Prevention strategies should follow the most potent risk factor findings. Since the majority of older adults use firearms as a means of suicide, some have proposed that reduction in access to firearms may be an effective, preventive measure. However, others have argued that substitution in suicide methods may minimize the potency of this prevention approach (1990).
Research findings of increases in intent with age suggest that older persons who are at risk for suicide may be more difficult to identify as being at imminent risk than is the case for younger persons. Thus, clinical intervention strategies that target individuals who are at high risk for suicide, as indicated by a variety of demographic and psychiatric variables, may be more effective for preventing suicide than interventions that solely target individuals with suicide ideation or behavior. The fact that the majority of older adults are seen in primary care settings within the month of their deaths, coupled with the finding that most later life suicide victims have had a late onset, depressive episode, suggests that detecting and treating depression in primary care may be an efficient way to prevent later life suicides.
Although the identification and adequate treatment of depression is proposed as the most promising research avenue when considering preventive interventions in late life suicide, there are a number of factors that work against these prevention efforts. Ageism works against out-reach efforts. Many health providers, family members, and older adults themselves believe that depression and suicidal ideation are part of the normal aging process. Prevention efforts will need to consider these issues in public education and provider training to advance efforts in increased detection and treatment of depression.
JANE L. PEARSON
BUDA, M., and TSUANG, M. T. ‘‘The Epidemiology of Suicide: Implications for Clinical Practice.’’ In Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients. Edited by S. J. Blumenthal and D. J. Kupfer. Washington, D.C.: American Psychiatric Press, Inc., 1990. Pages 17–37.
CONWELL, Y. (1994). ‘‘Suicide in Elderly Patients.’’ In Diagnosis and Treatment of Depression in Late-Life. Edited by L. S. Schneider, C. F. Reynolds, B. D. Lebowitz, and A. J. Friedhoff. Washington, D.C.: American Psychiatric Association, 1994. Pages 397–418.
CONWELL, Y., and BRENT, D. ‘‘Suicide and Aging I: Patterns of Psychiatric Diagnosis.’’ International Psychogeriatrics 7 (1995): 149–181.
CONWELL, Y.; DUBERSTEIN, P. R.; COX, C.; HERRMANN, J. H.; FORBES, N. T.; and CAINE, E. D. ‘‘Age Differences in Behaviors Leading to Completed Suicide.’’ American Journal of Geriatric Psychiatry 6 (1998): 122–126.
DRAPER, B. ‘‘Attempted Suicide in Old Age.’’ International Journal of Geriatric Psychiatry 11 (1996): 577–587.
DUBERSTEIN, P. R. ‘‘Openness to Experience and Completed Suicide across the Second Half of Life.’’ International Psychogeriatrics 7 (1995): 183–198.
MANN, J. J. ‘‘The Neurobiology of Suicide.’’ Nature Medicine 4 (1998): 25–30.
MOSCICKI, E. K.; O’CARROLL, P.; RAE, D. S.; LOCKE, B. Z.; ROY, A.; and REGIER, D. A. ‘‘Suicide Attempts in the Epidemiologic Catchment Area Study.’’ Yale Journal of Biology and Medicine 61 (1988) 259–268.
MURPHY, G. E.; WETZEL, R. D.; ROBINS, E.; and MCEVOY, L. ‘‘Multiple Risk Factors Predict Suicide in Alcoholism.’’ Archives of General Psychiatry 49 (1992): 459–463.
NORDENTOFT, M.; BREUM, L.; MUNCK, L.; NORDESTGAARD, A. G.; HUNDING, A.; and BJÆLDAGER, P. A. L. ‘‘High Mortality by Natural and Unnatural Causes: A 10 Year Follow Up Study of Patients Admitted to a Poisoning Treatment Centre after Suicide Attempts.’’ British Medical Journal 306 (1993): 1637-1641.
RIFAI, A. H.; GEORGE, C. J.; STACK, J. A.; MANN, J. J.; and REYNOLDS, C. F. ‘‘Hopelessness in Suicide Attempters After Acute Treatment of Major Depression in Late-Life.’’ American Journal of Psychiatry 151 (1994): 1687–1690.
ROSS, R. K.; BERNSTEIN, L.; TRENT, L.; HENDERSON, B. E.; and PAGANINI-HILL, A. ‘‘A Prospective Study of Risk Factors for Traumatic Death in the Retirement Community.’’ Preventive Medicine 19 (1990): 323–334.
SCHNEIDER, L. S. ‘‘Biological Commonalities among Aging, Depression, and Suicidal Behavior.’’ In Suicide and Depression in Late-Life: Critical Issues in Treatment, Research and Public Policy. Edited by G. J. Kennedy. New York: John Wiley & Sons, Inc., 1996. Pages 39–50.
SZANTO, K.; REYNOLDS, C. F., 3D; CONWELL, Y.; BEGLEY, A. E.; and HOUCK, P. ‘‘High Levels of Hopelessness Persist in Geriatric Patients with Remitted Depression and a History of Attempted Suicide.’’ Journal of the American Geriatrics Society 46 (1998): 1401–1406.
ZWEIG, R. A., and HINRICHSEN, G. A. ‘‘Factors Associated with Suicide Attempts by Depressed Older Adults: A Prospective Study.’’ American Journal of Psychiatry 150 (1993): 1687–1692.