Regular Article
Suicidal and Death Ideation in Older Primary Care Patients With Depression, Anxiety, and At-Risk Alcohol Use

https://doi.org/10.1097/00019442-200207000-00008Get rights and content

The authors identified correlates of active suicidal ideation and passive death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Participants included 2,240 older primary care patients (age 65+), who were identified in three mutually exclusive groups on the basis of responses to the Paykel suicide questions: No Ideation, Death Ideation, and Suicidal Ideation. Chi-square, ANOVA, and polytomous logistic regression analyses were used to identify characteristics associated with suicidal ideation. The highest amount of suicidal ideation was associated with co-occurring major depression and anxiety disorder (18%), and the lowest proportion occurred in at-risk alcohol use (3%). Asians have the highest (57%) and African Americans have the lowest (27%) proportion of suicidal or death ideation. Fewer social supports and more severe symptoms were associated with greater overall ideation. Death ideation was associated with the greatest medical comorbidity and highest service utilization. Contrary to previous reports, authors failed to find that active suicidal ideation was associated with increased contacts with healthcare providers. Accordingly, targeted assessment and preventive services should be emphasized for geriatric outpatients with co-occurring depression and anxiety, social isolation, younger age, and Asian or Caucasian race.

Section snippets

METHODS

The PRISMe Study (Primary Care Research in Substance Abuse and Mental Health for the Elderly) is a multisite, randomized comparative trial examining two models of care for older persons with depression, anxiety, and at-risk alcohol consumption. The overall goal of the study is to compare the effects of integrated and referral models of behavioral healthcare on engagement, participation, patient outcomes, and cost. A variety of sites and culturally diverse populations are represented by the 11

RESULTS

For the total study sample of 2,240 subjects, responses to the Paykel suicide questions included the following: 1) Life not worth living: 773 (34.5%); 2) Wished you were dead: 518 (23.1%); 3) Thoughts of taking own life: 229 (10.2%); 4) Seriously considered/made plans to take life: 74 (3.3%); and 5) Made an attempt in past 12 months: 13 (0.6%). In aggregate, three groups were defined: No Ideation: 1,390 (62.1%), Death Ideation: 616 (27.5%); and Suicidal Ideation: 234 (10.4%).

Demographic

DISCUSSION

This study describes characteristics associated with suicidal and death ideation in a large sample of older primary care patients with identified psychopathology, including depression, anxiety disorder, and at-risk alcohol use. As such, our findings focus attention on the most common mental health problems that are likely to be associated with greater suicidal ideation. Our objective was to explore the association of suicidal and death ideation with demographic and clinical characteristics and

CONCLUSIONS

One in 10 older primary care patients with depression, anxiety disorder, or at-risk alcohol use experiences active suicidal ideation. Although routine screening for suicidal ideation is unlikely to be a practical, standard part of primary-care clinical practice, data describing risk factors may help healthcare providers target those most in need of more thorough clinical assessment and preventive measures. Our findings suggest that older persons who are at greatest risk of suicidal ideation

References (47)

  • S Barnow et al.

    Epidemiology and psychiatric morbidity of suicidal ideation among the elderly

    Crisis

    (2000)
  • M Heikkinen et al.

    Life events and social support in suicide

    Suicide Life Threat Behav

    (1993)
  • PA Nisbet et al.

    The effect of participation in religious activities on suicide versus natural death in adults 50 and older

    J Nerv Ment Dis

    (2000)
  • Y Conwell et al.

    Completed suicide among older patients in primary care practices: a controlled study

    J Am Geriatr Soc

    (2000)
  • D Goldberg

    General Health Questionnaire (GHQ-12)

    (1992)
  • R Spitzer et al.

    Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 Study

    JAMA

    (1994)
  • R Katzman et al.

    Validation of a Short Orientation-Memory-Concentration Test of Cognitive Impairment

    Am J Psychiatry

    (1983)
  • DV Sheehan et al.

    The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10

    J Clin Psychiatry

    (1998)
  • LS Radloff

    The CES-D Scale: a self-report depression scale for research in the general population

    Applied Psychological Measurement

    (1977)
  • AT Beck et al.

    An inventory for measuring clinical anxiety: psychometric properties

    J Consult Clin Psychol

    (1988)
  • FC Blow

    Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G)

    (1991)
  • JE Ware et al.

    The MOS 36-item Short-Form Health Survey (SF-36), I: conceptual framework and item selection

    Med Care

    (1992)
  • Meyers BS, Sirey J, Bruce ML: NIMH Conference on Improving the Condition of People with Mental Illness: The Role of...
  • Cited by (187)

    • Suicidal behaviour in older age: A systematic review of risk factors associated to suicide attempts and completed suicides

      2021, Neuroscience and Biobehavioral Reviews
      Citation Excerpt :

      Conversely, personality disorders and psychoses were poorly correlated to suicide attempts in older age (De Leo et al., 2001). Depressive and anxiety disorders appeared to have the major load on suicide attempts in older age (Bartels et al., 2002). Mental illness in the form of depression was predominant among the younger females (68 % of cases) and the older males (75 % of cases) (Nowers, 1993).

    • Violence, older adults, and serious mental illness

      2021, Aggression and Violent Behavior
      Citation Excerpt :

      Furthermore, there may not be nursing home units available in certain areas for adults with SMI who also exhibit aggressive behaviors (Lane, 2011). Although suicidal ideation in older adults with major depressive disorder has been well researched (Bartels et al., 2002), there is a modicum of literature on attempted suicide in the elderly with SMI (Chiu, Lam, Pang, Leung, & Wong, 1996). Some literature suggests that individuals with SMI are at greater risk for suicide than the general population (Chen et al., 2011; Conwell, Van Orden, & Caine, 2011; Douzenis et al., 2013).

    View all citing articles on Scopus

    The authors acknowledge the invaluable efforts of Aricca Dums, B.A., in helping to prepare this manuscript.

    PRISMe Study investigators (in alphabetical order): Carolyn Aoyama (HRSA), Pat Arean (Co-PI), Steve Bartels (PI), Hongtu Chen (PI), Henry Chung (Co-PI), Marisue Cody (Co-PI), Giuseppe Costantino (PI), U. Nalla B. Durai (PI), Carroll Estes (PI), Susan Cooley (VA), Jack Fitzpatrick (Co-PI), Brian Goodman (Co-PI), Trevor Hadley (Co-PI), Tim Howell (Co-PI), Ira Katz (Co-PI), Joanne Kirchner (PI), Dean Krahn (PI), Sue Levkoff (PI), Karen Linkins (Co-PI), Maria Llorente (PI), Jim Maxwell (Co-PI), Keith Miles (Co-PI), Robert Molokie (Co-PI), Jack McIntyre (PI), Betsy McDonel Herr (SAMHSA), Mike Nazar (Co-PI), Ed Olsen (VA), David Oslin (PI), Tom Oxman (Co-PI), Andy Pomerantz (Co-PI), Louise Quijano (Co-PI), Melissa Rael (SAMHSA), Pat Sabry (SAMHSA), Bill Van Stone (VA), Heidi Syropoulos (Co-PI), Paul Wohlford (SAMHSA), Cynthia Zubritsky (PI).

    The PRISMe Study is a collaborative research study funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Veterans Affairs (VA), and the Health Resources and Services Administration (HRSA).

    View full text