Adults aged 65 years and older who are suicidal appear to report higher levels of intent compared with younger adults who are suicidal, but they are less likely to meet the criteria for major depression and several other mental disorders. These findings were published Monday in the American Journal of Geriatric Psychiatry.
Older adults’ lower scores on ratings of psychiatric symptoms “may cloud the clinician’s assessment of the serious nature of suicide attempts in older patients,” wrote Stefan Wiktorsson, Ph.D., of the University of Gothenburg in Sweden and colleagues. “If this is the case, safety issues and treatment needs may be underestimated.”
Wiktorsson and colleagues recruited patients aged 18 and older who had sought or been referred to emergency psychiatric services for self-harm at three hospitals in Sweden. Mental health staff conducted face-to-face interviews with the study participants, during which they collected information about the participants’ physical and mental health, as well as their contact with health care professionals. The researchers used the Columbia-Suicide Severity Rating Scale to help them separate participants who had made a suicide attempt from those who did not; participants whose self-injury was determined to be nonsuicidal were excluded from the study.
The researchers used the Suicide Intent Scale (SIS) to evaluate the circumstances surrounding the suicide attempt (for example, active preparation) and the Mini International Neuropsychiatric Interview (MINI) to determine other psychiatric diagnoses (including depression, anxiety, and substance use disorders). A total of 683 participants were selected for the study, and they were divided into three age groups: younger (18 to 44), middle-aged (45 to 64), and older (65 and older) adults.
Older adults scored higher on the SIS total score as well as the SIS subjective subscale compared with the younger adults, Wiktorsson and colleagues reported. No age group differences were detected for the objective subscale of the SIS. Half of the older adults met the criteria for major depression according to the MINI, as compared with three-fourths of the participants in each of the other two age groups. Anxiety disorders and substance use disorders were also less common in older adults. In contrast, a greater proportion of older adults reported living alone and/or having a serious physical condition/disability compared with younger and middle-aged adults.
“[T]hese findings point to a need for increased availability of services for older adults with suicidal issues, as well as treatment augmentation for those who already have mental health care contacts. Considering the finding that two-thirds of the older group had serious physical illness, multidisciplinary interventions are likely to be indicated,” the authors wrote. “Attention must be paid to medical morbidity and living situation, as well as other sources of vulnerability not examined in this study, that may be relevant for individualized preventive approaches.”
For related information, see the Psychiatric Services article “Suicide Mortality Among Veterans Health Administration Care Recipients With Suicide Risk Record Flags.”
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