To compare differences in pain, depression, function, and informal caregiving pre-major and post-major elective surgery among older adults with and without serious illness; and determine whether serious illness was independently associated with increasing pain, depression, assistance in activities of daily living (ADLs) and informal caregiving postsurgery.

The American College of Surgeons has endorsed the integration of palliative care (PC) into surgical care in adults with serious illness but targets for PC during surgical episodes such as pain, depression, function, and informal caregiving are understudied.

We used Health and Retirement Study-linked Medicare data (2008 to 2018) to identify older (≥66 years) adults with and without serious illness who had major elective surgery. We performed difference-in-difference analysis to measure changes in pain, depression, function, and informal caregiving presurgery and postsurgery between groups. We tested associations between serious illness and changes in pain, depression, function, and informal caregiving using multivariable regression.

Among 1896 adults who had major surgery, 1139 (60%) were seriously ill. Compared with adults without serious illness, those with serious illness had greater baseline pain (43% vs 38%), depression (22% vs 13%), assistance with ADLs (12% vs 0%,) and informal caregiving (18% vs 4%); and, greater increases in assistance with ADLs presurgery and postsurgery (difference-in-difference: 6%, 95% CI: 3.7 to 8.3). Serious illness was independently associated with increasing pain [odds ratio (OR): 1.6, 95% CI: 1.1 to 2.2], depression (OR: 1.5, 95% CI: 1.1 to 2.2), assistance with ADLs (OR: 2.1, 95% CI: 1.3 to 3.4), and informal caregiving (OR: 2.1, 95% CI: 1.4 to 3.1) postsurgery.

Most older adults having elective surgery are seriously ill. Pain, depression, function, and caregiving are targets for PC to improve post-surgical outcomes.

Inpatient suicide is a significant problem, accounting for the third-highest ratio(17.8 %) of suicides in South Korea in 2017. We aimed to investigate the characteristics of inpatient suicides using national data, evaluate risk factors, and provide recommendations for suicide prevention.

This nationwide case-control study utilized national data on all inpatient suicides from police investigations between 2013 and 2017. A total of 4998 individuals were included, comprising 833 inpatient suicides and 4165 controls. Inpatient suicide risk factors were assessed through cross-tabulations and logistic regression analyses.

Among eight hundred thirty-three individuals died by suicide in hospitals; most were male (74.9 %), older than 60 years (61.3 %), married (43.0 %), and unemployed (85.1 %). The primary method of inpatient suicide were jumping from a height (49 %), followed by hanging (39.7 %). Major depressive disorder was the most prevalent psychiatric diagnosis among inpatient suicides. The risk of inpatient suicide was significantly higher in patients with schizophrenia, dementia, and alcohol use disorder.

Effective management of hospital facilities and environments is essential to prevent inpatient suicides. Nursing hospitals treating patients with dementia require more rigorous psychiatric evaluations and facility safety standards. We recommend implementing crisis interventions and comprehensive psychiatric assessments to prevent inpatient suicide.

After a slight decline in suicide rates during the COVID-19 pandemic, suicide rates and suicide attempts in the U.S. have been increasing again in 2022 and 2023. Compared to younger age groups, the 50+ age group has significantly higher rates of serious medical outcomes from suicide attempts. In this study, we examined the medical outcome severities associated with different classes of substances involved in suicide attempt cases age 50 and older who were reported to poison centers.

We used the America's Poison Center's National Poison Data System from 2016 to 2023 (N = 335,171 cases age >50). Following descriptive statistics on the characteristics of suicide attempters and involved substances by medical outcomes (no/minimal effects, moderate effects, major effects, death, and unable to follow), we fitted multinomial and binary logistic regression models to examine the associations of medical outcomes with involved substances.

Of all cases, 22.5% used antidepressants, 21.1% benzodiazepines, 16.4% cardiovascular drugs, and 12.5% prescription opioids; 44.1% had no/minimal effect, 37.9% had a moderate effect, 12.5% had a major effect, 1.2% resulted in death, and 4.4% were unable to follow, but the proportions of major effects and death were higher in 2022-2023 than in 2016-2017. Tricyclic antidepressants were associated with the highest risks of major effects [relative risk ratios (RRR) = 5.57, 95% CI = 5.26-5.90] and death (RRR = 4.26, 95% CI = 3.67-4.94). Large RRRs were also shown for bupropion and serotonin-norepinephrine reuptake inhibitors for major outcomes and death. Cardiovascular drugs, opioids, and muscle relaxants were also associated with consistently higher risks of moderate and major effects and death. Our results also show that older ages were associated with higher death rates and that female sex was associated with higher odds of moderate/major effects compared to minimal effects but lower odds of major effects/death.

Healthcare providers, including pharmacists, can play an important role in promoting medication safety for older adults. Healthcare workers need training in assessing and recognizing signs of suicide risk in older adults who are prescribed antidepressants and sedatives. Our findings also point to the importance of better non-pharmacological chronic pain management than reliance on opioids.

Individuals with physical disabilities are at a higher risk of suicide due to daily activity limitations and dependency on others. Family relationships are important to their mental health and well-being. This study investigated the impact of changes in the family relationship status of physically disabled individuals on suicidal ideation.

We used data from the Disability and Life Dynamics Panel for 2018-2022. A total of 3,704 individuals were used in the analysis. Family relationships were classified into four groups: 1) good → good, 2) poor → good, 3) good → poor, and 4) poor → poor. We assessed suicidal ideation and attempts based on self-reported questionnaires. A generalized estimating equation model was used to analyze the impact of changes in family relationships on suicidal ideation in people with physical disabilities.

Individuals with physical disabilities whose family relationships declined were 1.63 times more likely to have suicidal ideation (95% CI 1.22-2.19) compared to those with consistently good family relationship. Among the subfactors of family relationships, family problem-solving ability showed the strongest association with suicidal ideation when it deteriorated (OR 1.34, 95% CI 1.03-1.74). Individuals with consistently poor family relationships were 1.78 times more likely to have suicidal ideation alone (95% CI 1.33-2.38) and 2.29 times more likely to have both suicidal ideation and attempts (95% CI 0.89-5.93).

Our findings suggest the importance of addressing family relationships in suicide prevention strategies and mental health interventions for individuals with physical disabilities.

Depressive disorders in older people are often accompanied by thoughts of their own death and the specific wish to die. Therefore, it can be assumed that depressive older people will express the wish for assisted suicide more frequently if legal provisions have been made. The following aspects must be taken into account when examining the decision-making capacity of those affected: depressive disorders can be reversible. Severe depressive disorders can be accompanied by an impaired capacity for judgment and making decisions, which rules out the possibility of making decisions of one's own free will. Particularly in old age, somatic comorbidities and an increased risk of loneliness are often found, which can additionally promote suicidal ideation. Without comprehensive assessments it will not be possible to clarify the actual autonomy of the will and it will be difficult to assess the permanence of the decisions made. It is also conceivable that the legal expert opinion could come to a different conclusion than the treating physician, who has followed the course of the illness during various phases of the patient's life and observed many changes in the patients will. In summary, it is currently not clearly recognizable in what form the assessment of free will could be organized in connection with possible legal regulations on assisted suicide, as long observation periods would be required for an adequate assessment.

It is important to know predictors of long-term course over time of suicidal thoughts and ideation in depressed older persons.

In this study, 378 depressed older persons were interviewed at baseline, and after 2 and 6 years to evaluate the presence of depressive disorder. The Inventory of Depressive Symptomatology (IDS) was administered every 6 months for 6 years. Latent Class Growth Analysis was performed on the IDS item on suicidal ideation to identify subgroups with different trajectories.

Five subgroups with suicidal ideation trajectories were identified: 1) severe, transient (10.9 %), 2) severe, persisting (8.0 %), 3) mild, but increasing (14.9 %), 4) moderate, persisting (35.6 %), and 5) no thoughts (30.6 %). Mixed model analysis showed that trajectories were related to 6-year course of depressive symptoms. Yet, suicidal ideation or thoughts of loss of meaning of life were still present in 22.7 % and 17.4 % of those who remitted after 2 and 6 years. Independent of baseline depressive symptom severity, loneliness, childhood trauma, history of suicidal ideation or attempt, openness to experience, earlier age of depression onset, anxiety symptom severity and worse mastery predicted worse trajectories.

47 % dropped out at 6-years follow-up, we did not distinguish between thoughts of death and suicide, we did not assess death by suicide.

Although trajectories of suicidal ideation and thoughts of loss of meaning of life were strongly related to the course of depression severity, they also appear after remission. Clinicians should be vigilant for suicidal ideation or death wish, even after remission of depression.

The rapid aging of the global population presents pressing public health challenges, notably an increase in suicide rates among older adults. Despite this critical issue, there is a scarcity of comprehensive assessments regarding the existing literature on suicide within this demographic. This study seeks to employ bibliometric analysis and knowledge mapping to elucidate prevailing research trends and the overall status of this field.

We performed a comprehensive computer-based search of the Web of Science Core Collection to identify relevant articles and reviews concerning suicide in the elderly. A bibliometric analysis was conducted, examining various aspects including countries or regions, institutions, authors, journals, keywords, and references. This analysis utilized tools such as CiteSpace, VOSViewer, Pajek, and Excel 365 to facilitate a thorough assessment.

The analysis covered 1,116 publications from 2005 to 2024. The annual number of publications showed a fluctuating upward trend, with notable decreases in 2007, 2012, 2015, 2017, and 2022, and increases in 2009, 2013, 2016, and 2019, peaking at 121 in 2021, with citations reaching 4,741 in 2022, but declining since then. The United States stands out as the most productive and influential country in the field, boasting the highest number of publications and citations. The country is home to institutions leading in both publication and citation metrics. Prominent authors contributing significantly to this domain include Conwell Yeates, Van Orden Kimberly A., and Waern Margda. Key journals disseminating crucial research are the Journal of Affective Disorders, American Journal of Geriatric Psychiatry, and Lancet. Frequent keywords in this field encompass depression, suicidal ideation, suicide, older-adults, risk, risk factors, prevalence, older adults, ideation, behavior, health, mental health, life, age, people, prevention, symptoms, scale, population, and elderly. The contemporary research emphasis is primarily on identifying, treating, and preventing the suicide risk associated with depression in older adults.

This study highlights the growing research focus on suicide in older adults, particularly related to depression and the identification, treatment, and prevention of suicide risk. The findings underscore the need for targeted prevention strategies and further investigation in this critical public health area.

Many psychiatric and somatic comorbidities increase the risk of suicidal behavior, but the effect of co-existing comorbidities is sparsely elucidated. We described co-existence of psychiatric and somatic comorbidities and the influence of the combined comorbidity burden on the risk of suicidal behavior.

We defined two case populations above 10 years in the Danish health registries: those who 1) died by suicide (2010-2020) and 2) had an incident suicide attempt (2010-2021). Co-existing somatic and psychiatric comorbidities and relative odds of suicidal behavior at increasing comorbidity burden were assessed.

Among 5.9 million Danish citizens (2021), 6,257 individuals died by suicide whereas 30,570 had an incident suicide attempt. More than half had ≥2 co-existing psychiatric and/or somatic comorbidities. Of those who died by suicide, 18% had co-existing mood disorders and stress disorders, while 5% had both mood disorders and cancer. An 88-fold increase of odds for attempting suicide and a 35-fold increase of odds for suicide were observed among those with the highest combined burden of somatic and psychiatric comorbidities relative to those without. The presence of somatic comorbidities seemed to protect against suicide in older individuals.

Psychiatric and somatic comorbidities commonly co-exist in individuals with suicidal behavior. Higher combined burden of psychiatric and somatic comorbidities increased the odds of suicidal behavior, though the presence of somatic diseases had a potential protective effect on the risk of suicide in older individuals. This warrants collaboration and enhanced awareness of suicidal behavior risks across somatic and psychiatric departments.

Older people (people aged 65 years and older) have high rates of death by suicide, and self-harm is a major risk factor for suicide. While rates of self-harm decrease with age, rates of suicide increase among this age group. The overall aim of this research project is to identify real-life evidence of the characteristics associated with older people who present with self-harm and suicidal ideation to emergency departments in Ireland. In examining the variables associated with self-harm, we may be better able to identify the characteristics of older adults who are at highest risk, including those presenting with high lethality attempts.

Our data are a cohort study of older people in Ireland involving two workstreams. The first will use a 5-year cohort of data from the National Clinical Programme for Self-Harm and Suicide-related Ideation (NCPSHI) which comprises over 70 000 presentations. The second workstream will use a 15-year cohort of electronic patient records from the Mater Misericordiae University Hospital (MMUH) comprising over 30 491 presentations (900 aged 65 years and older) to collect more detailed information on characteristics of older people presenting with self-harm and suicidal ideation.

This study has received full ethical approval. The Clinical Research Ethics Committee of the MMUH approved the MMUH workstream-Reference number: 1/378/2327 TMR. Ethical approval for the NCPSHI workstream has been granted by the University College Dublin's Office of Research Ethics.Our findings will be disseminated via peer-review publications and presentations to the scientific community, along with reports for clinicians and policymakers.

According to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.

To (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response-like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.

This cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.

Thirty-one specific medical conditions as well as prior mental disorder.

The main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.

A total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response-like relationship between the disability burden of medical conditions and suicide.

Medical conditions are generally associated with increased risk of suicide in a dose-response-like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.

Schizophrenia is associated with an increased risk of suicide. Few studies have investigated the risk of suicide across different ages, likely due to limitations around sample size.

From the National Health Insurance Research Database in Taiwan, this study identified 195,787 patients with schizophrenia from January 1, 2000, to December 31, 2019. During the study period, 3848 patients died from suicide. We calculated the standardized mortality ratio (SMR) for suicide stratified by age. In this age-stratified, nested case-control study, risk set sampling was used to match each case with 4 living controls by age, sex, and the year of the first diagnosis with schizophrenia. Conditional logistic regression was used for estimating age-stratified risk profiles.

The SMR was the highest in the <25 years age group (52.8) and inversely correlated with age. Unemployment was associated with an increased risk of suicide in the 25 to 34, 35 to 44, 45 to 54, and 55 to 64 years age groups. Depressive and sleep disorders before suicide were more common among suicide cases with schizophrenia than among controls across all age groups. Drug-induced and alcohol-induced mental disorders were significantly associated with suicide but were observed only in the age group younger than 54. Heart disease, pneumonia, and moderate or severe renal disease were risk factors for suicide in the age groups less than 65.

The risk factors for suicide differ by age. This study's findings can be used to optimize health-care interventions for preventing suicide in patients with schizophrenia.

Patients receiving palliative care often express a desire to die. Forms and backgrounds of these expressions can be diverse. To contribute to a better understanding of this phenomenon, we analyzed patients' desire to die expressions reported by palliative care providers participating in 11 communication trainings on desire to die. The 102 participants were asked to reproduce related patients' statements from their everyday practice. The 165 reported statements could be assigned to the four topics: "Putting an end to life by …," "Social death," "Death images," as well as "Specific and unspecific references to life, death and dying." Across these topics, phrasing differs particularly regarding sentence type (interrogative, declarative, propositional, exclamatory), explicitness and (the way of) referencing others (e.g. attribution of power). The compilation of statements reflects a chorus of expressions, which the palliative care providers might hear throughout their professional career as well as during a patient's process(ing) of disease.

Contradictory findings link trait conscientiousness in mid- and late life to increased healthspan and lifespan, as well as to death by suicide. It remains unclear whether conscientiousness is associated with higher odds of attempting suicide or with more severe suicidal behavior among attempters, and whether its relationship to suicide risk varies with aging-related stressors, such as declining health.

In this cross-sectional study comprising 313 depressed adults aged ≥40 years and participating in the Longitudinal Research Program in Late-Life Suicide (Pittsburgh, USA), we employed logistic and linear regression to test whether conscientiousness was associated with the presence of recent suicidal behavior (≤2 years) and with intent severity in recent attempters (n = 84). We further tested whether the above relationships varied based on mental, cognitive, and physical health status, measured as depression severity, cognitive functioning, and the presence/absence of severe physical illness.

Participants were 62.1 years old on average (SD = 7.6), 85% White, and 53% female. Recent attempters had a mean age of 61.8 years at their most recent attempt (SD = 8.5), had lower cognitive functioning and were more likely severely physically ill than comparisons. Conscientiousness was positively associated with a higher likelihood of recent suicidal behavior overall (adjusted OR = 1.44, 95% CI = 1.09, 1.90, p = .010), but not in case of co-occurring severe physical illness (interaction OR = 0.54, 95% CI = 0.30, 0.97, p = .039). Conscientiousness was also positively associated with suicidal intent at the most recent attempt (adjusted β = 1.60, SE = 0.62, p = .012), explaining 7% of its variance, although this association lost significance after adjusting for other personality dimensions.

Highly conscientious middle-aged and older adults may be at increased risk of resolute suicidal behavior, although conscientiousness may not confer additional suicide risk among those severely physically ill.

Suicide is a major public health problem, especially among individuals over 50 years old. Despite the suitability of this life stage for prevention, research on the efficacy of psychological interventions is scarce and methodologically limited, affecting their clinical utility and efficacy. Brief, flexible interventions that can be applied both in-person and remotely are needed. This study aims to evaluate the efficacy of a brief problem-solving-based suicide prevention program applied through various modalities to individuals over 50 years old.

A randomized controlled trial will be conducted. A sample of 212 adults aged 50 or older with suicidal ideation will be randomly assigned to a problem-solving-based psychological intervention administered face-to-face (PSPI-P; n = 53), by telephone multiconference (PSPI-M; n = 53), via a smartphone app (PSPI-A; n = 53), or to a usual care control group (UCCG; n = 53). The intervention will be delivered in 7 sessions or modules of 90 min each. Blind trained evaluators will conduct assessments at pre-intervention, post-intervention, and follow-ups at 3, 6, and 12 months. The primary outcome will be suicidal ideation evaluated using the Suicidal Ideation Scale (SSI) and the Columbia Suicide Severity Rating Scale (C-SSRS). Secondary outcomes will include hopelessness, anxiety and depression symptoms, reasons for living, impulsivity, problem-solving skills, social support, anger syndrome, gratitude, personality, dropouts, treatment adherence, and satisfaction with the intervention.

This study will provide evidence of the efficacy of a brief problem-solving-based intervention for suicide prevention in individuals over 50 years old, administered face-to-face, by telephone multiconference, and via a smartphone app. If results are favorable, it will indicate that an effective, accessible, clinically and socially useful suicide prevention intervention has been developed for affected individuals, families, and communities.

ClinicalTrials.gov NCT06338904. Registered April 1, 2024.

The aim of this study was to explore how individuals aged 70 or older living in Sweden understood a recent suicidal act, and what changed in them and around them in the aftermath.

Four women and five men (age range 71-91 years) receiving care at a geriatric psychiatric outpatient clinic in a large Swedish city took part in two interviews about their most recent suicidal act. Most of the women and none of the men had engaged in prior suicidal acts. Interpretative phenomenological analysis was employed.

The suicidal act was explained as a response to losses (in physical and cognitive functions, social roles and relationships) that rendered previous coping strategies unviable. The participants reported being dependent on a healthcare system that they experienced as indifferent and even dismissive of their suffering. The suicidal act was described as an unplanned act of despair. Positive changes followed for participants who reported having had suicidal ideation prior to the suicidal act and had insights into its triggers. Some gained access to needed medical care; others developed greater awareness of their psychological needs and became more effective at coping. Individuals who said that they had not had suicidal thoughts prior to the suicidal act and could not explain it reported no positive change in the aftermath. The respondents' narratives indicated gendered themes.

Participants' age-related losses were in many cases exacerbated by negative interactions with health care providers, indicating that continued attention needs to be given to implicit ageism in medical professionals. The suicidal acts were described as impulsive, which was unexpected because a dominant belief is that older adult suicidal behavior is planned. One reason for the discrepancy may be that this study focused on nonfatal acts, and planned acts may be more likely to be fatal. Another reason could be shame due to suicide stigma. Alternatively, these acts were truly unplanned. The older adult suicide planning question should be addressed in larger studies across geographical and cultural settings. Future studies should also include questions about gender norms of suicidality and separately examine women's and men's data.

This study aims to increase the understanding of suicidality in older adults by investigating the prevalence, characteristics, risk and protective factors of suicidal phenomena in community-dwelling older adults (60+) in Flanders, specifically of a current wish to die (WTD) and lifetime suicidal ideation and behaviour (LSIB).

Cross-sectional data from the Belgian Ageing Studies (BAS) is used (N = 3050). The BAS aims to monitor the needs and quality of life of community-dwelling older adults through a standardised survey. Statistical methods used are bivariate analyses and binary logistic regression.

Prevalence rates of 4.8% for WTD and 8.2% for LSIB are found. LSIB is the biggest predictor of a current WTD, followed by requiring support on three domains, elder abuse, depression and subjective cognitive complaints, and elder abuse were significant risk factors for both WTD and LSIB. Limited effects of protective factors were found.

Previous research regarding risk factors to be confirmed in this study, and new insights on the effect of elder abuse, subjective indicators of cognitive complaints and requiring support are added. Further research into protective factors and underlying mechanisms is required.

This study aimed to estimate the population-attributable fraction (PAF) of psychiatric and physical disorders for suicide among older adults, focusing on sex- and age-specific factors.

Data from Taiwan's National Health Insurance Research Data and National Death Registry included 9136 cases of suicide in individuals aged 65+, with 89,439 matched controls. Physical and psychiatric disorders were identified through diagnostic records. Conditional logistic regression assessed risk factors, and PAF was calculated using disorder prevalence and adjusted odds ratios.

Major suicide risk factors among older adults were depressive disorders, anxiety disorders, and sleep disorders. Physical disorders like hypertension, peptic ulcers, and cancer also showed significant PAF values. The combined PAF of physical disorders equaled that of psychiatric disorders. Psychiatric disorders had a greater impact on women and the youngest-old adults, while physical disorders had a higher contribution among men, middle-old adults, and oldest-old adults.

Relying solely on claim data to identify psychiatric and physical disorders may underestimate their prevalence and associations with suicide due to unrecorded cases of individuals not seeking help and the absence of key risk factors like social isolation and family support.

This study identifies preventable or treatable risk factors for older adult suicide, emphasizing the need to target specific psychiatric and physical disorders in suicide prevention efforts while taking into account sex- and age-specific considerations. It also underscores the importance of establishing social welfare support systems to address the unique challenges older adults face.

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

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.

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.

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.

To identify characteristics of older adult emergency department (ED) patients aged ≥65 with suicidal ideation and/or behavior.

A single center retrospective chart review analyzed 392 patients (≥65) with suicidal ideation and/or behavior (2013-2019). Comprehensive full-text searches were used. Subgroup analyses for age and gender were conducted.

Depressive disorder was documented in 50% of cases. Notably, 54% of all women were prescribed antidepressants, compared to only 31% of men. Most patients had general medical conditions (74.5%) and chronic multimorbidity (71.2%). Social stress affected 40.1%; 35.7% were intoxicated upon presentation. Alcohol abuse was more common in the 65-74 age group, while dementia impacted 20% of those ≥75. Men had a six-fold higher 30-day post-discharge mortality.

Older ED patients with suicidal ideation and/or behavior exhibit typical characteristics. The dementia prevalence suggests tailored care for those ≥75, and the heightened post-discharge mortality rate in older men requires further research.

Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.

A nationwide retrospective explorative study investigating medical records.

Primary care in Sweden.

Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.

The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).

A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.

The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation.

The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships.

The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation.

Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

There are still many gaps in both national and international literature on elderly suicide. This study aimed to identify the most influential journals in elderly suicide, the countries and authors that contribute the most to the field, and the trends in the field.

Studies published on elderly suicide between 1951 and 2022 were retrieved utilising the Web of Science Core Collection. Co-authorship analysis of countries and authors, as well as co-occurrence analysis of keywords, were conducted using VOSviewer 1.6.18.

There were 2864 articles retrieved, including 95 countries, 889 academic journals, 9162 authors and 4160 keywords. The number of publications in this field has significantly increased after the 2000s, and the United States is the most productive country (996). The most prolific author is Yeates Conwell, while the journal with the highest number of publications in this field is the International Journal of Geriatric Psychiatry. Other than 'suicide' and 'elderly', the most trending keywords are 'depression', 'primary care', 'treatment', 'antidepressant', 'loneliness', 'quality of life' and 'COVID-19'.

There has been an increase in both the thematic diversity and quantity of studies on elderly suicide over time. However, these publications predominantly originate from socioeconomically affluent countries with relatively low suicide rates. While the increasing numbers of publications from developing countries in recent years are promising, there is a greater need for publications from countries with lower socioeconomic status for the prevention or intervention of elderly suicides.

Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients.

From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes.

Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement.

There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage.

Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.

Suicide rates in older adults are often the highest of any age group, particularly among high income countries. However, there is a limited understanding of the factors that could protect against suicidality in older age. This systematic review aimed to identify and evaluate the psychological factors that protect against suicidality in older age.

An a priori protocol was established and registered on PROSPERO (CRD42022343694). EMBASE, MEDLINE, PsycINFO, Web of Science and Scopus were searched. Papers were quality assessed using the Quality Assessment with Diverse Studies (QuADSs) tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seventeen papers were included and narratively synthesised.

The initial searches identified 10,673 records, resulting in the screening of 5441 records after the removal of duplicates. The protective factors identified were (1) meaning/purpose in life, (2) reasons for living, (3) coping styles, (4) psychological wellbeing, (5) life satisfaction, (6) personality factors, (7) cognitive functioning, and (8) sense of belonging. The factors with the most empirical support were meaning in life, followed by psychological wellbeing and coping responses, such as primary control strategies, and personality traits, such as positive affect and agency. There was also evidence to suggest that the influence of some protective factors, for example meaning in life, may depend upon stage in older life and gender.

This review identified several psychological factors that have been found to protect against suicidal ideation in older adults, representing potential treatment targets for reducing suicide in older adults. Recommendations for future research includes greater use of longitudinal and case-control designs, measuring outcomes across the continuum of suicidality and using samples that allow comparison between younger and older adults and within the spectrum of old age.

The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide.

Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity.

Anxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months - 1 week). Two-thirds had been prescribed antidepressants at time of death.

Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents.

Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.

Disability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles' links to end-of-life care arrangements and place of death, and predictors of the profiles.

In total, data were extracted from the records of 10,529 deceased individuals from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analyses, bivariate analysis, and multivariate logistic regression were applied to identify prior-to-death disability profiles, explore the profiles' links to end-of-life care arrangements and place of death, and examine predictors in the profiles, respectively.

Three prior-to-death disability profiles, namely, Disabled-Incontinent (37.6%), Disabled-Continent (34.6%), and Independent (27.8%), were identified. Those with the Independent profile were more likely to live alone or with a spouse and receive no care or care only from the spouse before death. Disabled-Continent older adults had a higher chance of dying at home. Being female, not "married and living with a spouse", suffering from hypertension, diabetes, stroke or cerebrovascular disease (CVD), bronchitis/emphysema/pneumonia, cancer, or dementia, and dying in a later year were associated with more severe prior-to-death disability patterns. Not having public old-age insurance predicted lower chances of having a Disabled-Incontinent profile, and advanced age increased the chance of having a Disabled-Continent profile.

Three prior-to-death disability patterns were identified for Chinese adults aged 65 years and older. These profiles were significantly linked with the end-of-life caregiving arrangements and place of death among older adults. Both demographic information and health status predicted prior-to-death disability profiles.

Although the relationship between functional disability and suicidal ideation among older adults has been well documented, limited research exists regarding how socioeconomic status might moderate the relationship between functional disability and suicidal ideation. The objective of this study is to identify the relationship between functional disability and suicidal ideation and assess how SES moderates this relationship among Korean older adults.

Using data from wave 3 of the Korean Retirement and Income Study, this study has conducted a linear regression analysis with interaction terms.

There are three main findings. First, the main effects of Activities of Daily Living, Instrumental Activities of Daily Living, and economic status on suicidal ideation were identified. Second, functional disability is identified as a serious risk factor for suicidal ideation among Korean older individuals who express dissatisfaction with their economic circumstances. Last, the moderating effect of economic condition and education on the relationship between functional disability and suicidal ideation exhibited some differences.

This study suggests that the interactions of functional disability and economic status yield a significant predictive effect on suicidal ideation in South Korea.

Objectives: Family members and close friends provide countless hours of care for patients enrolled in hospice care. They do so without pay, often sacrificing their own financial well-being and health in the process. This study asks 4 research questions: (1) What is the prevalence and severity of depressive symptoms among caregivers of hospice cancer patients? (2) What demographic and contextual factors (such as relationship with patient) are related to the severity of depressive symptoms among caregivers of hospice cancer patients? (3) Are caregiver quality of life and caregiver burden associated with depressive symptoms? and (4) Is baseline depression associated with change in depression over time? Methods: This was a secondary analysis of data collected in a cluster randomized controlled trial. Results: Thirty-five percent of caregivers reported depressive symptoms of moderate or greater severity. These depressive symptoms were found to increase depending on the relationship of the caregiver to the patient. Caregivers with higher reported burden and lower reported quality of life were also found to have higher depressive symptoms. Significance of Results: Hospice agencies are encouraged to assess caregiver depressive symptoms and have protocols in place to assist caregivers with high depressive symptoms.

Suicide is the first cause of external death in Spain. International studies show frequent and varied health contacts in the months prior to suicide. There are hardly any studies on that phenomenon in this country.

To analyze health care use in the year prior to suicide between 2010 and 2018 in the Basque Country, as well as pharmacological prescriptions and psychiatric diagnoses received.

Retrospective descriptive study with all suicides registered by the Basque Institute of Legal Medicine (BILM) between 2010 and 2018. The records of the BILM and the Basque Health Service (Osakidetza) were cross-checked.

1526 suicides were analyzed. 74% had health contacts in the previous year. The use was higher in women (p<0.05) and in older ages (p<0001). Primary care was the most used specialty (58.8% the previous year and 7.1% the previous week), followed by Hospital Emergencies (50.3% and 10.2%) and Outpatient Medical Specialties (49% and 11.6%), especially Radiology. Outpatient psychiatry only contacted 29.6% that year, although it had the highest average number of visits (15.1 SD22.6). The most frequent diagnostic category among psychiatric patients was F30-39 (26.7%), with differences between sexes and ages. 49.7% received psychotropic drugs.

The results are aligned with international evidence, which they also extend, and reinforce the need to extend prevention beyond psychiatric services. It seems advisable to increase proactivity in the search for risk by sensitizing and training different professional profiles, but also to work from non-health settings to improve assistance to highly vulnerable profiles (young men) with low health links.

Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.

High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear.

Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults.

The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals.

This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.

Suicides among older women have received little research attention. In this study based on the 2017-2019 National Violent Death Reporting System data, we examined the prevalence of depression in older female suicide decedents (N = 3,061), associations between depression and other suicide precipitants, and the associations between suicide methods and depression. Descriptive statistics and generalized linear models (GLM) for a Poisson distribution with a log link were used to examine the research questions. Of the decedents, 15.0% had depressed mood without a reported diagnosis and 41.8% had a depression diagnosis. Nearly one-half of the decedents with reported depression were receiving mental health/substance use treatment at the time of injury. The likelihood of depression was lower among those who were age 85 and older compared to those were age 65-74, but higher among those who had anxiety disorder (IRR = 1.50, 95% CI = 1.33-1.69), history of suicidal ideation (IRR = 1.22, 95% CI = 1.10-1.35), history of suicide attempt (IRR = 1.27, 95% CI = 1.14-1.41), and bereavement problems (IRR = 1.45, 95% CI = 1.27-1.65). Those who had depression were less likely to have used firearms (IRR = 0.85, 95% CI = 0.75-0.97) but more likely to have used hanging/suffocation (IRR = 1.37, 95% CI = 1.13-1.67). The findings show that gun ownership was likely an important factor for firearm use. The high prevalence of depressed mood and/or depression diagnosis among older female suicide decedents at the time of their fatal injury underscores the importance of assessing depression and providing evidence-based depression treatment as an essential suicide prevention approach.

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.

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.

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.

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.

This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH.

A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data.

Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review.

Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older.

CMH care within 14 days from index, versus not.

Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates.

Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall.

CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.

This study aimed to explore the prevalence of suicidal thoughts and potential associations (i.e., strength and direction) with caregiver characteristics or factors. A targeted survey was distributed to dementia caregivers aged 55+ years. Questions concerning psychological distress, suicidal thoughts while caregiving and antecedents of suicidal behaviours were administered. A sample of 71 French-speaking Canadian caregivers completed the survey between May and October 2019. Among them, 52.1 per cent (n = 37) reported suicidal ideation while providing care to a relative or a friend living with dementia. Caregivers who presented suicidal ideation reported more abusive behaviour toward the care recipient. Caregivers who reported suicidal thoughts were significantly more distressed than caregivers without them on measures of burden, depression, and anxiety. Suicidal thoughts in caregivers are important evaluation targets, primarily for the prevention of suicide, but also because caregivers who report suicidal thoughts also present a heightened risk for abusing the care recipient.

Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group.

Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18-64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group.

Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01).

Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.

Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults.

Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors.

28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only.

There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Suicide and the risk factors associated with it have been researched with increasing interest over the last 5 decades with respect to socioeconomic status, age, geographic location, and ethnic background. There has been less focus related to the risk factors specific to gender and how to incorporate clinical screening and interventions to reduce the mortality of suicide in males. With men accounting for a disproportionate number of deaths from suicide in the United States and worldwide, how gender could impact suicidal behavior and ideations remains a topic understudied and with great potential for significant improvement in clinical recognition and treatment.

South Korea is predicted to become a superaged society around 2025. Depression in older adults is a major factor influencing suicide. South Korea exhibits the highest suicide rate among the Organization for Economic Co-operation and Development countries.

This study aimed to examine the factors associated with depression and suicidal ideation among individuals aged 85 years or older based on gender. Data were obtained from the Korea Institute for Health and Social Affairs, 2017. Overall, 768 individuals aged ≥85 years were included in the final analysis. The participants' general, health-related, and social characteristics were analyzed as factors influencing depression and suicidal ideation.

Among male oldest-old adults, living arrangements and the number of chronic diseases were factors affecting depression, while activities of daily living restrictions and the number of chronic diseases were factors affecting suicidal ideation. Among female oldest-old adults, only the number of chronic diseases affected depression, while financial status and the number of chronic diseases were the factors affecting suicidal ideation.

The healthcare and welfare services for older adults must be expanded to cater to oldest-old adults who live alone, have activities of daily living restrictions, and have lower financial status. Additionally, the oldest age group's psychological health must be monitored regularly for depression and suicidal ideation to implement active interventions for this high-risk group.

Social rewards (e.g., social feedback, praise, and social interactions) are fundamental to social learning and relationships across the life span. Exposure to social rewards is linked to activation in key brain regions, that are impaired in major depression. This is the first summary of neuroimaging literature on social reward processing in depressed and healthy individuals.

We screened 409 studies and identified 25 investigating task-based fMRI activation during exposure to social stimuli in depressed and healthy populations across the lifespan. We conducted a systematic review followed by an Activation Likelihood Estimation (ALE) analysis of three main contrasts: a) positive social feedback vs. neutral stimuli; b) negative social feedback vs. neutral stimuli; c) positive vs. negative social feedback. We also compared activation patterns in depressed versus healthy controls.

Systematic review revealed that social rewards elicit increased activation in subcortical reward regions (NAcc, amygdala, ventral striatum, thalamus) in healthy and depressed individuals; and decreased activation in prefrontal reward regions (medial prefrontal cortex, orbitofrontal cortex) among depressed persons. Our meta-analysis showed, in both depressed and healthy individuals, increased cluster activation of the putamen and caudate in response to negative social stimuli vs. positive stimuli. We also found increased cluster activation in the inferior frontal gyrus (IFG) and the medial frontal gyrus (MFG) in healthy controls vs. depressed individuals, in response to negative social stimuli.

Processing of social stimuli elicits activation of key brain regions involved in affective and social information processing. Interventions for depression can increase social reward responsivity to improve outcomes.

A critical health concern for older adults is suicide, particularly for those above the age of 60 years. Despite this, research on suicide in this age group is relatively scarce compared to studies on younger populations. This article is intended to summarize the existing literature on etiological/risk factors, including problems with one's physical and mental health, social isolation, money, and life changes like retirement and the death of a spouse and methods for preventing suicide specific to the geriatric population. We conducted a comprehensive literature search to identify the original reports and reviewed publications through various databases, including Google Scholar, PubMed, and the CDC. We gathered information on Google from reputable sources such as the WHO and the National Crime Records Bureau (NCRB). Our review found that the risk factor of suicide in the geriatric population includes physical illness, familial issues, financial issues, and hopelessness. The suicide rate for older adults declined, dropping from 16.17 per 100,000 individuals to 14.25 per 100,000 individuals aged 50 to 69 years and from 27.45 per 100,000 individuals to 24.53 per 100,000 individuals for those over 70 years. A more significant proportion of elderly suicide attempters come from rural than urban locations. Young individuals have better professional opportunities in urban areas, but older people are dispersed to underdeveloped or rural areas, where they are more likely to experience social isolation. By systematically identifying these risk factors, we can develop prevention and intervention strategies to decrease the suicide rates among the geriatric population.

Psychoactive medications play an important role for the mental health and risk of suicidal behaviour in the oldest segment of the population (75+). A better understanding of psychoactive medication use is advocated to prevent suicide in this age group.

We investigated the risk of suicide associated with the use of psychoactive medications in the total population aged ≥ 75 years, with and without exposure to antidepressants.

A national population-based register study, including all Swedish residents aged ≥ 75 years between 2006 and 2014 (N = 1,413,806). A nested case-control design was used to investigate psychoactive medications associated with suicide among users and non-users of antidepressants. Risk estimates were calculated in adjusted conditional logistic regression models for the entire cohort and by gender.

Suicide occurred in 1305 persons (907 men and 398 women). Among them, 555 (42.5%) were on an antidepressant at the time of suicide. Adjusted incidence rate ratio (aIRR) for suicide was increased in those who were on hypnotics in the total cohort (aIRR 2.05, 95% confidence interval 1.74 to 2.41), in both users and non-users of antidepressants and for both genders. Elevated suicide risk was observed in those who concomitantly used anxiolytics with antidepressants (1.51, 1.25 to 1.83). Decreased risk of suicide was observed among those who were on anti-dementia drugs, in the total cohort (0.33, 0.21 to 0.52) and in both users and non-users of antidepressants. Use of antipsychotics and mood stabilisers showed no effect on suicide risk.

Use of hypnotics and concomitant use of anxiolytics with antidepressants was associated with increased risk of late-life suicide. Our findings suggest the need for careful evaluation of the benefit-risk balance of psychoactive medications as well as their availability as a possible suicide means. Future research should consider the indication of use of the psychoactive medications and the severity of psychiatric and medical illnesses of the patients.

Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode.

Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode.

There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care.

The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.