Suicide across the adult life span: Replications and failures

Suicide is a multidimensional event. To understand this complexity, psychological theory is needed, which is often lacking in current research. This archival study, utilizing 60 suicide notes from across the adult life span, examines models of suicide. An attempt to replicate a previous model (1989) failed to account best for the current data and an alternative theoretical model is provided. Yet, this result should be expected, not only because psychological theory has to be open-ended to define an event, but also because empirical methods for theory construction (such as cluster analysis in this study) are not simply result seeking but are result imposing. Nevertheless, the present study strongly supported an adult life span perspective. Young adults continue to show the greatest amount of differences in their suicide; for examples, higher levels of psychopathology, lower levers of ego strength and a poorer ability to cope with life's demands, e.g., intimacy vs. isolation.     

Suicide and the continental divide

Cross-cultural research is one avenue for investigating suicide. with Canada and the United States being obvious units for comparison. Studies of rates and patterns. homicide and suicide, facts and myths, psychological aspects. psychopathology, attitudes towards suicide and domestic and economic variables are reported. It is concluded that Canada has a higher rate and different pattern of suicide than the United States. Although there may be numerous similarities (e.g., psychological aspects. psychopathology), differences were noted in the relation between homicide and suicide, the attitudes toward suicide (e.g., Canadian young people, Canada's highest at risk group, see suicide as more normal and as an acceptable solution to issues than their American counterparts), and domestic stress, i.e., marriage. A historical explanation is provided as an avenue to understand these cultural differences in suicide.     

Toward an understanding of late life suicidal behavior: the role of lifespan developmental theory

Objectives: Suicidal behavior in late life differs in important ways from suicidal behavior that occurs earlier in the lifespan, suggesting the possibility of developmental differences in the etiology of suicidal behavior. This paper examines late life suicidal behavior within the context of lifespan developmental theory.

Methods: This paper presents a conceptual framework for using lifespan developmental theory to better understand late life suicidal behavior.

Results: We argue that the motivational theory of lifespan development, which focuses on control, is particularly relevant to late life suicide. This theory posits that opportunities to exert control over important aspects of one's life diminish in late life as a result of declines in physical functioning and other factors, and that successful aging is associated with adaptive regulation of this developmental change. Although continued striving to meet goals is normative throughout the lifespan, most individuals also increase the use of compensatory strategies in old age or when faced with a decline in functioning. We propose that individuals who do not adapt to developmental changes by altering their strategies for exerting control will be at risk for suicidal behavior in late life. This paper reviews evidence that supports the importance of control with respect to suicidal outcomes in older adults, as well as findings regarding specific types of control strategies that may be related to suicide risk in older adults with health-related limitations.

Conclusion: Although suicidal behavior is not a normal part of aging, the application of lifespan developmental theory may be useful in understanding and potentially preventing suicide among older adults.     

Are child-, adolescent-, and adult-onset depression one and the same disorder?

This paper reviews prior research studies examining neurobiological correlates and treatment response of depression in children, adolescents, and adults. Although there are some similarities in research findings observed across the life cycle, both children and adolescents have been found to differ from depressed adults on measures of basal cortisol secretion, corticotropin stimulation post-corticotropin releasing hormone (CRH) infusion, response to several serotonergic probes, immunity indices, and efficacy of tricyclic medications. These differences are proposed to be due to 1) developmental factors, 2) stage of illness factors (e.g., number of episodes, total duration of illness), or 3) heterogeneity in clinical outcome (e.g., recurrent unipolar course vs. new-onset bipolar disorder). Relevant clinical and preclinical studies that provide support for these alternate explanations of the discrepant findings are reviewed, and directions for future research are discussed. To determine whether child-, adolescent-, and adult-onset depression represent the same condition, it is recommended that researchers 1) use the same neuroimaging paradigms in child, adolescent, and adult depressed cohorts; 2) carefully characterize subjects' stage of illness; and 3) conduct longitudinal clinical and repeat neurobiological assessments of patients of different ages at various stages of illness. In addition, careful attention to familial subtypes (e.g., depressive spectrum disorders vs. familial pure depressive disorders) and environmental factors (e.g., trauma history) are suggested for future investigations.     

Elderly suicide in primary care

BACKGROUND: Primary care is probably the most suitable setting to start a strategy for suicide prevention for the elderly especially as more people are seen before committing suicide in primary care than in secondary care. AIM: This study examines the nature of complaints and timing of presentation to general practitioners by suicide victims in their last GP consultation, comparing persons aged 65 and over with those aged between 18 and 64. METHODS: Details of all cases of suicide verdict and open verdict, which were returned in inquests, held at the Coroner's Court of Birmingham and Solihull, between January 1995 and December 1999 were reviewed. The study provided a comparison between older people (65+) and younger adults. RESULTS: Older people had more physical illness, and were more likely to have seen their GP in the 6 months before suicide. Younger adults presented with more psychiatric symptoms, while older adults presented with more physical symptoms. Complaints to the GP in the last consultation were significantly different between the two age groups. Older people are more commonly present with physical pain and depression. CONCLUSIONS: The study found that elderly suicide victims had different characteristics and attributes from those of younger adults presenting to primary care. This difference may have implications for suicide research, training of primary care staff and suicide prevention programmes.     

Age and attempted suicide

Clinical and demographic factors associated with suicide attempts admitted to the West Midlands Poisons Unit over a 2-year period were compared by age group. Risk factors for future suicide (living alone, physical illness, psychiatric illness and high suicidal intent in the attempt) were significantly more common among elderly patients (65 years and over) than middle-aged patients (35-64 years) and significantly less common among young patients (under 35 years) than middle-aged patients. Elderly patients that attempted suicide resemble elderly patients that completed suicide and should be considered at high risk of future suicide.     

Antecedents and sex/gender differences in youth suicidal behavior

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this “gender paradox” in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others’ or one’s own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one’s ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.     

Differences in Irish Urban and Rural Suicide Rates, 1976–1994

The recent rise in the Irish suicide rate is a male phenomenon. The present paper calculates urban and rural suicide rates for Ireland and looks at some possible explanatory variables for the differences observed. Irish suicide and undetermined death rates, age-adjusted to the European Standard Population, are calculated for the years 1976 to 1994 to determine if there are any discernible trends between urban and rural areas. Possible associated factors are then examined, including the distribution of psychiatric illness using the National Psychiatric In-Patient Reporting Scheme. Between 1980 and 1990, the Irish rural male suicide rate rose by 50% while there was no increase in the male urban rate. The most radical increases have occurred in the young and elderly rural males. A. t the start of the study period, the urban female suicide rate was higher than the rural rate but the two rates have been almost identical since 1985. Some factors associated with suicide were examined but failed to provide sufficient explanation for the difference in rates. Further research is needed to clarify the reasons for these differences and to monitor ongoing trends.     

Suicide as an indicium of biologically-based brain disease

Neurobiological evidence indicates that more than mood disorders, impulsive self-directed and other-directed violence and associated behaviors resistent to impulse control are biologically based and associated with alterations in serotonin metabolism. Serotonergic mechanisms are involved with sexual drive, affect, and fight or flight behavior (Linnoila et al., 1983; Traskman-Bendz et al., 1990) which at times may manifest itself as impulsive and be self-destructive. Serotonergic aberrations have been reported with assaults, rape, and eating disorders, in addition to suicides and homicides (Cohen et al., 1988). Schizophrenia, obsessive-compulsive disorder and panic disorder, is also reported associated with serotonergic dysfunction (Vander Kar, 1990). Many healthy people without evidence of psychiatric disorder show a decrease in CSF-5–HIAA (Asberg et al., 1990). supporting a multifactorial concept of suicide. In addition to the biogenetic vulnerably evinced in indoleamine metabolism, situational (e.g., stress, life events, lack of social support, severe illness, reversal of fortune), existential (e.g., angst), and psychological (e.g., early loss, hopelessness), play roles in compelling a person to take his or her own life (Asberg et al., 1990). The reduction of suicidal and impulsive behaviors, such as homicide and rape, requires a coordinated treatment plan involving psychopharmacotherapy, psychotherapy, and socio-therapy (Slaby, 1993). It is the challenge of researchers in suicide to identify which interventions are critical for managing patients with these disorders.     

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008–2014

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n?=?5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR?=?1.92; 95% CI: 1.06, 3.46), dishonors family (OR?=?1.83; 95% CI: 1.01, 3.28), or is tired of living (OR?=?2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.     

Gender in elderly suicide: analysis of coroners inquests of 200 cases of elderly suicide in Cheshire 1989-2001

OBJECTIVES: The aim of this study is to review gender differences in elderly suicide in relation to specific social aspects of the suicidal process and health care contact before death. Such information may have practical value in identifying and targeting vulnerable elderly in whom suicide may be potentially preventable. METHODS: Data were extracted from the records of coroner's inquests into all reported suicide of persons aged 60 and over, in Cheshire over a period of 13 years 1989-2001. The Coroner's office covers the whole county of Cheshire (population 1 000 000). RESULTS: Men were less likely to have been known to psychiatric services (Odds Ratio [OR] 0.4 95% 0.2-0.6) and with less frequently reported history of previous attempted suicide compared to women (OR 0.5 95% Confidence Intervals [CI] 0.2-1). All deceased from ethnic minorities were men, none of whom had been known to psychiatric services. There was no significant difference between women and men in relation to, physical or psychiatric morbidity, GP contact prior to suicide, intimation of intent or living alone. Of suicide victims not known to services a surprisingly high proportion of 38% and 16% were found to have psychiatric morbidity in men and women respectively. CONCLUSION: Suicide is an important problem in the elderly with gender playing an important part in their social behaviour but a high proportion of the deceased were not known to local services. Primary Care professionals have an important role to play in reducing elderly suicide as most contact with the health service in elderly suicide seem to be with GPs.     

The Psychological Autopsy and Determination of Child Suicides: A Survey of Medical Examiners

This study explored the decision-making processes of medical examiners in the determination of child suicide. Ninety-four medical examiners completed a survey regarding those factors considered when making a child suicide determination, sources of information used, and considerations in accident vs. suicide classifications. No significant differences between groups of respondents were observed. Well-known risk factors such as suicide notes were considered by virtually all participants, but other risk factors (e.g., substance abuse) were not consistently taken into consideration. Common sources of information included informant interviews and review of records. Results indicate that age and evidence of intent are critical considerations in this process. Implications in terms of misclassification and prevention efforts are discussed.     

Differences in suicide behaviour in the elderly: a study in two provinces of Northern Italy

BACKGROUND: to investigate the suicide phenomenon among the elderly (people aged 65 and over) in the Italian provinces of Novara and Verbania, in the time span between January 1990 and December 2000, in order to evaluate if the characteristics of the suicide behaviour correlate to the place of living with particular attention to the psychosocial factors. METHODS: the information was collected from the Republic Procuration of the two provinces. Frequencies and contingency tables were evaluated to compare the data found in the two provinces. Standardised Mortality Ratios (SMRs) with their confidential intervals (95% confidence intervals) were calculated in comparison with the average suicide rates in North West Italy in the same period and in the same age group. RESULTS: One hundred and eighty-four suicides were committed from the elderly, with an average rate of 14.07 per 100 000 inhabitants in Novara and 25.56 in Verbania. The most common methods used to commit suicide were hanging and jumping from height. The factors chiefly related to suicide were mental disease, followed by organic illness. The analysis of SMRs point out that the incidence of suicide in the province of Verbania is higher than in North West Italy while in Novara it is lower. CONCLUSION: the evaluation of the suicide risk in the elderly in a diagnostic and preventive framework must take into consideration the psychosocial factors that vary with the place of living.     

The acquired capability for suicide: A comparison of suicide attempters,suicide ideators,and non‐suicidal controls

Background: The Interpersonal Theory of Suicide states that to make a serious or lethal suicide attempt, a person must experience reductions in fear and pain sensitivity sufficient to overcome self preservation reflexes (i.e., the acquired capability for suicide). The purpose of this study was to examine the fearlessness component of the acquired capability for suicide using self‐report assessment instruments and an objective measure of aversion (the affectively modulated startle reflex task). Methods: Depressed suicide ideators (n=15), depressed suicide attempters (n=15), and a group of control participants (n=14) were compared on their self‐report of acquired capability and painful and provocative life events, and completed the affectively modulated startle reflex task. This task compared electromyography recordings of participants' eye‐blink response to a startle probe while viewing pictures of varying hedonic valence (neutral, positive, negative, and suicide‐related). Results: Suicide attempters reported the highest levels of fearlessness and pain insensitivity and a greater history of painful and provocative life events. Although no group differences were found on the psychophysiology data, participants reacted to suicide‐related images with less aversion compared to neutral images with no differences between suicide‐related and positive images. Conclusions: Self‐reported fearlessness and pain insensitivity can differentiate suicide attempters and suicide ideators. Results suggest that one's self‐perception (i.e., cognitions regarding fear and pain tolerance) are more functionally related to suicide attempts than psychophysiological reactivity to suicide‐related stimuli. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Trends in suicide rates of the elderly in Austria, 1970-2004: an analysis of changes in terms of age groups, suicide methods and gender

BACKGROUND: Suicides of the elderly (persons aged 65 and older) make up a large proportion of total suicides. Since suicide rates of the elderly are highest in western populations, addressing them as a risk group in prevention plans has been recommended. In order to assess possible approaches to prevention strategies, this study examines high-risk groups of the elderly. METHODS: We examined official statistics on suicides that occurred in Austria between 1970-2004 (18,101 Suicides of the elderly). We analyzed time trends and differences in suicide methods as well as in age groups and both genders of the elderly. RESULTS: Three major high-risk groups were identified: elderly male suicides by firearms; elderly female suicides by poisoning, which occur more often with increasing age; and suicides of both genders by jumping from heights. CONCLUSION: Besides conducting treatment of psychiatric disorders of the elderly, restricting the means to commit suicide may help to prevent it among the elderly. Such specific prevention strategies should be implemented in national suicide prevention plans for the high-risk groups identified in this study.     

Protective Factors of Suicide and Suicidal Behavior Relevant to Emergency Healthcare Settings: A Systematic Review and Narrative Synthesis of Post-2007 Reviews

Suicide is a major public health concern and, with recent societal changes, such as economic and technological changes, there may be emerging protective factors that mitigate suicide risk that are unrecognized in emergency healthcare. This systematic review aims to identify protective factors for suicide that can feasibly be assessed in time-limited emergency healthcare settings. A systematic review of reviews was conducted via PsycINFO, CINAHL and Medline (2007–2015). Reviews were assessed for methodological quality using AMSTAR. A total of 24 reviews met the inclusion criteria and 8 were assessed as high quality and included in a narrative synthesis. Known protective factors were identified (e.g., social support), along with emerging protective factors (e.g., internet support). The review synthesizes recent research evidence on protective factors and discusses their relevance to emergency healthcare.     

Suicide Letters in Singapore

The contents of suicide letters provide insight into the reasons for suicide and the mental states of victims. Coroner court records of 1,721 Singaporean suicides occurring between 2000 and 2004 were reviewed, 398 (23%) of whom left suicide letters. Letter writers tended to be younger, single, and less likely to have mental or physical illness. A reason for suicide was evident in 58%. Major reasons included school and relationship problems in the young, financial and marital problems in adults and physical illnesses in the elderly. Positive sentiment (care/concern) was expressed in 59%. Negative emotions in 45% of which despondency/agony (60%) was the most common, followed by emptiness (25%), guilt/shame (15%), hopelessness (10%), and anger (3%). The study of these letters suggests that there are combinations of social, psychological and physical factors that influence a person to suicide, all of which are important in the prevention, assessment, and management of suicide.     

Reasons for living and their protective value: A Turkish sample

Turkey has a comparably low rate of suicide internationally; however, a slow but constant increase is occurring. Deaths due to suicide peak in males among 15–24 and 25–34 year olds. The purpose of the present study was to investigate the various variables (e.g., depression, loneliness) associated with suicide; specifically, the reasons for living. The results indicate, as predicted, that people with more optimism towards life are less prone to depression and loneliness. In this Turkish sample, females were significantly more optimistic, a finding divergent from the international literature to date. Cultural factors and related contradictory findings in the West are discussed (e.g., moral/religious values).     

Elderly suicide in Hong Kong--a case-controlled psychological autopsy study

OBJECTIVE: To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case-controlled psychological autopsy approach. METHOD: Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization. RESULTS: Eighty-six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy-seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One-third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls. CONCLUSION: Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late-life suicide in the Chinese population of Hong Kong, similar to findings in western studies.