evaluating for suicidal risk among older adults. The findings also highlight the need to consider personality traits in developing prevention strategies.

Socioeconomic risk factors for hospital admittance due to a suicide attempt in Belgium: a population-based study using administrative data

PURPOSE

This population-based study aims to investigate socio-economic factors, depression and psychosis as independent risk factors for a suicide attempt that requires hospitalization, and estimate the incidence of suicide attempts.

METHODS

Individual-level administrative data were analysed that were collected for all members of the Socialist Health Insurance Schemes in Belgium during the period 2011-2013 (N = 3,156,030) in the context of the financing of the health care services provided. Bivariate and multivariate odds ratios were calculated for multiple socio-economic factors, socio-demographic factors and the presence of depression and psychosis.

RESULTS

During the study period, 4063 persons were hospitalized due to a suicide attempt. The incidence of suicide attempts with hospital admittance was 48.0/100,000 persons/year. Being unemployed, incapable of work over a shorter or longer period with substitute income, living on social welfare, having an increased healthcare reimbursement, living alone and using antidepressants or antipsychotics were identified as independent factors that contributed to the risk of hospitalization due to a suicide attempt.

CONCLUSIONS

Persons from low income groups, however defined, those living alone, or persons using antidepressants or antipsychotics are at an increased risk of attempting suicide and needing hospitalization for it. A social policy that focuses on the improvement of these factors or their consequences may be expected to have a favourable effect on the number of suicide attempts. Funding of mental health care should also better match population needs.

Community social support as a protective factor against suicide: A gender-specific ecological study of 75 regions of 23 European countries

By studying differences in suicide rates among different geographical regions one may identify factors connected to suicidal behaviour on a regional level. Many studies have focused on risk factors, whereas less is known about protective factors, such as social support. Using suicide rates and data from the European Social Survey (ESS) we explore the association between regional level social support indicator and suicide rates in 23 European countries in 2012. Linear multiple regression analyses using region as the unit of analysis revealed inverse relationships between mean respondent valuing of social support and suicide rates for both genders, with some indication of a stronger relationship among men. Social support may have a protective effect against suicide on a regional level. Thus, increasing social support could be an effective focus of preventive activities, resulting in lowering suicide rates, with greater expected results among men.

Perceived burdensomeness is associated with low-lethality suicide attempts, dysfunctional interpersonal style, and younger rather than older age

OBJECTIVES

Perceived burdensomeness is thought to contribute to suicide risk. However, suicidal behavior is clinically and psychologically heterogeneous. Does a high level of perceived burdensomeness differentiate medically serious suicidal acts, most closely resembling death by suicide, from less serious ones? How is perceived burdensomeness related to dysfunctional personality dimensions implicated in suicide? We sought to answer these questions in a cross-sectional, case-control study of adults, aged 42 years or older (n = 165).

METHODS

Participants were suicidal depressed with history of high-lethality and low-lethality attempts, depressed with serious suicidal ideation, depressed non-suicidal, and psychiatrically healthy controls. Following detailed clinical characterization, we assessed perceived burdensomeness, the Big Five, impulsivity, and anger rumination.

RESULTS

Low-lethality attempters reported the highest levels of perceived burdensomeness, followed by ideators, high-lethality attempters, non-suicidal depressed, and healthy controls. Group differences were robust to confounders, including demographics, severity of depression, and physical illness burden. In suicide attempters, perceived burdensomeness scaled positively with neuroticism, impulsivity, and anger and negatively with extraversion, conscientiousness, and age.

CONCLUSIONS

Our findings suggest that perceived burdensomeness is most prominent in a subgroup of younger individuals with lower-lethality suicide attempts and a dysfunctional interpersonal style. Older adults with high-lethality attempts are surprisingly more resilient to the feelings of burdensomeness. Copyright © 2016 John Wiley & Sons, Ltd.

Family history of suicide and interpersonal functioning in suicide attempters

Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters' interpersonal problems is of importance to lower their distress.

Understanding Suicide in Socially Vulnerable Contexts: Psychological Autopsy in a Small Town in Mexico

In Mexico, suicides are increasing in certain latitudes where local rates have grown to levels of alert; suicide is also the second most common cause of death for the group aged 15 to 19. The psychological autopsy method was utilized to uncover and analyze common factors in all of the registered suicides within 2011 and 2012 in a small town of the state of Guanajuato, located in the center of Mexico. A total of nine decedents were analyzed, and 22 interviews were conducted. The most salient factors were as follows: poverty, financial stress, substance abuse, low levels of education, conflictive relationships, and a poor handling of emotions. The concepts of social exclusion and vulnerability were employed to analyze suicides as symptoms of a much deeper problem of this country, suggesting that anomie and social malady are nowadays important suicidal factors, mostly for children and young people.

Impulsive traits and unplanned suicide attempts predict exaggerated prefrontal response to angry faces in the elderly

OBJECTIVE

Abnormal responses to social stimuli are seen in people vulnerable to suicidal behavior, indicating possible disruptions in the neural circuitry mediating the interpretation of socioemotional cues. These disruptions have not been empirically related to psychological and cognitive pathways to suicide. In the present study of older suicide attempters, we examined neural responses to emotional faces and their relationship to impulsivity, one of the components of the suicidal diathesis.

METHODS

Using functional magnetic resonance imaging, we recorded neurohemodynamic responses to angry faces in a carefully characterized sample of 18 depressed elderly with history of suicide attempts, 13 depressed nonsuicidal patients, and 18 healthy individuals, all aged 60+. Impulsivity was assessed with the Social Problem Solving Inventory Impulsivity/Carelessness Style subscale and Barratt Impulsiveness Scale. The Suicide Intent Scale planning subscale was used to describe the degree of planning associated with the most lethal attempt.

RESULTS

Depression and history of attempted suicide were not associated with neural responses to angry faces, failing to replicate earlier studies. Higher impulsivity, however, predicted exaggerated responses to angry faces in fronto-opercular and dorsomedial prefrontal cortex (pcorr <0.05). Poorly planned suicide attempts also predicted increased fronto-opercular responses. Results were robust to effects of medication exposure, comorbid anxiety and addiction, severity of depression, burden of physical illness, and possible brain injury from suicide attempts.

CONCLUSION

Impulsive traits and history of unplanned suicide attempts partly explain the heterogeneity in neural responses to angry faces in depressed elderly. Displays of social emotion command excessive cortical processing in impulsive suicide attempters.

The Moderating Effect of Social Support on the Relationship Between Impulsivity and Suicide in Rural China

This study was to investigate the relationship among social support, impulsivity, and suicide, so as to test the hypothesis that social support moderates the effect of impulsivity on suicide for the rural young suicides in China. Subjects were 392 consecutively recruited suicides aged 15-34 years and 416 community controls of the same age range sampled in China. The case-control data were obtained using psychological autopsy. The results showed that high social support had the protective effect among individuals with low impulsivity. It can be concluded that impulsivity is a potential area for further study of suicidal behavior. The suicide prevention efforts in rural China may address impulsivity.

Factors associated with resilience of adult survivors five years after the 2008 Sichuan earthquake in China

Given the paucity of quantitative empirical research on survivors’ resilience and its predictors in the context of long-term recovery after disasters, we examined how resilience predictors differed by gender among adult survivors five years after the Sichuan earthquake. This was a cross-sectional survey study of adult survivors (N = 495; aged 18–60) living in reconstructed communities five years into the recovery process after the Wenchuan earthquake. The instruments we used included assessments of sociodemographic characteristics and earthquake exposure level, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale. Support-seeking behaviors emerged as a significant predictor of male survivors’ resilience, while subjective support and marital status were found to be predictors of female survivors’ resilience. Annual household income and chronic disease were predictors for both male and female groups. The findings of this study can be used in devising methods to boost survivors’ resilience by promoting their satisfaction with social support and their ability to obtain effective support. Additionally, the results suggest how to assist survivors who may have relatively poor resilience.

Risk of suicidal ideation in diabetes varies by diabetes regimen, diabetes duration, and HbA1c level

OBJECTIVE

To investigate patient subgroups based on the clinical characteristics of diabetes to evaluate risk factors for suicidal ideation using a large population-based sample in South Korea.

METHODS

Data from the Fifth Korea National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, were analyzed. The participants were 9159 subjects aged ≥40years. We defined patients with diabetes based on self-reported physician-diagnosed diabetes. We evaluated clinical risk factors for suicidal ideation according to diabetes regimen, diabetes duration, and glycated hemoglobin (HbA1c) level compared with no diabetes. Given the complex sample design and unequal weights, we analyzed weighted percentages and used survey logistic regression.

RESULTS

Diabetes per se was not associated with suicidal ideation. However, suicidal ideation was significantly more prevalent among patients who had injected insulin, had a duration of diabetes ≥5years and had HbA1c levels ≥6.5 compared with those without diabetes. Depressive symptoms were the most prominent predictor of suicidal ideation.

CONCLUSIONS

Insulin therapy, diabetes of long duration, and unsatisfactory glycemic control were identified as risk factors for suicidal ideation; thus, patients with these characteristics warrant special attention. Our findings suggest the need to integrate efforts to manage emotional distress into diabetes care.

The cost of social punishment and high-lethality suicide attempts in the second half of life

Age-related cognitive changes may contribute to impairments in making complex social decisions. Interpersonal conflict is a key factor behind suicidal behavior in old age, with suicidal motivations ranging from escape to revenge. Such conflicts may prove catastrophic for people prone to suicide, in part because of their tendency to make disadvantageous decisions. Yet, little is known about social decision making in older suicidal individuals. We assessed economic bargaining behavior using the Ultimatum Game, where players decide whether to accept or punish (reject) unfair monetary offers from another player. Our sample included depressed older adults with a history of high-medical-lethality suicide attempts, low-medical-lethality suicide attempts, nonsuicidal depressed older adults, and those with no psychiatric history who served as control groups. Participants in all groups punished their counterparts in response to unfair offers. However, low-lethality attempters, nonsuicidal depressed, and nonpsychiatric controls punished less as the cost of punishment increased, accepting more unfair offers as the stakes grew large. High-lethality attempters did not adjust their choices based on stake magnitude, punishing unfair offers without regard to the cost. Two thirds of the difference between the high-lethality attempters and nonpsychiatric controls was explained by individual differences in fairness judgments: the comparison group judged offer fairness as a joint function of inequality and magnitude, whereas the high-lethality attempter participants judged offer fairness on the basis of inequality. In real life, high-lethality attempters' relative insensitivity to the cost of retaliation may lead to uncompromising, catastrophic responses to conflict.

Differential association of socio-economic status with gender- and age-defined suicidal ideation among adult and elderly individuals in South Korea

South Korea has the highest suicide rate among countries in the Organisation for Economic Co-operation and Development (OECD), with a rising trend that contrasts with the trend in most other OECD countries. This study assessed differential associations of socio-demographic factors with suicidal ideation in South Korea. We used five waves of data from the 2010 Korea National Health and Nutrition Examination Survey. Study subjects included 5803 men and women aged >25 years. We analysed weighted percentages with consideration of the complex survey sample design and unequal weights. Surveylogistic regressions were applied. Protective effects against suicidal ideation were found for higher household income, higher educational attainment, and being married. Functional limitations and depressive symptoms were risk factors for suicidal ideation. However, these significant factors may exert different effects on vulnerability for suicidal ideation among different genders and age groups. Thus, household income was mainly protective for women and subjects aged 25-44 years, and educational attainment was protective for individuals aged >65 years. Our findings suggest the need for extended social protection policies for the less privileged population and special strategies for different groups.

Sense of belonging and suicide: a systematic review

OBJECTIVE

To systematically review the research on the association between sense of belonging and suicide.

METHOD

We systematically reviewed electronic databases for studies that included assessments of suicidality and belonging.

RESULTS

We found 16 studies that met our eligibility criteria. They all found an association between belonging and suicidality but nearly all of the studies were in nonclinical populations, and the association was weak and could be taken into account by confounding factors.

CONCLUSIONS

Low sense of belonging has a weak association with suicidality. However, current concepts make it hard to distinguish from loneliness or other measures of social support. An alternative view of belongingness, as a sense of connectedness to things other than people and in the past as well as the present, may generate alternative ideas about useful clinical interventions that may be especially relevant to indigenous populations.

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery-Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

Psychological and socioeconomic health of community-dwelling older adults

Different dimensions of health are intertwined. The purposes of this study were: (1) to investigate the psychological and socioeconomic health status of community-dwelling older adults in Taiwan, and (2) to compare the psychological and socioeconomic health differences among people of different age groups, gender, marital status, and exercise habits. Using stratified random sampling, 384 Taiwanese community-dwelling older adults were recruited for this survey research. Based on the Health Model of Older Adults, seven constructs were measured: (1) psychological health: sleep quality, emotional health, cognitive functioning, and health promotion behaviors; (2) socioeconomic health: social engagement, social support, and financial status. Results showed that most participants were in a good state of psychological and socioeconomic health, except that 38.02% of them suffered from sleep disruptions, and the majority of them were not involved in any social group, nor engaged in any volunteer work. Young-old older adults had better psychological and socioeconomic health than middle-old and old-old older adults. Male older adults had better psychological health than female older adults; however, they had less social engagement and social support than female older adults. Married older adults and exercisers performed better in most of the psychological and socioeconomic health indicators than single/widowed older adults and non-exercisers.

[Impact of family support on depressive complaints in the elderly in Santiago, Chile]

INTRODUCTION

Epidemiological changes can have an effect on social and, and in particular, family ties, which are important elements in the mental health of older people. The objective of this study was to evaluate the impact of family support on depressive disorders in older people of the community.

MATERIAL AND METHODS

Face to face interviews were conducted on a representative sample of adults 60 years and older, living in urban area of Santiago de Chile. The information on depressive disorders was related to family composition, emotional and instrumental support, presence of conflict, health self-perception, functionality and self-efficiency. Data were analyzed using logistic regression models.

RESULTS

From a total of 394 participants, 62% females, mean age 74 years (SD=8.1), 16% felt depressed almost every day. Depressive disorders were significantly associated in regression models with impaired self-perception of health and efficacy, lower instrumental support, and with the presence of conflict. The variable that most contributed to the model was self-rated poor health, increasing the odds of depressive disorders by 3.2.

CONCLUSIONS

Poor perception of health was the main determining factor for depressive complaints in older people, followed by lower family support, specifically instrumental support, and the presence of conflict. This information can help future programs in order to improve the quality of life in older people.

The Moderating Role of Social Support on the Relationship Between Impulsivity and Suicide Risk

Background: Suicide is the second leading cause of death among college students. There has been considerable research into risk factors for suicide, such as impulsivity, but considerably less research on protective factors. Aims: The present study examines the role that social support plays in the relationship between impulsivity and suicide risk. Methods: Participants were 169 undergraduates who completed self-report measures of impulsivity and social support. Suicide risk was assessed using an interview measure. Results: Social support moderates the relationship between impulsivity and suicide risk, such that those who are highly impulsive are less likely to be at risk for suicide if they also have high levels of social support. Conclusions: Social support can be a useful buffer to suicide risk for at-risk individuals who are highly impulsive.

Social emotion recognition, social functioning, and attempted suicide in late-life depression

OBJECTIVES

: Lack of feeling connected and poor social problem solving have been described in suicide attempters. However, cognitive substrates of this apparent social impairment in suicide attempters remain unknown. One possible deficit, the inability to recognize others' complex emotional states has been observed not only in disorders characterized by prominent social deficits (autism-spectrum disorders and frontotemporal dementia) but also in depression and normal aging. This study assessed the relationship between social emotion recognition, problem solving, social functioning, and attempted suicide in late-life depression.

DESIGN, PARTICIPANTS, MEASUREMENTS

: There were 90 participants: 24 older depressed suicide attempters, 38 nonsuicidal depressed elders, and 28 comparison subjects with no psychiatric history. We compared performance on the Reading the Mind in the Eyes test and measures of social networks, social support, social problem solving, and chronic interpersonal difficulties in these three groups.

RESULTS

: Suicide attempters committed significantly more errors in social emotion recognition and showed poorer global cognitive performance than elders with no psychiatric history. Attempters had restricted social networks: they were less likely to talk to their children, had fewer close friends, and did not engage in volunteer activities, compared to nonsuicidal depressed elders and those with no psychiatric history. They also reported a pattern of struggle against others and hostility in relationships, felt a lack of social support, perceived social problems as impossible to resolve, and displayed a careless/impulsive approach to problems.

CONCLUSIONS

: Suicide attempts in depressed elders were associated with poor social problem solving, constricted social networks, and disruptive interpersonal relationships. Impaired social emotion recognition in the suicide attempter group was related.

Protective factors and suicidality in members of Arab kindred

BACKGROUND

Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors.

AIMS

To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors.

METHODS

We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale.

RESULTS

Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2=11.17, p=.001), an anxiety disorder (87.5% vs. 22.9, χ2=21.02, p<.001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher's, p=.003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31±1.36 vs. 4.96±1.40, t=4.10, df=62, p<.001), and they have the view that suicide is somehow unacceptable (1.83±.10 vs. 1.89±.07, t=2.76, df=60, p=.008).

CONCLUSIONS

Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

Sense of coherence in elderly suicide attempters: the impact of social and health-related factors

BACKGROUND

An association between sense of coherence (SOC) and suicidal behavior has been suggested. The aim of this study was to identify factors associated with low SOC in elderly suicide attempters.

METHODS

Eighty non-demented hospital-treated suicide attempters aged 70 years and older (38 men, 42 women, mean age 79.4 years) took part in an interview with a research psychologist and completed the 29-item SOC questionnaire. The interview included questions regarding social situation and health-related factors. The Comprehensive Psychopathological Rating Scale (CPRS) provided symptom ratings that were used in a diagnostic algorithm for DSM-IV major depression. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to identify individuals with serious physical illness.

RESULTS

There was a strong relationship between major depression and SOC. While we could show no relationship between severe physical illness and SOC, associations were demonstrated with social variables including too little time spent with children, too little time spent with grandchildren and having moved within the past five years. These associations remained significant in regression models adjusted for sex, age and major depression.

CONCLUSIONS

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.

Suicides in late life

Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age. Data from psychological autopsy studies supplemented with recent studies of suicidal ideation and attempts point to a consistent set of risk factors for the spectrum of suicidal behaviors in late life (suicide ideation, attempts, and deaths). Clinicians should be vigilant for psychiatric illness (especially depression), physical illness, pain, functional impairment, and social disconnectedness. Recent advances in late-life suicide prevention have in common collaborative, multifaceted intervention designs. We suggest that one mechanism shared by all preventive interventions shown to reduce the incidence of late-life suicide is the promotion of connectedness. For the clinician working with older adults, our recommendation is to not only consider risk factors, such as depression, and implement appropriate treatments but to enhance social connectedness as well.

Is the proposed DSM-V Suicide Assessment Dimension suitable for seniors?

High suicide rates are observed in elderly men, and the identification of high risk individuals is a challenging task. The Suicide Assessment Dimension (see Box 1) is intended to aid the evaluation process. We are concerned that the proposed assessment may miss some seniors in need of intensive management.

Conceptual relations between loneliness and culture

PURPOSE OF REVIEW

To clarify ways in which loneliness and culture are connected conceptually.

RECENT FINDINGS

Loneliness may be distinguished from being alone or social isolation by a common property of loneliness across cultures - that is, an undesired absence of reciprocal empathic understanding. Cultural meanings shape the experience of loneliness in that they create expectations of the nature and the extent of closeness in relationships as well as social connectedness. Conversely, the extent and nature of loneliness in a culture may be described as a property of that very culture, allowing one to speak of 'a culture of loneliness'. Accordingly, a culture of loneliness is found in both individualist and communal cultures, but of different kinds. A third conceptual relation may be described as a cultural loneliness, whereby someone is lonely while being in a foreign culture that leaves one feeling not understood and not able to reciprocate understanding about cultural meanings.

SUMMARY

Loneliness shares common features across cultures, yet culture shapes it and is shaped by it.