Permissive beliefs and attitudes about older adult suicide: a suicide enabling script?

Ethical dilemmas and legal ambiguity in China: a chain mediation model linking suicide rumination, legitimization, and acceptance among acutely-ill adults

Background

This study explores the complex intersection of euthanasia, legal ambiguities, cultural attitudes, and the psychology of suicide among seriously ill patients in China. It addresses the lack of clear legislation on euthanasia and doctor-assisted killing, the impact of cultural and philosophical beliefs, and the evolution of legal and ethical perspectives on suicide. Additionally, it examines the psychological aspects of suicide ideation in acutely-ill patients, focusing on factors like familial burden and loss of dignity.

Method

A survey was conducted with 356 Chinese adults, aged 23 to 64 years, using popular social media platforms in China. The study aimed to reflect a broad spectrum of the adult population in terms of age, education, and professional sectors. The research model involves suicide rumination as an independent variable, acutely-ill patients' suicide acceptance as a dependent variable, and three mediators: cognitive depression, ethical suicide acceptance, and suicide legitimization.

Results

The findings reveal a significant total effect of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance, underlining a robust direct relationship that supports Hypothesis 1. The analysis indicates that Suicide Rumination is a significant predictor of Cognitive depression, explaining approximately 8.05% of its variance, thereby fully supporting Hypothesis 2a. However, the effect of Suicide Rumination on Ethical Suicide Acceptance did not emerge as significant, failing to support Hypothesis 2b, while its impact on Suicide Legitimization was also non-significant, not supporting Hypothesis 2c. Cognitive depression was found to have a substantial effect in the models for both Ethical Suicide Acceptance and Suicide Legitimization, supporting Hypotheses 3a and 3b. In the comprehensive model assessing Acutely-ill Patients' Suicide Acceptance, incorporating all mediators, a significant variance (R-squared = 0.6625) was explained. Notably, Suicide Rumination, Ethical Suicide Acceptance, and Suicide Legitimization all emerged as significant predictors of this acceptance, with varying effects, thus supporting Hypotheses 4a and 4b. The role of Cognitive depression in this model was marginally significant, offering limited support for Hypothesis 4c. Crucially, the indirect effects of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance through different mediational paths varied in significance and impact. The indirect effect via Cognitive depression alone, and through the sequential combination of Cognitive depression and Ethical Suicide Acceptance, were significant, highlighting the nuanced role of these mediators. These findings underscore the importance of considering multiple pathways in understanding the dynamics of Suicide Rumination and its influence on the acceptance of suicide among acutely-ill patients.

Conclusion

This paper presents a comprehensive analysis of the legal, cultural, ethical, and psychological dimensions of euthanasia, doctor-assisted killing, and suicide in China. The findings highlight the significant direct and mediated effects of suicide rumination on the acceptance of suicide among acutely-ill patients. The study contributes valuable insights into the evolving bioethics and the interplay of various factors in the context of end-of-life decision-making in modern Chinese society.

Resilience as a Protective Factor in Older Adult Suicide: A Rapid Review

Nearly 700,000 suicide deaths occur each year. One in every five suicide death occurs among adults over 60 years of age or older. As the aging population increases rapidly, there is a need to understand protective factors to prevent older adult suicide. This study used the rapid review methodology to search literature from 1997 to 2022, examining whether resilience was a protective factor. The literature search was conducted over the following six databases for peer-reviewed journals and gray literature including Abstracts in Social Gerontology, Academic Search Premier, APA PsycInfo, CINAHL Complete, MEDLINE, and SocINDEX with Full Text. A total of six peer-reviewed journal articles met the inclusion criteria. The conclusion of the articles suggested resilience may be a protective factor in older adult suicide. Despite its underpinning, resilience in suicide prevention literature is lacking. More studies should examine resilience and its constructs as part of the effort to prevent older adult suicide.

Measuring Gatekeeper Instructor Comfort to Inform Suicide Prevention Train-The-Trainer Recruitment & Training in Agricultural Communities

Farmers experience psychological distress and suicide at consistently higher rates than workers in other industries. A gatekeeper is an individual who has been trained to recognize warning symptoms of possible suicidal ideations in others. Gatekeeper programs are recognized by the federal Substance Abuse and Mental Health Services Administration as a best practice for suicide prevention. While gatekeeper programs offer promise to addressing the increasing worldwide suicide rate, how to develop these networks in communities with largely ingrained stigma and taboo related to mental health and suicide remains unanswered. Three of this study's researchers were part of the development and pilot of an agricultural community gatekeeper program and questioned how gatekeeper instructor psychological comfort could be conceptualized and operationalized for the purpose of informing gatekeeper instructor recruitment and training. After a thorough review of the literature, the researchers constructed a conceptual developmental model of gatekeeper instructor comfort and created a Gatekeeper Instructor Comfort Measure instrument which was then piloted with Kentucky K-12 and university agricultural educators. The researchers of this study employed the Rasch model to determine whether the developmental model of gatekeeper instructor comfort held together empirically. Infit and outfit mean squares (0.73 to 1.33) indicate that the items measure one construct, or are unidimensional, while person reliability and separation statistics indicate that the Gatekeeper Instructor Comfort Measure is composed of enough items to differentiate respondents into almost four strata of gatekeeper comfort. The Gatekeeper Instructor Comfort Measure's fit to the Rasch model indicates that the instrument meets the requirements of invariant measurement and should serve as a useful measure for other researchers. The instrument's item difficulty hierarchy also serves as a guide for those training gatekeepers on how to target different gatekeeper outcomes sequentially or developmentally. Researchers recommend restructuring item responses to enable greater discrimination between categories and then piloting the instrument again with a more diverse sample. The revised measure could be used pre- and post-gatekeeper instructor training to determine the impact of training on gatekeeper comfort.

Two sides of the same coin? The association between suicide stigma and suicide normalisation

AIMS

Evidence suggests that suicide stigma (i.e. negative attitudes towards persons affected by suicide/suicidality) and suicide normalisation (i.e. liberal attitudes towards suicide) are both associated with increased suicide risk. Despite conceptual similarities and potential interaction, suicide stigma and suicide normalisation have usually been investigated separately. We used cross-sectional data from a community sample to test the association between suicide stigma and suicide normalisation as well as to identify their respective determinants and consequences.

METHODS

Participants were N = 3.269 adults recruited from an established online-panel using quotas to reflect the composition of the German general population with regard to age, gender, education and region. We collected information about suicide stigma, suicide normalisation, intentions to seek help for suicidality, current suicidality, suicide literacy, negative mood and socio-demographic variables. We used regression modelling to determine the association between suicide stigma and suicide normalisation as well as to identify their determinants and consequences.

RESULTS

Suicide stigma and suicide normalisation were inversely associated so that higher suicide stigma scores were linked to lower suicide normalisation. More suicide stigma was associated with reduced intentions to seeking professional help, increased willingness to seek help from family and friends and lower odds to experience current suicidality, however the association between suicide stigma and intentions to seek professional help diminished after controlling for confounding variables. Increased suicide normalisation was linked to reduced intentions to seek help from professionals or family and friends, as well as higher odds to experience current suicidality, even after controlling for confounding variables.

CONCLUSIONS

Our findings suggest that interventions to reduce public suicide stigma are at risk to unintentionally increase suicide normalisation, which appears to be a key barrier to seeking help for suicidality. Future research should therefore identify strategies to improve attitudes towards persons affected by suicidality that avoid normalisation, i.e. do not convey the message of suicide as an acceptable solution for difficult life situations. One strategy with great potential to safely reduce public suicide sigma could be interventions that stimulate interpersonal contact with affected persons sharing their recovery story.

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.

Sociocultural perspectives on suicidal behaviour at the Coast Region of Kenya: an exploratory qualitative study

OBJECTIVES

To explore perceived sociocultural factors that may influence suicidality from key informants residing in coastal Kenya.

DESIGN

We used an exploratory qualitative study design.

SETTING

Mombasa and Kilifi Counties of Coastal Kenya.

PARTICIPANTS

25 key informants including community leaders, professionals and community members directly and indirectly affected by suicidality.

METHODS

We conducted in-depth interviews with purposively selected key informants to collect data on sociocultural perspectives of suicide. Thematic analysis was used to identify key themes using both inductive and deductive processes.

RESULTS

Four key themes were identified from the inductive content analysis of 25 in-depth interviews as being important for understanding cultural perspectives related to suicidality: (1) the stigma of suicidal behaviour, with suicidal victims perceived as weak or crazy, and suicidal act as evil and illegal; (2) the attribution of supernatural causality to suicide, for example, due to sorcery or inherited curses; (3) the convoluted pathway to care, specifically, delayed access to biomedical care and preference for informal healers; and (4) gender and age differences influencing suicide motivation, method of suicide and care seeking behaviour for suicidality.

CONCLUSIONS

This study provides an in depth understanding of cultural factors attributed to suicide in this rural community that may engender stigma, discrimination and poor access to mental healthcare in this community. We recommend multipronged and multilevel suicide prevention interventions targeted at changing stigmatising attitudes, beliefs and behaviours, and improving access to mental healthcare in the community.

The role of context in shaping the relationship between physical health and suicide over the life course

U.S. suicide rates are at a thirty-year high while physical health, as measured by life expectancy and pain, has declined, particularly for those without a college degree. We investigate how these patterns may be related by exploring the role of physical health problems in suicide deaths using 2019 data from the National Violent Death Reporting System. We estimate multilevel logistic regression models to examine (1) how individual risk factors are associated with the likelihood of a physical health circumstance underlying a suicide over the life course and (2) how context – the socioeconomic, health and policy environment of the state in which a decedent resides – may play a role. Physical health circumstances were present in about 20% of all suicides and in over half of suicide deaths for the older population in 2019. A gender crossover effect exists, in which women are more likely to have a physical health problem contribute to a suicide prior to age 60, but men surpass women after age 60 in that probability. Net of individual characteristics, we find significant variation across states in the likelihood of physical health circumstances. For all age groups, physical health circumstances are more likely in states that are less densely populated with weaker gun control laws and higher suicide rates. Among decedents younger than 65, the likelihood is elevated in states with limited health care access. This study highlights the critical interaction between physical and mental well-being, the ways in which that interaction may be experienced differently by gender, and the important role of social safety nets in prevention.

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Poor physical health is an important risk factor for suicide.

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Overall, women and older suicide decedents are more likely to have a physical health circumstance.

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A gender crossover effect exists, with older men more likely to have a physical health circumstance.

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State health and policy environment affects the likelihood of a physical health circumstance.

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Improving physical health and social support is an avenue to suicide prevention.

Language, culture, gender, and intersectionalities in suicide theory, research, and prevention: Challenges and changes

Over the decades suicidology has experienced many challenges and changes. Language, culture, gender, and intersectionalities of experience have been domains of challenge and change. In this article I document my contributions to suicidology's transformation in these domains. These contributions include challenging stigmatizing and biased suicide-language (e.g., expressions like "successful" and "failed" suicide); questioning gender myths of suicidal behaviors (e.g., the myth that women and men are opposites in terms of suicide motives); the gender-paradox-of-suicide idea; and suicide-scripts theory and research. I then describe the evolution of suicide-scripts theory. Suicide-scripts theory builds on evidence that in each culture there are unique situations when suicidal behavior is expected from specific people, using specific methods, and with specific social consequences. The theory posits that these scripts contribute to variations in suicidality across cultures, and within cultures, across sociodemographic groups, intersectionally. Studies using a diversity of methodologies and focusing on a diversity of sociodemographic groups and cultures point to the role of suicide scripts in suicidality. The article concludes with a discussion of the implications, for suicide prevention, of suicide-scripts theory and evidence.

Places of living and places of dying: the case for preventing suicide in residential long-term care

This commentary addresses the increasing public health problem of suicide in later life and presents the case for preventing suicide in residential long-term care settings. We do so by examining this issue from the perspective of three levels of stakeholders - societal, organisational and individual - considering the relevant context, barriers and implications of each. We begin by discussing contemporary societal perspectives of ageing; the potential impact of ageism on prevention of late-life suicide; and the roles of gender and masculinity. This is followed by a historical analysis of the origin of residential long-term care; current organisational challenges; and person-centred care as a suicide prevention strategy. Finally, we consider suicide in long-term care from the perspective of individuals, including the experience of older adults living in residential care settings; the impact of suicide on residential care health professionals and other staff; and the impact of suicide bereavement on family, friends and other residents. We conclude with recommendations for policy reform and future research. This commentary aims to confront the often unspoken bias associated with preventing suicide among older adults, particularly those living with complex medical conditions, and invoke an open dialogue about suicide prevention in this population and setting.

Does self-esteem inflation mitigate mortality salience effects on suicide attitudes?

INTRODUCTION

Suicide stigma is a major barrier to prevention and intervention efforts. Using terror management theory as the guiding framework, the present study examined whether enhancing self-esteem would buffer against suicide stigma and lead to prosocial attitudes and behavior.

METHODS

Experimental methods were utilized in the present study. After being primed with death-related thoughts, participants were randomly assigned to one of two conditions: (1) positive feedback (experimental group) and (2) no feedback (control group). The dependent variables included (1) evaluations of a suicide decedent, (2) intentions to intervene against suicide, and (3) charitable donation behavior toward a suicide prevention organization.

RESULTS

The most consistent findings for the self-esteem boost hypothesis were for the interaction effects of death anxiety and self-esteem boost for the donation allocation task and intentions to intervene against suicide. For participants who were reminded of death, the self-esteem boost intervention mitigated the negative impact of death anxiety on donation behavior (i.e., an average difference of $16.37). Positive feedback for participants with reported low self-esteem also led to increased willingness to intervene against suicide.

CONCLUSION

These findings provide some promising potential for the self-esteem enhancement intervention to attenuate defensive reactions to suicide.

Negative Life Events and Suicide in the National Violent Death Reporting System

Negative life events may be a major precipitating factor for suicide and may differ across sociodemographic groups. We used data from the National Violent Death Reporting System (NVDRS) to explore whether age, gender, current mental illness, and disclosure around suicide predicted adult decedents' precipitants for suicide. Method: An NVDRS data set was used that included 58,247 adults who died by suicide between 2005 and 2010. Multivariate logistic regression was used to explore the relationship between sociodemographic characteristics and precipitating factors while controlling for the impact of other factors. Results: Age group (18-34, 35-64, or ≥ 65), sex, current mental illness, and disclosure around suicide significantly predicted various precipitants. Males were more likely than females to have most precipitating factors, particularly a criminal legal problem (odds ratio [OR]: 2.76), job problem (OR: 1.97), or financial problem (OR: 1.42). While younger decedents had more crises and intimate partner problems, middle-aged decedents had more loss of housing (OR: 1.87) and financial (OR: 1.81) and job-related (OR: 1.35) precipitants than the younger group. The odds of a physical health issue increased successively with each age group. Identified mental illness was associated most strongly with a job (OR: 1.43) or physical health problem (OR: 1.35). Individuals who disclosed suicidal ideation had a higher incidence of all precipitants. Conclusions: The precipitants to suicide appear to vary according to individuals' demographic factors, current mental illness, and disclosure of intent. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

Suicide prevention strategies for older persons-An integrative review of empirical and theoretical papers

AIM

To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults?

DESIGN

Integrative review.

DATA SOURCES

Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019.

REVIEW METHODS

An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis.

RESULTS

Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults' physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.

Beliefs About Suicide Acceptability in the United States: How Do They Affect Suicide Mortality?

OBJECTIVES

Societies develop cultural scripts to understand suicide and define conditions under which the act is acceptable. Prior empirical work suggests that such attitudes are important in understanding some forms of suicidal behavior among adolescents and high-risk populations. This study examines whether expressions of suicide acceptability under different circumstances are predictive of subsequent death by suicide in the general U.S. adult population and whether the effects differ over the life course.

METHOD

The study uses 1978-2010 General Social Survey data linked to the National Death Index through 2014 (n = 31,838). Cox survival models identify risk factors for suicide mortality, including attitudinal and cohort effects.

RESULTS

Expressions of suicide acceptability are predictive of subsequent death by suicide-in some cases associated with a twofold increase in risk. Attitudes elevate the suicide hazard among older (>55 years) adults but not among younger (ages 33-54) adults. Fully-adjusted models reveal that the effects of attitudes toward suicide acceptability on suicide mortality are strongest for social circumstances (family dishonor; bankruptcy).

DISCUSSION

Results point to the role of cultural factors and social attitudes in suicide. There may be utility in measuring attitudes in assessments of suicide risk.

Psychometric Properties of the Suicide Acceptance Questionnaire

Only a few questionnaires are available for measuring attitude towards suicide as a unidimensional construct, i.e. emphasizing acceptance or disapproval of the suicidal act under a set of difficult life circumstances. The aim of this study was to develop the Suicide Acceptance Questionnaire (SAQ) and examine its psychometric properties. A group of 177 Psychology, Medicine and Law students completed the SAQ, Attitudes Towards Suicide questionnaire and a demographic survey. Exploratory factor analysis found the SAQ to have a single factor structure, explaining 55.49% of variance, with high goodness of fit. Owing to the nature of explicit attitudes, the SAQ may have limited power in predicting behavior. The findings indicate that the SAQ demonstrates appropriate reliability and concurrent validity for measuring the acceptance of suicide act. Future research with use of confirmatory factor analysis is needed for determining whether the proposed construct fits data.

Aging with Honor: Examining Ambivalent Ageism and Interpersonal Risk-Factors for Suicide as Explanations for the Honor-Suicide Link

Introduction: Prior research has demonstrated that rates of suicide are greater in more honor-oriented regions of the U.S. (particularly among White men), and that this difference in suicide rates becomes greater as men enter older adulthood. Research into the honor-suicide link has suggested explanatory factors that coincide with the interpersonal theory of suicide, such as untreated depression, heightened risk-taking, and the use of firearms in suicide.

Method: The present study exam-ined ambivalent ageism, permissive attitudes toward suicide, and interpersonal risk factors for suicide as explanations for the honor-suicide link among a sample of 201 American men in midlife and above.

Results: After controlling for participant age and religiosity, participants with greater endorsement of honor ideology but lower levels of honor fulfillment expressed heightened levels of thwarted belongingness—an established interpersonal risk factor for suicide. Additionally, lower levels of honor fulfillment predicted greater anxiety about aging, greater perceived burdensomeness, and more positive implicit attitudes toward youth. Conversely, greater levels of honor fulfillment also predicted more positive attitudes toward older adults.

Discussion: Our results extend previous research on the honor-suicide relationship by demonstrating the utility of integrating the inter-personal theory of suicide with research on cultures of honor.

Rational Suicide in Late Life: A Systematic Review of the Literature

Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians' and population's perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting "silent" suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the "rationality" of patients' decision to die should be avoided, the possibility of rational suicide cannot be precluded.

Physical Health Problems as a Late-Life Suicide Precipitant: Examination of Coroner/Medical Examiner and Law Enforcement Reports

BACKGROUND AND OBJECTIVES

In light of high late-life suicide rates, we compared older suicide decedents with and without physical health problems as a suicide precipitant with respect to their clinical characteristics and suicide means. We also examined health-related concerns noted in summary coroner/medical examiner or law enforcement (CME/LE) reports.

RESEARCH DESIGN AND METHODS

The National Violent Death Reporting System, 2005-2014, provided data (N = 16,924 aged 65 or older). Quantitative data were analyzed using logistic regression models with physical health problems as a suicide precipitant as the dependent variable and depressive symptoms, other precipitating/risk factors, and suicide means as the independent variables. CME/LE reports were analyzed using content analysis and descriptive statistics.

RESULTS

Physical health problems were recorded as a suicide precipitant for 50% of the older decedents. Compared to those without, those with physical health problems as a precipitant were older and more likely to have had depressed mood (adjusted odds ratios [AOR] = 2.39, 95% confidence interval [CI] = 2.21-2.59 for men and AOR = 1.79, 95% CI = 1.50-2.14 for women), disclosed suicide intent, left a suicide note, and used a firearm as suicide means. In CME/LE reports, pain and cancer were mentioned most frequently (29% and 28%, respectively). Dementia-related functional decline, fear of becoming a burden to loved ones, refusal of nursing homes, and loss of independence were also mentioned.

DISCUSSION AND IMPLICATIONS

Study findings call for more targeted, intensive suicide prevention strategies for older adults suffering from debilitating and painful health conditions. Training health care providers and informal support systems to assess suicide risk and in evidence-based intervention plans/guidelines is needed.

Psychometric evaluation of the Questionnaire on Attitudes Towards Suicide (ATTS) in Poland

The Questionnaire on Attitudes Towards Suicide (ATTS) is widely used to evaluate the views of an individual regarding acceptability of suicide and orientation towards suicide prevention. However, recent findings suggest that it requires some revision. The present study examines the factor structure of the ATTS questionnaire in two Polish samples, consisting of 239 students (sample one) and 128 students (sample two) of the helping professions. The previously-established 10-factor model was not supported by confirmatory factor analysis (CFA). Theoretical revaluation of the scale followed by factor analysis suggested that the best fit was provided by a five-factor model accounting for 48.2% of the variance. The adapted Polish ATTS questionnaire showed satisfactory reliability and validity; however, the factor loading patterns and factor structure varied from earlier studies. These improvements in the ATTS theoretical base and construct validity may enhance the utility of the revised scale.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

BACKGROUND

Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower.

AIMS

This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP.

METHOD

Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care.

RESULTS

Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?"

CONCLUSION

Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Few Sex Differences in Hospitalized Suicide Attempters Aged 70 and Above

Relatively little research attention has been paid to sex issues in late life suicidal behaviour. The aim was to compare clinical characteristics of women and men aged 70+ who were hospitalized after a suicide attempt. We hypothesized higher depression and anxiety scores in women, and we expected to find that men would more often attribute the attempt to health problems and compromised autonomy. Participants (56 women and 47 men, mean age 80) were interviewed by a psychologist. In addition to psychiatric and somatic health assessments, participants responded to an open-ended question concerning attributions of the attempt. There were no sex differences in depression and anxiety. Forty-five percent of the men and 14% of the women had a history of substance use disorder (p = 0.02). At least one serious physical disability was noted in 60.7% of the women and 53.2% of the men (p = 0.55). Proportions attributing their attempt to somatic illness did not differ (women, 14.5% vs. men 17.4%, p = 0.79), and similar proportions attributed the attempt to reduced autonomy (women, 21.8% vs. men, 26.1%, p = 0.64). We found strikingly similar figures for depression scores, functional disability and attributions for attempting suicide in older men and women. Larger studies are needed in diverse settings as sex differences might be influenced by cultural context.

Suicide Means among Decedents Aged 50+ Years, 2005-2014: Trends and Associations with Sociodemographic and Precipitating Factors

OBJECTIVE

To examine 1) temporal trends between 2005 and 2014 in the three most frequently used suicide means (firearms, hanging/suffocation, alcohol/drug/medicine overdose) by decedents aged 50+ years and 2) associations of suicide means with sociodemographic and precipitating factors.

METHODS

The National Violent Death Reporting System, 2005-2014, provided data (N = 46,857). Suicide means were identified from ICD-10 codes for underlying cause of death and coroner/medical examiner (CME) reports. Precipitating factors are based on either CME or law enforcement report. Age-group (50-64 and 65+ years) and gender-separate logistic regression analyses were used to examine study questions.

RESULTS

In the 50-64 years age group, each advancing year (i.e., from 2005 to 2014) was associated with a 1% decrease in the odds of firearm use and a 6% increase in the odds of hanging/suffocation among men; a 9% increase in the odds of hanging/suffocation among women; and a 4% decrease in the odds of overdose among each gender. In the 65+ years age group, each advancing year was associated with a 4% increase in the odds of overdose among men. Physical health was a significant factor for firearm use among men (adjusted odds ratio: 1.47; 95% CI: 1.39-1.55) only. Regardless of gender and age, mental health and substance abuse problems and prior suicide attempts were associated with hanging/suffocation and overdose.

CONCLUSIONS

Firearm use decreased among men aged 50-64 years between 2005 and 2014, but its use did not change among the other gender by age groups. With rapidly growing numbers of older adults, routine suicide risk assessments, firearm safety monitoring, and interventions to improve quality of life are needed.

Older Suicide Decedents: Intent Disclosure, Mental and Physical Health, and Suicide Means

INTRODUCTION

This study examined: (1) associations of suicide intent disclosure with depressed mood and health problems; (2) age-group differences in those associations; and (3) relationship between disclosure and suicide means among suicide decedents aged ≥50 years (N=46,857).

METHODS

Data came from the National Violent Death Reporting Systems, 2005-2014. Data analysis was conducted in 2017. Chi-square tests were used to compare disclosers and nondisclosers on sociodemographic and precipitating factors and suicide means. Logistic regression analyses were used to examine the research questions.

RESULTS

The overall disclosure rate was 23.4%. Logistic regression results showed that both depressed mood (AOR=1.57, 95% CI=1.50, 1.65, p<0.001) and health problems (AOR=1.56, 95% CI=1.48, 1.64, p<0.001) were associated with increased odds of disclosure. Compared with decedents aged 50-59 years, those aged 70-79 years and ≥80 years had greater disclosure odds. When interaction terms of age group X health problems were entered in the model, disclosure odds increased among those with health problems in the groups aged 60-69 years (ratio of AOR=1.19, 95% CI=1.06, 1.34, p=0.003), 70-79 years (ratio of AOR=1.29, 95% CI=1.13, 1.48, p<0.001), and ≥80 years (ratio of AOR=1.41, 95% CI=1.20, 1.66, p<0.001). Compared with other suicide means, both firearm use and hanging/suffocation were associated with lower disclosure odds.

CONCLUSIONS

The older the decedents were, the more likely they were to have disclosed suicidal intent, and health problems largely explained their higher odds of disclosure. Healthcare providers need better preparation to screen and aid those in need to prevent suicide. Social support system members should also be assisted in identifying warning signs and linking older adults to services.

Suicide in the Mountain West Region of the United States

Abstract. Background: The Mountain West region of the United States consistently reports the highest rates of suicide in the country. This pattern could reflect a regional culture-of-suicide script in support of suicide that implicitly influences individual's behavior. Aims: The primary aim of this study was to investigate whether suicide rates are elevated in the Mountain West across a wide range of demographic groups, thereby supporting a regional cultural script. Method: Suicide rates in the Mountain West between 1999 and 2014 were compared to the rest of the country across a wide range of demographic categories and levels of population density using the Center for Disease Control Multiple Causes of Death dataset published on the WONDER online database. Results: Suicide rates are elevated in the Mountain West for men and women, all racial groups, all age groups, and at every level of population density compared to the rest of the country. Limitations: Missing and suppressed data, the use of coroner reports, and the arbitrary nature of state and regional boundaries are all discussed as possible limitations to this study. Conclusion: These findings support a broad culture-of-suicide script that is pervasive in this region across demographic groups and all levels of population density.