Reasons for living, meaning in life, and suicide ideation: investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults

The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study

INTRODUCTION

With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack.

METHODS

A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023).

RESULTS

Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels.

DISCUSSION

Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.

Psychological maltreatment, meaning-centered coping, psychological flexibility, and suicide cognitions: A moderated mediation model

BACKGROUND

Mental health problems are currently diversifying, increasing the possibility of suicide. Exposure to psychological maltreatment is one of the factors that increases suicidal cognitions. In addition, psychological flexibility and meaning-centered approaches may be effective in coping with suicidal cognitions.

OBJECTIVE

A hypothesized model was tested to examine the relationships among psychological maltreatment, suicidal cognitions, psychological flexibility, and meaning-centered coping.

METHOD

Data were collected from a sample of 652 participants. Mediation and moderation analyses were conducted to examine the mediating and moderating role of psychological flexibility and meaning-centered coping in the relationship between childhood psychological maltreatment and suicide cognitions among Turkish adults.

RESULTS

The results of the study indicated significant negative and positive relationships between psychological maltreatment, suicide cognitions, psychological flexibility, and meaning-centered coping. The findings suggest that psychological flexibility and meaning-centered coping have a serial mediating effect on the relationship between psychological maltreatment and suicide cognitions. Furthermore, according to the study results, psychological flexibility plays a moderating role both between psychological maltreatment and suicidal cognitions and between meaning-centered coping and suicidal cognitions.

CONCLUSIONS

The study suggests that psychological maltreatment can be considered as a risk factor and meaning-centered coping and psychological flexibility as protective factors in suicide prevention studies.

Obstructive respiratory disease in U.S. veterans: Prevalence, characteristics, and health burden

OBJECTIVE

To examine the psychiatric and physical health burden of obstructive respiratory disease in a nationally representative sample of U.S. Veterans.

METHODS

Secondary data analyses were conducted using data from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. Veterans. Participants self-reported health professional-diagnosed obstructive respiratory disease (i.e., asthma, chronic bronchitis or chronic obstructive pulmonary disease). Veterans who reported obstructive respiratory disease (n = 502) were compared to veterans without this disease but with at least one or more other medical conditions-controls (n = 3169) on measures of sociodemographic, trauma, psychiatric, and physical health characteristics. Multivariable regression analyses examined independent associations between obstructive respiratory disease and psychiatric conditions and physical characteristics.

RESULTS

A total 12.5% of the sample reported a diagnosis of obstructive respiratory disease. Compared to controls, veterans with obstructive respiratory disease were more likely to be female, unmarried/partnered, lower income, residing in the Midwest, receiving VA healthcare, and had greater lifetime and childhood trauma burden. In adjusted analyses, veterans with respiratory disease had 47-91% greater odds of screening positive for current posttraumatic stress, major depressive, and generalized anxiety disorders, and had 48% greater odds of current suicide ideation. They were also more likely to have lifetime nicotine use disorder and had more medical comorbidities and more severe somatic symptoms.

CONCLUSIONS

Obstructive respiratory disease is prevalent among U.S. veterans and associated with significant mental and physical health burden. Results highlight the need for timely screening and treatment for psychiatric and medical conditions that are highly comorbid with obstructive respiratory disease in this population.

Psychometric Evaluation of Brief Reason for Living Inventory for Adolescents (BRFL-A) Instrument in the Indonesian Language

Objectives. The Brief Reason for Living Inventory for Adolescents (BRFL-A) is used to assess protective factors against suicide in non-clinical settings. This study aimed to validate the psychometric properties of BRFL-A in Bahasa Indonesia. Methods. A total of 728 high-school and university students filled BRFL-A questionnaire and the results were analyzed. The reliability, content, convergent, discriminant, and factorial or construct validity, were investigated using content validity index Cronbach's Alpha, while content validity index (CVI), confirmatory factor analysis, and Pearson product-moment correlation were assesed with MSPSS, SIS, INQ-15, and DASS-18. Results. The results showed that the Indonesian version of BRFL-A had good internal consistency, test-retest reliability, as well as content and concurrent validity, supporting both the 1-factor and the 5-factor model of factorial validity. Conclusions. The Indonesian version of the BRFL-A was valid and reliable to measure protective factors against suicide risk among adolescents and young adults in non-clinical settings.

A systematic review of psychosocial protective factors against suicide and suicidality among older adults

BACKGROUND

Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults.

METHOD

First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis.

RESULTS

A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures.

CONCLUSION

Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

Mental pain as a mediator in the association between avoidant attachment and suicidal ideation among older men

OBJECTIVES

In the present study, our aim was to deepen the understanding of suicidality in older men by adopting a biopsychosocial approach. The study focused on older men as they face an elevated risk of suicide, surpassing not only other age groups but also exhibiting higher rates compared to women. We examined the contribution of mental pain as a mediator in the association between attachment avoidance and suicidal ideation among older men, taking into consideration the severity of their physical illnesses.

METHODS

Participants were 200 men in Israel, aged ≥65 years, living in the community and without cognitive impairment. Data collection was based on self-report measures of suicidal ideation (Beck Scale for Suicidal Ideation, BSSI), attachment (Experience in Close Relationships, ECR-R), mental pain (Orbach and Mikulincer Mental Pain Scale, OMMP), and the severity of physical illnesses (Cumulative Illnesses Rating Scale, CIRS).

RESULTS

Mental pain was found to mediate the association between attachment avoidance and suicidal ideation, but only among participants with higher levels of physical illnesses.

CONCLUSIONS

Mental pain should be considered as a complication of an avoidant coping strategy, which increases the risk of suicide among older men, especially those suffering from significant physical illnesses. The theoretical and clinical implications of these findings are discussed.

"Meaning in Life" Mediates the Relationship between Loneliness and Depressive Symptoms among Older Adults during the COVID-19 Pandemic

BACKGROUND

Loneliness was found to be a commonly experienced feeling among older adults during the COVID-19 pandemic and is considered to be a high-risk factor for depressive symptoms. Maintaining meaning in life has been found to be a protective resource for mental health among older adults. The purpose of this study was to examine the mediating effects of an individual's meaning in life in the relationship between loneliness and depressive symptoms among older Korean adults.

METHODS

The data were obtained from a sample of 213 community-dwelling older adults aged over 65. The instruments were the UCLA Loneliness Scale, the Center for Epidemiologic Studies Depression Scale, and the Meaning in Life Questionnaire.

RESULTS

Loneliness was positively associated with depressive symptoms and negatively associated with the presence of and search for meaning among older adults. The presence of meaning mediated the relationship between loneliness and depressive symptoms but the search for meaning did not. The search for meaning mediated the relationship between loneliness and depressive symptoms through the presence of meaning.

CONCLUSIONS

Our study findings suggest that efforts to reduce loneliness and improve meaning in life should be undertaken to prevent depressive symptoms among older adults.

Longitudinal associations between mental health and social environment in older adults: a multilevel growth modeling

OBJECTIVES

This study aimed to assess longitudinal relationships between social environment indicators (social connectedness, social engagement, social contribution) and mental health indicators (depression and anxiety) among community-dwelling adults age 55 years and older.

METHODS

Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N = 2,020; age range = 55-94 years). We developed multilevel growth models to ascertain the relationships of interest, controlling for sociodemographic and physical health factors.

RESULTS

Over the 20-year period of study, lower levels of emotional social support, social integration and social contribution significantly predicted depression and anxiety, whereas social network and social engagement were not significant predictors of these mental health outcomes in older adults. The models also indicated a moderation effect of the number of chronic conditions on the slopes of depression and anxiety.

DISCUSSION

Considering our findings, interventions to enhance social contribution and social connectedness could be effective to help older adults maintain positive mental health, as well as programs that facilitate older adults' connections with their families, communities and health care providers. These interventions must also account for multiple chronic conditions since functional limitations drive declining integration in the community and participation in social activities.

Stress and suicidal ideation in Korean baby boomers: the mediating effect of mindfulness and meaning in life

Stress has been shown to enhance elderly suicidal ideation. However, the effect of mindfulness and meaning in life on the relationship between stress and suicidal ideation in Korean baby boomers are still unknown. This study investigated (a) a significant correlation between the stress, suicidal ideation, mindfulness, and meaning in life, (b) the mediating effect of mindfulness in the association between stress and suicidal ideation, and (c) the serial mediating effect of mindfulness and then meaning in life on the relationship between stress and suicidal ideation. Data were collected from 200 baby boomers (born between 1955-1963) concerning their stress, mindfulness, meaning in life, and suicidal ideation. These findings suggest that if interventions directed at baby boomers can successfully improve their mindfulness and by extension raise their meaning in life, suicidal ideation will decrease within their population.

Identifying the suicidal ideation risk group among older adults in rural areas: Developing a predictive model using machine learning methods

AIMS

The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods.

DESIGN

This study applied an exploratory, descriptive and cross-sectional design.

METHODS

The participants were older adults (N = 650) aged over 65 living in rural areas of South Korea. Self-report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0.

RESULTS

The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity.

CONCLUSION

The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas.

IMPACT

Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings.

REPORTING METHOD

The reporting of this study (Observational, cross-sectional study) conforms to the STROBE statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

IMPLICATION FOR THE PROFESSION AND/OR PATIENTS CARE

Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide.

Mining voices from self-expressed messages on social-media: Diagnostics of mental distress during COVID-19

The COVID-19 pandemic has had a severe impact on mankind, causing physical suffering and deaths across the globe. Even those who have not contracted the virus have experienced its far-reaching impacts, particularly on their mental health. The increased incidences of psychological problems, anxiety associated with the infection, social restrictions, economic downturn, etc., are likely to aggravate with the virus spread and leave a longer impact on humankind. These reasons in aggregation have raised concerns on mental health and created a need to identify novel precursors of depression and suicidal tendencies during COVID-19. Identifying factors affecting mental health and causing suicidal ideation is of paramount importance for timely intervention and suicide prevention. This study, thus, bridges this gap by utilizing computational intelligence and Natural Language Processing (NLP) to unveil the factors underlying mental health issues. We observed that the pandemic and subsequent lockdown anxiety emerged as significant factors leading to poor mental health outcomes after the onset of COVID-19. Consistent with previous works, we found that psychological disorders have remained pre-eminent. Interestingly, financial burden was found to cause suicidal ideation before the pandemic, while it led to higher odds of depressive (non-suicidal) thoughts for individuals who lost their jobs. This study offers significant implications for health policy makers, governments, psychiatric practitioners, and psychologists.

Intent disclosure in late-life suicide: Age group differences in correlates and associations with suicide means

Age-adjusted suicide rates declined from 2018 to 2020. However, suicide rates among older adults, particularly males 75 and older, have continued to rise, and the evidence base for effective interventions to prevent suicide in late life remains limited. One strategy to prevent older adults' suicidal behavior is to intervene when they reveal suicide intent. Previous research found that a significant proportion of older suicide decedents disclosed their suicide intent close to the fatal incident. In this study, based on the 2017-2019 United States National Violent Death Reporting System (NVDRS) data, we examined: (1) correlates of intent disclosure among three age groups (65-74, 75-84, and 85+) of older suicide decedents (N = 17,917; 14,856 men and 3,061 women); and (2) associations of suicide means with intent disclosure and suicide contributing factors. The results show that 19.9% of all suicide decedents aged 65+ (18.7%, 21.0%, and 22.0% in the 65-74, 75-84, and 85+ age groups, respectively) disclosed their suicide intent to their partner, family/friends, and healthcare providers within a month of their death. Multivariable analyses using generalized linear models for a Poisson distribution with a log link showed that physical and mental health, substance misuse, addiction problems, and relationship/other life stressors were associated with a higher likelihood of intent disclosure in the 65-74 and 75-84 age groups. However, only physical health problems were associated with a higher likelihood of intent disclosure among those aged 85 and older. Intent disclosure was not associated with using firearms and poisoning as suicide means but with a lower likelihood of hanging or suffocation. Mental health and substance misuse problems were associated with higher odds of hanging or suffocation and poisoning, and physical health problems and male sex in the 85+ age group were associated with higher odds of firearm use. Suicide prevention strategies for those who have disclosed their suicide intent or are at risk of suicidal behavior should include more patient-centered comfort and palliative care, mental health/substance misuse/addiction treatment, and restriction of access to potential suicide means. More research on older adults who disclose suicide intent and late-life suicide prevention strategies is needed.

Suicidality in the geriatric population

Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.

Examining the Interrelationships Among Suicide Cognitions, Suicidal Ideation, and Theoretically Derived Protective Factors

INTRODUCTION

Several protective factors for mitigating suicidal ideation (SI) such as positive affect, reasons for living, purpose in life, meaning in life, gratitude, grit, optimism, social support, and hope have been identified and received empirical support. However, few studies have examined the interrelationships of these protective factors and the identification of protective factors most closely linked to lower levels of SI may be useful for both theory-building initiatives and improvement of suicide-specific interventions. Network analysis offers an approach for testing the relation among these constructs, SI, and suicide risk factors.

METHODS

A sample N = 557 undergraduate students oversampled for lifetime SI completed a cross-sectional, online survey. The data was used to estimate an undirected, cross-sectional network of the aforementioned protective factors.

RESULTS

The resulting inferred network implicates strong negative influence of suicide cognitions, but not recent SI, and the strong positive influence of presence of meaning in life, trait hope, and low negative affect.

CONCLUSIONS

Implications for dimensionality of SI versus suicide cognitions, targeting presence of meaning in life, trait hope, and negative affect in treatment, and cross-cultural variations in reasons for living are discussed. The study is limited by the cross-sectional and convenience sampling methodology.HighlightsProtective factors may have less direct influence on suicidal ideationSuicide cognitions and the suicidal mode may be of phenomenological importancePresence of meaning and trait hope may be primary targets for suicide interventions.

Self-Identity and Meaning in Life as Enablers for Older Adults to Self-Manage Depression

Depression is the most common mental illness in older adults and is a leading cause of global disability. Generally, those who have a stronger sense of self-identity and find meaning in their lives tend to manage the symptoms of depression better than those who do not. Little is known about the association between self-identity, meaning in life and self-management of depression in older adults. The aim of this grounded theory study was to explicate how older adults with depression attempted to reclaim self-identity in ways that facilitated self-management. Data collection and analysis were informed by Corbin and Strauss' approach to grounded theory. Thirty-two older adults with a formal diagnosis of moderate depression participated in in-depth, semi-structured interviews. The core problem for participants related to their sense that they were not treated as individuals as they sought to receive and adapt to a depression diagnosis. This challenge was conceptualised as Struggling to maintain personal identity as an older adult with depression. By empowering themselves and striving for a meaningful existence, participants strived to master their current circumstances in ways that strengthened their sense of personal identity. This, in turn, supported their efforts to effectively manage their symptoms of depression and employ adaptive coping strategies that optimise well-being. Our findings identify the need for recovery-oriented models of interdisciplinary practice that enhance self-identity and meaning in life in older adults, in ways that support self-management of depression.

Protective effects of reasons for living against suicidal ideation in daily life

How do individuals resist suicidal urges in a crisis? Deterrents for suicide can be conceptualized as reasons for living (RFL), but our understanding of their protective effects is predominantly informed by cross-sectional research. We examined the protective effects of RFL on suicidal ideation (SI) in daily life in a high-risk sample. We also tested whether personality traits moderated the strength of the dynamic RFL-SI link. Adults with a borderline personality disorder diagnosis (N = 153, n_{suicide attempters} = 105) completed a 21-day ambulatory assessment protocol. Daily endorsements of RFL were negatively linked to SI at the within-person but not the between-person level. Whereas suicide attempters endorsed RFL less frequently than non-attempters, the protective effect of RFL was undiminished in this group. Furthermore, RFL's protective effect was particularly pronounced in those with higher average levels of suicidal ideation. While people high on extraversion endorsed RFL more often, this increase was not protective against SI, indicating that RFL reflect heterogeneous underlying psychological processes, only some of which protect against SI.

Entrapment and suicidal ideation: The protective roles of presence of life meaning and reasons for living

OBJECTIVE

The integrated motivational-volitional model of suicide proposes that feelings of entrapment play a key role in the development of suicidal ideation. The model also posits a set of motivational moderators which either facilitate or hinder the development of suicidal thinking when entrapment is present. These motivational moderators include factors such as attitudes, future goals, thwarted belongingness, and social support. Two previously studied protective factors against suicide, reasons for living and life meaning, have received support in suicidology and might serve as motivational moderators in this model.

METHODS

The current cross-sectional study included college students (N=195) oversampled for recent suicidal ideation who took a series of self-report questionnaires online.

RESULTS

Our findings demonstrated that both reasons for living and life meaning are protective against the relation between entrapment and suicidal ideation, especially when presence of life meaning and reasons for living of high. Search for life meaning was found demonstrated a less protective relation with SI severity, particularly when reasons for living were low.

CONCLUSION

Both motivational moderators demonstrated protective relationships with suicidal ideation and may be relevant to suicide prevention strategies. Limitations and future directions are discussed.

Screening for suicide risk among older adults: assessing preliminary psychometric properties of the Brief Geriatric Suicide Ideation Scale (BGSIS) and the GSIS-Screen

OBJECTIVES

To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen).

METHODS

A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173).

RESULTS

Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings.

CONCLUSION

Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.

Meaning in life as a mediator of the associations among depression, hopelessness and suicidal ideation: A path analysis

WHAT IS KNOWN ON THE SUBJECT

The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation. Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression. Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one-point increase in meaning in life score was associated with 0.47-point decrease in depression score and 0.13-point decrease in suicidal ideation score, respectively.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Logotherapy is a meaning-centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression. Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly.

ABSTRACT

Introduction Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method A cross-sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p < .03), and meaning in life had a direct negative association with depression (β = -0.51, p < .01) and indirect association with suicidal ideation through depression; this indirect association was -0.21 (p < .01). Discussion Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice Logotherapy is a meaning-centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation.

Systematic review of psychometric properties and cross-cultural adaptation of the University of California and Los Angeles loneliness scale in adults

This systematic review assessed the psychometric properties and the cross-cultural adaptation of the University of California and Los Angeles Loneliness scale (UCLA-LS) in adults. A systematic search of four electronic databases (PubMed, EMBASE, Scopus, and PsycINFO) was conducted from inception until March 2021. We followed the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for data extraction and evidence synthesis. Eighty-one studies assessed the validity and reliability of the UCLA-LS, translated into many languages, and applied across several countries/societies. Three versions of the 20-item and nine short versions of the UCLA-LS with 3 to 20 questions were identified. High-quality evidence supported the internal structure of the UCLAs: 4, 6, 7 and 10, while low-to moderate-quality evidence supported the construct validity of the UCLAs: 3, 4, 6, 8, 16 and 20. Moderate-quality evidence supported the test-retest reliability of version 3 UCLA-20 with excellent interclass coefficients values of 0.76-0.93. The UCLAs: 4, 6, 7 and 10 had the most robust internal structure and may therefore be the most useful for informing clinicians and social psychologists engaged in assisting those with loneliness.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02494-w.

The role of meaning in life as a protective factor in suicidal ideation among elderly men with physical illnesses

The highest suicide rates are among elderly men. The aim of the present study is to extend previous findings by focusing on meaning in life as a protective factor for suicidal ideation among elderly men. Self-report measures were administered to 170 elderly men aged 65 and over in community. Meaning in life and physical illness predicted suicidal ideation among elderly men. Physical illness moderated the association between meaning in life and suicidal ideation. In the young-old group (ages 65-74), meaning in life predicted suicidal ideation among those who reported higher rates of physical illness. This moderation effect was not found among the older group (aged 75 years and older). The findings of this study highlight the importance of age-differences in studying suicidal ideation among elderly men. Our findings emphasize the importance of cultivating and maintaining meaning in life when coping with chronic illnesses and point at meaning in life as a goal in therapeutic interventions designed to reduce suicidal ideation among elderly.

A Content Analysis of Reddit Users' Perspectives on Reasons for Not Following Through with a Suicide Attempt

Despite a growing understanding of the triggers for suicidal thoughts and behavior, little is known about the mechanisms that prevent people from killing themselves. The goal of the present study was to use publicly available Reddit data to better understand the reasons that people give for not following through with a potentially lethal suicide attempt. Threads containing key terms (e.g., "kill yourself") within the subreddit /r/AskReddit were collected and all top posts from these threads were thematically coded. Across the posts collected, 11 different themes were identified; friends and family, curiosity and optimism about the future, spite, purpose, transience, hobbies, animals/pets, fear of survival, fear of pain, death and/or the afterlife, apathy/laziness, and intervention. Some additional themes were captured in an "other" category, and a twelfth theme, use of pharmaceutical drugs, was identified, but not discussed. These findings provide a broad overview about the proximal protective factors that directly stopped people from making a suicide attempt. They also illustrate the potential for Reddit as platform through which to better understand factors that may help to identify and support those in suicidal crisis. Such insight may help to inform intervention and prevention strategies for suicide and those in suicidal crisis.

Almost Everyone Loses Meaning in Life From Social Exclusion, but Some More Than the Others: A Comparison Among Victims, Voluntary, and Forced Rejecters

Social exclusion has been a major societal concern because it hinders the attainment of needs for belonging and relationship. While we know much about the effects of social exclusion on victims and perpetrators, there is limited insight regarding how different types of rejecters (voluntary vs. forced) might affect important outcomes. The purpose of this study is to bridge this gap and to examine how different types of social exclusion (forced and voluntary) influence meaning in the life of participants. To this end, we conducted two experiments using two social exclusion paradigms: the recall paradigm and the Cyberball game. The results of the two experiments were consistent. Both experiments revealed that (1) the meaning in the life of the victim group and the forced rejecter group (i.e., those who were forced to exclude others) was significantly lower than this of the control group and the voluntary rejecter group (i.e., those choosing to exclude others). There were no significant differences between the victim group and the forced rejecter group, and there were no significant differences between the voluntary rejecter group and the control group. These results reveal that social exclusion not only negatively affects the victims of exclusion but also reduces the meaning in the life of forced rejecters. These findings are specific, and they show that the types of will in exclusion can create differences in the effects of social exclusion on the rejecters.

Determinants of Suicidal Ideation among Older Adults

Abstract. This study examined the relationship of depression and life satisfaction with suicidal ideation among older Iranian adults. In this cross-sectional study, a total of 159 older adults in Tehran (73% community-residing, 60 years or older) participated. The data were gathered using the Beck Scale for Suicidal Ideation (BSSI), the Geriatric Depression Scale (GDS), and the Life Satisfaction Index-Z (LSIZ). According to the results, depression and life satisfaction are significantly related to suicidal ideation; the two variables predict 0.39% of the variance of suicidal ideation in older adults ( p < .01). The interaction between depression and life satisfaction is a stronger predictor of suicidal ideation in older adults than each of the variables alone.

Meaning in life and vagally-mediated heart rate variability: Evidence of a quadratic relationship at baseline and vagal reactivity differences

Higher meaning in life (MIL) consistently predicts better health, but the physiological processes underlying this relationship are not well understood. This study examined the relationship between MIL and vagally-mediated heart rate variability (VmHRV) under resting (N = 77), stressor (n = 73), and mindfulness intervention (n = 72) conditions. Regression was used for MIL-VmHRV analyses at baseline, and longitudinal mixed models were used to examine phasic changes in VmHRV as a function of MIL. Regression revealed a quadratic MIL-VmHRV relationship, and mixed models linked higher MIL to greater stress-reactivity but not enhanced stress-attenuation. MIL and mindfulness did not interact to influence VmHRV recovery after experimental stress. Findings suggest that cardiac vagal tone and cardiac vagal reactivity are linked to MIL, shedding light on the physiology underlying MIL and its health associations.

The relationship of frailty and disability with suicidal ideation in late life depression

OBJECTIVES

Frailty and disability are commonly found in Late Life Depression (LLD) and have been associated with increased depression severity, health comorbidities and mortality. Additionally, physical frailty has been associated with suicide in later life, independent of presence of a mood disorder. The objective of our study was to assess the associations of physical frailty and functional disability with suicidal ideation, controlling for depression severity and demographic factors, in an older depressed sample.

METHODS

This study used data from community-dwelling older adults with major depression. Eligible participants were ≥ 65 years old, completed measures of depression symptom severity (Hamilton Depression Rating Scale-24 item; HDRS-24), current suicidal ideation (Geriatric Suicide Ideation Scale; GSIS), and physical frailty/functional capacity measures.

RESULTS

Participants were 88 older adults with a mean age of 71.5 (SD = 6.0) and 66% of the sample was female. Poorer performance on frailty measures of gait speed (B = .239, p = .003) and muscle weakness (B = -.218, p = .01) were significantly associated with higher levels of suicidal ideation, independent of depression severity and demographic factors. Functional disability was also significantly related to suicide ideation, specifically impairment in financial capacity (B = -.290, p = .008), social interaction (B = .408, p < .001), and communication skills (B = .373, p = .001).

CONCLUSION

Our findings show that, in LLD, frailty and functional disability are significantly associated with higher levels of suicide ideation, independent of depression symptom severity.

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.

Can Physical Design Help Reduce Loneliness in the Elderly? A Theoretical Exploration

BACKGROUND

Over the past several years, a new problem affecting the elderly population has been increasingly reported in popular press-the elderly population is dying as a result of loneliness and related factors at a rate greater than that of lack of medical care. The problem is so pervasive that loneliness is being described as an epidemic.

OBJECTIVE

The objective of this inquiry was to examine whether the physical design of the lived environments could contribute to reducing loneliness in the elderly population.

METHOD

A combination of scoping and conceptual review of published literature was adopted for the study. The process involved multiple phases of searching, and a review was conducted at each stage. Databases targeted include PsycINFO, Academic Search Complete, PsycArticles, Psychology and Behavioral Sciences Collection, and SocINDEX. In all, 44 articles and books were subjected to in-depth analyses of underlying concepts, constructs, relationships, and empirical findings.

RESULTS

Several theories including meaning in life theory, lifespan ego-development theory, symbolic interaction theory, proxemics, and affordance theory suggest that the design of the physical environment may have a role in addressing loneliness in the elderly. A potential explanatory model articulating the causal pathway is presented in this article.

CONCLUSIONS

Between theoretical propositions and empirical literature, there exist grounds to assert that a plausible causal pathway exists between the physical environment and loneliness in the elderly population. The explanatory pathway suggests that the physical design could play both a direct and moderating role in influencing loneliness.

Meaning in Life Predicts Decreased Depressive Symptoms and Increased Positive Affect over Time but Does Not Buffer Stress Effects in a National Sample of African-Americans

Few studies have specifically focused on meaning in life in African Americans and many important questions remain, including whether effects of meaning in life are direct or moderated by levels of stress. In a national sample of 909 African Americans, we tested meaning in life as a prospective predictor of changes in depressive symptoms and positive affect over a 2.5-year period. Controlling for demographics and hassles, meaning in life predicted decreased depressive symptoms and increased positive affect across the span of 2.5 years. Moderation effects were not found for hassles, age, or income. Gender moderated the effect of meaning on positive affect such that effects were stronger for women than for men. These results suggest that, for African Americans, meaning in life appears to robustly protect against future depressive symptoms and promote positive affect over time unaffected by amount of stress experienced or most demographic factors.

The Role of Demoralization and Meaning in Life (DEMIL) in Influencing Suicidal Ideation Among Patients Affected by Chronic Pain: Protocol of a Single-Center, Observational, Case-Control Study

BACKGROUND

Chronic pain is a significant risk factor for suicidal ideation (SI) and suicidal behavior (SB), including a 20%-40% prevalence rate of SI, a prevalence between 5% and 14% of suicide attempts, and a doubled risk of death by suicide in patients with chronic pain compared to controls. In most studies, associations between chronic pain and suicidality are robust, even after adjusting for the effect of sociodemographics and psychiatric comorbidity, and particularly for depressive conditions. A number of specific conditions that can modulate suicidality risk in patients with chronic pain have been investigated, but there is a need for their more specific characterization. Numerous recent studies have shown that demoralization and meaning in life (MiL) constructs affect suicidality as risk and protective factors, respectively. These constructs have been mainly investigated in patients with somatic illness and in community-dwelling individuals who may present with SI or SB independently of a psychiatric diagnosis of depression. However, a paucity of studies investigated them in suicidal patients affected by chronic pain.

OBJECTIVE

The primary objective of this project is to investigate the relationship between demoralization and MiL on SI risk in patients with chronic pain. The secondary objectives are (1) to test whether demoralization can occur independently of depression in patients with chronic pain and SI, (2) to examine whether the expected association between demoralization and SI may be explained by a sole dimension of demoralization: hopelessness, (3) to examine whether the presence of MiL, but not the search for MiL, is associated with less SI, and (4) to explore whether previously described MiL profiles (ie, high presence-high search, high presence-low search, moderate presence-moderate search, low presence-low search, and low presence-high search) emerge in our cohort.

METHODS

This project is a single-center, observational, case-control study-the Demoralization and Meaning in Life (DEMiL) study-conducted by the Division of Clinical Pharmacology and Toxicology, the Multidisciplinary Pain Centre, and the Service of Liaison Psychiatry and Crisis Intervention at the Geneva University Hospitals. Self- and hetero-administered questionnaires were conducted among patients and controls, matched by age and gender. The Ethics Committee of the Canton of Geneva approved the scientific utilization of collected data (project No. 2017-02138; decision dated January 25, 2018). Data have been analyzed with SPSS, version 23.0, software (IBM Corp).

RESULTS

From March 1, 2018, to November 30, 2019, 70 patients and 70 controls were enrolled. Statistical analyses are still in progress and are expected to be finalized in November 2020. To date, we did not observe any unfavorable event for which a causal relationship with the collection of health-related personal data could be ruled out. Results of this study are expected to form the basis for possible prevention and psychotherapeutic interventions oriented toward demoralization and MiL constructs for suicidal patients with chronic pain.

CONCLUSIONS

The interest in exploring demoralization and MiL in chronic pain patients with SI arises from the common clinical observation that experiencing chronic pain often requires a revision of one's life goals and expectations. Hence, the impact of chronic pain is not limited to patients' biopsychosocial functioning, but it affects the existential domain as well. The major clinical implications in suicidal patients with chronic pain consist in trying to (1) delineate a more precise and individualized suicide risk profile, (2) improve detection and prevention strategies by investigating SI also in individuals who do not present with a clinically diagnosed depression, and (3) enhance the panel of interventions by broadening supportive or psychotherapeutic actions, taking into consideration the existential condition of a person who suffers and strives to deal with his or her suffering.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24882.

The efficacy of group logotherapy on community-dwelling older adults with depressive symptoms: A mixed methods study

PURPOSE

This mixed-methods study evaluated a group logotherapy program's efficacy on Korean older adults with depressive symptoms.

DESIGN AND METHODS

An intervention group (n = 23) participated in eight sessions of group logotherapy; a control group (n = 21) received the usual care. Participants completed the pretest, posttest, and 4-week follow-up questionnaires. Ten participants also had focus group or individual interviews.

FINDINGS

A linear mixed model showed significant differences between groups in terms of changes in purpose in life, depression, self-esteem, and quality of life over time. These quantitative findings were supported and enriched by qualitative data.

The Living Ladder: Introduction and Validity Over 6-Month Follow-Up of a One-Item Measure of Readiness to Continue Living in Suicidal Patients

OBJECTIVE

The ability to predict suicide outcomes is limited by the lack of consideration of protective factors. This study examined the validity of the Living Ladder, a measure of readiness to continue living among individuals thinking of suicide.

METHODS

The Living Ladder consists of one item that assesses an individual's readiness to continue living when thinking about suicide. Participants (N = 130) completed the Living Ladder in-person at baseline and by-phone at 1-, 3-, and 6-month follow-up. The prospective association of the Living Ladder with suicidal ideation and risk for a suicide attempt was examined using models adjusting for baseline ideation and suicide attempts, respectively.

RESULTS

Each rung on the Living Ladder was associated with 18% lower likelihood of suicidal ideation, OR (95% CI) = 0.82 (0.68, 0.96), and less severe suicidal ideation among those with ideation. Scores >2, indicating contemplation of living, were associated with 64% lower risk for a suicide attempt, HR (95% CI) = 0.36 (0.13, 0.98). Findings for suicidal ideation were replicated when administered by-phone.

CONCLUSIONS

The Living Ladder is a one-item measure that is prospectively associated with suicidal ideation and suicide attempts. Findings support the relevance of motivation to live to suicide outcomes.

Reasons for living among those with lived experience entering the suicide prevention workforce

This study explored reasons for living among those with lived experience of suicide entering the suicide prevention workforce. The study recruited 110 participants from two Roses in the Ocean training programs (79% female, mean age 46.5). Responses to open-ended survey questions about reasons for living were analyzed using qualitative content analysis method. Connection to others and service were the most commonly stated reasons for living. Other categories included orientation toward future, life, self, pleasure, and spiritual reasons and values. These findings can be used in further research and design of support programs for peer specialists.

Aging and Feeling Valued Versus Expendable During the COVID-19 Pandemic and Beyond: a Review and Commentary of Why Mattering Is Fundamental to the Health and Well-Being of Older Adults

The current commentary and review examines the potentially protective role of feelings of mattering among elderly people during typical times and the current atypical times associated with the COVID-19 global pandemic. Mattering is the feeling of being important to others in ways that give people the sense that they are valued and other people care about them. We contrast this feeling with messages of not mattering and being expendable and disposable due to ageism, gaps in the provision of care, and apparently economically focused positions taken during the pandemic that disrespect the value, worth, and merits of older persons. We provide a comprehensive review of past research on individual differences in mattering among older adults and illustrate the unique role of mattering in potentially protecting older adults from mental health problems. Mattering is also discussed in terms of its links with loneliness and physical health. This article concludes with a discussion of initiatives and interventions that can be modified and enhanced to instill a sense of mattering among older adults. Key directions for future research are also highlighted along with ways to expand the mattering concept to more fully understand and appreciate the relevance of mattering among older adults.

Testing the Effectiveness of a Salutogenic Model for Reducing Suicidal Tendencies in a Population of Elderly and Young Adults

Suicide is a leading cause of mortality worldwide, with the elderly having the highest suicide rates. This study tests the effectiveness of a salutogenic model in normative elderly people compared with young adults in protecting against risk behaviors and suicidal tendencies, based on two variables: locus of control and meaning in life (mediating variable between locus of control and suicidal tendency). Participants were 191 people aged 65 to 100 years and 200 young adults aged 18 to 28 years old. Participants completed questionnaires on locus of control and purpose in life and were assessed for suicidal tendencies. Findings reveal a negative effect of age on locus of control, purpose in life, and a negative correlation between purpose in life and internal locus of control and suicidal tendency. Purpose in life mediates between internal locus of control and suicidal tendency in both populations. The salutogenic model has significant implications and can be used to reduce suicidal tendencies.

Meaning in life as a protective factor against suicidal tendencies in Chinese University students

BACKGROUND

A substantial increase in rates of suicide worldwide, especially among late adolescents and young adults, has been observed. It is important to identify specific risk and protective factors for suicide-related behaviors among late adolescents and young adults. Identifying specific factors across the masses, not only in the Western, but also in the Asian context, helps researchers develop empirically informed intervention methods for the management of protective and risk factors of suicide.

METHODS

In the current study, 2074 students (706 males), filled out the Meaning in Life Questionnaire, with subscales of Search for Meaning (MLQ-S) and Presence of Meaning (MLQ-P); the Future Disposition Inventory-24 (FDI-24), with subscales of Positive Focus (PF), Suicide Orientation (SO), and Negative Focus (NF); and the Beck Hopelessness Scale (BHS). These scales measure protective and risk factors that are linked to suicidal behaviors; while suicidal behaviors were measured by the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Mediation analyses were performed to test the models with both the MLQ-S and MLQ-P as the mediators between a) hopelessness, as measured by BHS and suicidal behaviors; and b) PF, SO, and NF, as measured by FDI-24, and suicidal behaviors.

RESULTS

We found that only MLQ-P mediated the relation between hopelessness and suicidal behaviors; while both MLQ-P and MLQ-S mediated PF, SO, and NF (as measured by FDI-24), and suicidal behaviors, respectively.

CONCLUSION

Meaning in life, including both the presence of meaning in life and search for meaning, can be good protective factors against suicidal behaviors.

Enhancing the Assessment of Resiliency to Suicide Ideation among Older Adults: The Development and Initial Validation of the Reasons for Living-Suicide Resiliency Scale (RFL-SR)

Objectives: To derive a brief late-life suicide resiliency scale from the 69-item Reasons for Living Scale-Older Adult version (RFL-OA).Methods: We conducted a series of secondary analyses of RFL-OA data (N = 204) from a dataset combining: 1. A follow-up assessment of nursing home residents in the Geriatric Suicide Ideation Scale (GSIS) development study; 2. A trial of Interpersonal Psychotherapy (IPT) with suicidal older adults; 3. A longitudinal study of risk and resiliency to late-life suicide ideation. We specifically assessed the distributions of RFL-OA items and their associations with suicide ideation and behavior to create an RFL-Suicide Resiliency subscale (RFL-SR); we then tested the psychometric properties of this measure's items drawn from the larger RFL-OA.Results: Nine RFL-OA items were significantly associated with suicide ideation and history of suicide behavior and were not highly correlated with social desirability. Psychometric analyses supported the internal consistency, test-retest reliability, and construct validity of this scale.Conclusions: The items of the RFL-SR demonstrated strong psychometric properties with older adults in clinical and community settings.Clinical Implications: The RFL-SR may make a useful addition to suicide risk assessment in gerontological research and clinical practice.

A Psychometric Assessment of the Suicidal Behaviors Questionnaire (SBQ-5) and Geriatric Suicide Ideation Scale-Screen (GSIS-screen) in Middle-Aged and Older Men

Objectives. To investigate the psychometric properties of the five-item Suicidal Behaviors Questionnaire (SBQ-5) and the Geriatric Suicide Ideation Scale-Screen (GSIS-Screen, submitted) among community-residing middle-aged and older men.Methods. The SBQ-5 and GSIS-Screen were administered to 93 men, 55 years or older, who participated in an eligibility assessment (Time 1) for an upstream psychological intervention study to prevent the onset of suicide ideation among men struggling to transition to retirement. Eligible participants later completed the full GSIS and measures of depression and hopelessness at a pre-group assessment (Time 2).Results. The SBQ-5 was positively associated with the GSIS-Screen at the eligibility assessment. Internal consistency for both measures was low but acceptable. Time 1 scores on both screens predicted suicide ideation at Time 2, controlling for the intervening time lag and for baseline cognitive and physical functioning. Only the GSIS-Screen uniquely predicted future depression and hopelessness ratings.Conclusions. The SBQ-5 and the GSIS-Screen have acceptable psychometric properties among middle-aged and older community-residing men; the GSIS-Screen is more closely associated with later-life suicide risk factors.Clinical Implications. Brief screening tools may be of use in effectively identifying suicide ideation in community-residing middle-aged and older men.

Determinants of Suicide-related Ideation in Late Life Depression: Associations with Perceived Stress

Objectives: Perceived stress is emerging as a potential contributing factor in suicide-related ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity.Methods: This study used data from community-dwelling older adults aged ≥65 with a current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale), and perceived stress (Perceived Stress Scale).Results: Participants were 225 older adults with a mean age of 71.4 (SD = 5.6). Sixty-five percent of the sample was female. Fifteen percent of the variance in suicidal ideation was accounted for by lower education (p = .03), male sex (p = .03) and higher current perceived stress (p < .001). Specifically, stress accounted for 12% of the variance.Conclusions: Perceived stress is an important avenue to increase identification of individuals with a higher risk of suicide-related ideation among older adults with a current diagnosis of major depression.Clinical Implications: Screening for perceived stress may allow for improved screening and prevention of suicidal activity in depressed older adults.

Predictors of Passive and Active Suicidal Ideation and Suicide Attempt Among Older People: A Study in Tertiary Care Settings in Thailand

PURPOSE

This study compared predictors of passive suicidal ideation (SI), active SI, and suicide attempt (SA) among elderly Thai patients in tertiary care settings.

PATIENTS AND METHODS

Psychiatric diagnoses and suicidality of 803 older people were assessed using the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV-TR. All participants completed the Montreal Cognitive Assessment, multidimensional scale of perceived social support (MSPSS), 15-item Thai geriatric depression scale (TGDS-15), 10-item perceived social scale and the Core Symptoms Index. The chi-square test, t-test and ANOVA were used for bivariate analysis of predictors of specific suicidality types. Multiple logistic regression was used to determine the predictors for each type of suicidality.

RESULTS

The patients' mean age was 69.24 ± 6.90 years, and the majority were female (69.74%). Passive SI, active SI and SA were found among 20.42%, 3.74% and 2.37%, respectively, of the patients. Major depressive disorder (MDD) was a predictor of both passive and active SI (OR = 2.06 and 3.74, respectively). Other predictors of passive SI included hypomania (OR = 8.27) and positive score on the TGDS-15 (OR = 1.29). Predictors of active SI included agoraphobia (OR = 6.84) and hypomania (OR = 7.10). Predictors of SA included a family history of alcohol dependence (OR = 14.16), a history of depression (OR = 4.78) and agoraphobia (OR = 19.89). Surprisingly, hypertension and self-reported anxiety symptoms were protective factors for passive SI (OR = 0.51 and 0.85, respectively). Likewise, MSPSS was a protective factor for SA (OR = 0.90).

CONCLUSION

Predictors of each type of suicidality differed. MDD was the main predictor for SI; however, agoraphobia and poor perceived social support were more pronounced among individuals with SA. Further investigation, especially in longitudinal fashion, should be warranted.

Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement

Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.

The Meaning in Life in Suicidal Patients: The Presence and the Search for Constructs. A Systematic Review

Background and Objectives: Research on suicidal behavior (SB) has frequently focused more on risk factors than protective factors. Since the historic works of Viktor E. Frankl, who inquired how some Nazi concentration camps prisoners maintained their will to live though confronted with pervasive absurdity, Meaning in Life (MiL) has been interpreted as a potent resiliency factor. MiL then declined along a multitude of theoretical perspectives and was associated with various functioning domains of the individual. Surprising, few studies investigated the role of MiL on SB. We aimed to review and synthetize current literature on possible associations between MiL and SB, which included suicidal ideation (SI), suicidal attempts (SA), and completed suicide, focusing on two MiL constructs (the presence of MiL and search for MiL) from the Michael F. Steger’s recent conceptualization. Material andMethods: A systematic strategy following PRISMA guidelines was used to search for relevant articles in Pubmed/MEDLINE, Scopus, PsycINFO, and ScienceDirect (January 1980–February 2019) and yielded 172 articles, 37 of which met our inclusion criteria. Results: MiL emerged as a protective factor against SI, SA, and completed suicides, directly or through mediation/moderation models with other SB-related variables. When distinguishing the presence of MiL and the search for MiL, a consensual protective impact was described for the former. Data for the latter were less consistent but rather oriented towards a non-protective impact Conclusions: These findings could have clinical repercussions for SB prevention, in both suicide risk assessment refinement and psychotherapeutic interventions. Further research is needed to examine the dynamic interplay of the two constructs.

A Shortened Version of the Reasons for Living-Older Adults Scale for Clinical and Research Utility

BACKGROUND AND OBJECTIVES

Older adults have elevated suicide rates, and identification of protective factors, such as reasons for living, is important in preventing suicide. The Reasons for Living-Older Adults scale (RFL-OA) is a 69-item measure of these protective factors in late life, which yields good psychometric properties. However, its length limits its utility in some clinical and research contexts where a shorter measure is ideal. The objective of this study was to create a shortened version of the RFL-OA.

RESEARCH DESIGN AND METHODS

First, data collected previously during validation of the original RFL-OA (n = 199, age 65 and older, 65% female) were used to select 30 items, spanning all content areas, that were highly endorsed. Second, new data were collected (n = 219, age 60 and older, 52% female) with the 30-item RFL-OA and measures of depression, hopelessness, suicidal ideation, religiosity, health, and social desirability to examine the measure's internal consistency and convergent and discriminant validity.

RESULTS

Scores on the 30-item RFL-OA exhibited strong internal consistency. The short RFL-OA demonstrated good convergent validity via significant, moderate correlations with suicidal ideation, hopelessness, depression, and religiosity. It demonstrated adequate discriminant validity via only small correlations with disability, subjective health, and social desirability.

DISCUSSION AND IMPLICATIONS

The shorter RFL-OA has good psychometric properties among community-dwelling older adults. It may have greater utility, compared to the original 69-item measure, for clinicians and researchers with limited time but who want to assess protective factors against suicidal behavior in late life.

Wisdom as the Mediator in the Relationships Between Meaning in Life and Attitude Toward Death

The goal of the presented research was to investigate if wisdom plays a mediating role in the relationships between meaning in life and the attitude toward death in the period of middle and late adulthood. A study was carried out that included 567 persons aged 40 to 75 years. Three measures were used: Personal Meaning Profile, Three-Dimensional Wisdom Scale, and Death Attitude Profile-Revised. The conducted analyses allowed the authors to confirm the mediating role of wisdom in the relationships between meaning in life and fear of death as well as death avoidance in persons during the period of middle and late adulthood.