Who is really at risk? The contribution of death anxiety in suicide risk and loneliness among older adults during the COVID-19 pandemic

A narrative review: suicide and suicidal behaviour in older adults

Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.

Loneliness and suicide risks in the general population before and during first-year COVID-19 in Taiwan

PURPOSE

Loneliness is a critical issue affecting the general population. Current evidence from national surveys of loneliness is scarce. The study aimed to examine the impact of COVID-19 pandemic on the prevalence of loneliness and its associating suicide risks in Taiwan.

METHODS

Four annual telephone interview surveys were performed by the Taiwan Suicide Prevention Center in 2015-2017 and 2020 during COVID outbreak. Each year the sample was randomly selected by stratifying the general public in different geographical areas and fulfilled a questionnaire collecting information including loneliness, psychological distress, and suicide risk assessment. All the data were analyzed using SPSS25 analysis.

RESULTS

A total of 8460 participants were recruited. The average prevalence of loneliness was 12.6 %. Feelings of loneliness was significantly correlated with psychological distress and most risk factors relating to suicide. The odds of loneliness for lifetime suicidal ideation, lifetime suicide attempt, and future suicide intent were 4.9, 5.1, and 9.2, respectively. During the COVID-19 period, loneliness and suicidality demonstrated a noteworthy decline trend, whereas "no one trustworthy to talk to" was the only item that showed significant increase under the pandemic and also impacted on loneliness.

CONCLUSION

Nearly one in ten Taiwanese people felt lonely before and during COVID-19. Loneliness was closely linked with various suicide risk factors such as lifetime suicide ideation and attempt or future intention. Although psychological distress and suicide risk were not increased during COVID-19, maintaining trustful relationships to seek support appeared to be critical to prevent the risks of loneliness or suicide.

The Relationship of Death Anxiety With Loneliness and Psychological Well-Being in the Elderly Living in a Nursing Home

This descriptive correlational study aimed relationship of death anxiety with loneliness and psychological well-being in the elderly living in a nursing home. The study was conducted on the elderly living in a nursing home in Istanbul, Turkey, between November 2021-February 2022. The study sample included 165 nursing home residents. The Sociodemographic Characteristics Form, Death Anxiety Scale (DAS), Loneliness Scale for the Elderly (LSE) and Psychological Well-Being Scale were used as data collection tools. The elderly participants obtained a mean score of 6.10 ± 3.50 from DAS, a mean score of 9.01 ± 4.08 from LSE, and a mean score of 38.97 ± 10.05 from Psychological Well-Being Scale. When death anxiety scale mean score of the elderly was compared with their mean scores of loneliness scale and psychological well-being scale, a weak and negative correlation was determined between psychological well-being and loneliness (p < 0.001). As the mean score of psychological well-being scale increases, loneliness scale mean score decreases.

Relationship of Depression, Hopelessness and Life Satisfaction With Death Anxiety in Individuals Who Have Had COVID-19

The aim of this study was to determine the relationship between depression, hopelessness and life satisfaction with death anxiety and the determinants of death anxiety in individuals who have had COVID-19. This descriptive and correlational study was conducted with 402 adult individuals. Personal Information Form, Thorson-Powell Death Anxiety Scale, Beck Depression Scale, Beck Hopelessness Scale and Satisfaction with Life Scale were used to collect the data. In the study, a positive relationship was found between death anxiety and depression and hopelessness, and a negative relationship was found between death anxiety and life satisfaction (p < .001). As a result, being female, having undergraduate or graduate education, having high levels of depression and hopelessness and low life satisfaction were found to be determinants of death anxiety.

Suicidal Ideation and Mental Health Help-Seeking Behaviors Among Older Chinese Adults During the COVID-19 Pandemic

OBJECTIVE

To examine prevalence and correlates of suicidal ideation in older Chinese adults (OCAs) during the COVID-19 pandemic, as well as mental health help-seeking behaviors of suicidal OCAs.

BACKGROUND

Few data on suicidal behaviors of older adults during the pandemic are available.

METHODS

In this cross-sectional survey, 1159 OCAs completed an online self-administered questionnaire between 23 February and 25 March 2020. A standardized single question and the 12-item General Health Questionnaire were used to assess the presence of suicidal ideation and common mental health problems (CMHPs), respectively. Suicidal ideators were further asked about their perceived need for mental health care and help-seeking from mental health workers.

RESULTS

4.1% of the OCAs experienced suicidal ideation during the past 2 weeks. Among the suicidal OCAs, 31.9% perceived a need for mental health care but only 10.6% had sought help from mental health workers. Factors significantly associated with suicidal ideation were a marital status of "others" (OR=2.39, P = .021), disagreement regarding the successful containment of the pandemic (OR=2.43, P = .022), physical health problems (OR=2.23, P = .012), and CMHPs (OR=4.99, P < .001).

CONCLUSIONS

During the COVID-19 pandemic, OCAs constitute a subpopulation that needs mental health services for suicidal problems but tends not to seek mental health help. Mental health services for OCAs may include mental health education, periodic evaluation of risk of suicide, expanded psychosocial support, and, when necessary, psychological crisis intervention and psychiatric treatment.