Highlights
- •What is the primary question addressed by this study?This study aims to address to what extent protective factors relate to presence and severity of depression and suicidal ideation, and history of suicide attempt.
- •What is the main finding of this study?We found that a combined measure of protective factors assessing constructs, previously associated with suicide and/or late-life depression (life satisfaction, engagement, mindfulness, flourishing, and social support), is associated with presence and severity of depression and presence of suicidal ideation. However, our measure of protective factors did not relate to the severity of suicidal ideation once present, nor did it relate to history of suicide attempt in depressed late-life participants.
- •What is the meaning of the finding?These findings highlight clinical implications that resiliency characteristics, relevant to psychological wellbeing and successful aging, may mitigate emergence of depression, suicidal ideation, as well as the severity of depression in late life.
Abstract
Objective
Suicide is an outcome arising from a combination of risk and protective factors. Examining
psychological resilience traits associated with successful aging may help to better
understand late-life suicide and depression. We examined self-reported protective
factors including mindfulness, life satisfaction and engagement, flourishing, and
subjective and objective social support in a high suicide-risk sample of depressed
older adults.
Methods
Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide
attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric
comparisons. Using linear and binomial logistic regression, we examined the effects
of a combined Protective Factor value on presence and severity of depression and suicidal
ideation, and history of suicide attempt.
Results
Relative to the non-psychiatric comparison group, all depressed participants had significantly
lower Protective Factor values. Higher Protective Factor value was associated with
lower likelihood of depression, depression severity, and likelihood of ideation, but
was not associated with ideation severity or history of suicide attempt. Participants
with one standard deviation higher Protective Factor had lower odds of ideation incidence
by a factor of OR=0.68 (95%CI=0.48–0.96).
Conclusion
Resiliency characteristics relevant to psychological wellbeing and successful aging
may mitigate the emergence of depression and suicidal ideation, as well as the severity
of depression in late-life. The Resilience Factor used in this study can help clinicians
nuance their appraisal of depression and suicide risk.
Key Words
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References
- Resilience in the face of adversity. Protective factors and resistance to psychiatric disorder.Br J Psychiatry. 1985; 147: 598-611https://doi.org/10.1192/bjp.147.6.598
- The association between psychological resilience and cognitive function in longitudinal data: results from the community follow-up survey.J Affect Disord. 2021; 290: 109-116https://doi.org/10.1016/j.jad.2021.04.062
- Personality traits and perceived social support among depressed older adults.Aging Mental Health. 2008; 12: 662-669https://doi.org/10.1080/13607860802343258
- Psychobiological factors of resilience and depression in late life.Transl Psychiatry. 2019; 9: 1-18https://doi.org/10.1038/s41398-019-0424-7
- Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.Psychol Bull. 2003; 129: 674-697https://doi.org/10.1037/0033-2909.129.5.674
- Ageism and psychological well-being among older adults: a systematic review.Gerontol Geriatric Med. 2022; 8 (23337214221087024)https://doi.org/10.1177/23337214221087023
- Is the link between socioeconomic status and resilience mediated by reserve-building activities: mediation analysis of web-based cross-sectional data from chronic medical illness patient panels.BMJ Open. 2019; 9e025602https://doi.org/10.1136/bmjopen-2018-025602
- Ageism in mental health assessment and treatment of older adults.in: Ayalon L Tesch-Römer C Contemporary perspectives on ageism. Springer International Publishing, Cham, Switzerland2018: 241-262https://doi.org/10.1007/978-3-319-73820-8_15 (International Perspectives on Aging)
- Definitions of successful ageing: a brief review of a multidimensional concept.Acta Biomed. 2019; 90: 359-363https://doi.org/10.23750/abm.v90i2.8376
- Building blocks of successful aging: a focus group study of older adults’ perceived contributors to successful aging.Am J Geriatr Psychiatry. 2007; 15: 194-201https://doi.org/10.1097/JGP.0b013e318030255f
- Association between older age and more successful aging: critical role of resilience and depression.Am J Psychiatry. 2013; 170: 188-196https://doi.org/10.1176/appi.ajp.2012.12030386
Thompson V. Mason's resilience model: transforming fear & promoting well-being. Center for the Advancement of Well-Being. Published January 20, 2020. Available at: https://wellbeing.gmu.edu/masons-new-resilience-model-transforming-fear-promoting-well-being/. Accessed October 13, 2022
- Happy people live longer: subjective well-being contributes to health and longevity: health benefits of happiness.Applied Psychol: Health Well-Being. 2011; 3: 1-43https://doi.org/10.1111/j.1758-0854.2010.01045.x
- The satisfaction with life scale.J Personality Assess. 1985; 49: 71-75https://doi.org/10.1207/s15327752jpa4901_13
- Association of enjoyable leisure activities with psychological and physical well-being.Psychosom Med. 2009; 71: 725-732https://doi.org/10.1097/PSY.0b013e3181ad7978
- The life engagement test: assessing purpose in life.J Behav Med. 2006; 29: 291-298https://doi.org/10.1007/s10865-005-9044-1
- Health stresses and depressive symptomatology in the elderly: a control-process approach.Current Directions Psychol Sci. 2004; 13: 17-20
- The relationship between depression, satisfaction with life, and social interest.South Pacific J Psychol. 1999; 11: 9-15https://doi.org/10.1017/S0257543400000717
- Long term life dissatisfaction and subsequent major depressive disorder and poor mental health.BMC Psychiatry. 2011; 11https://doi.org/10.1186/1471-244X-11-140
- New well-being measures: short scales to assess flourishing and positive and negative feelings.Soc Indic Res. 2010; 97: 143-156https://doi.org/10.1007/s11205-009-9493-y
- Flourishing in later life.Arch Gerontol Geriatr. 2016; 63: 85-91https://doi.org/10.1016/j.archger.2015.11.001
- Flourishing across europe: application of a new conceptual framework for defining well-being.Soc Indic Res. 2013; 110: 837-861https://doi.org/10.1007/s11205-011-9966-7
- Mindfulness training and physical health: mechanisms and outcomes.Psychosom Med. 2019; 81: 224-232https://doi.org/10.1097/PSY.0000000000000675
- The benefits of being present: mindfulness and its role in psychological well-being.J Personal Soc Psychol. 2003; 84: 822
- The importance of cultivating mindfulness for cognitive and emotional well-being in late life.J Evid Based Complementary Altern Med. 2015; 20: 35-40https://doi.org/10.1177/2156587214553940
- The nature and dimensions of social support among individuals with severe mental illnesses.Community Ment Health J. 2004; 40: 437-450https://doi.org/10.1023/B:COMH.0000040657.48759.0e
Necka EA, Rowland LM, Evans JD. Social disconnection in late life mental illness – commentary from the national institute of mental health. Am J Geriatr Psychiatry. Published online August 26, 2020. doi:10.1016/j.jagp.2020.08.013
- Purpose in life and reasons for living as mediators of the relationship between stress, coping, and suicidal behavior.The Journal of Positive Psychology. 2007; 2: 195-204https://doi.org/10.1080/17439760701228920
- The effects of mindfulness-based interventions on suicide outcomes: a meta-analysis.Arch Suicide Res. 2022; 26: 447-464https://doi.org/10.1080/13811118.2020.1833796
- Life satisfaction and suicide: a 20-year follow-up study.Am J Psychiatry. 2001; 158: 433-439https://doi.org/10.1176/appi.ajp.158.3.433
- Suicide in older adults: current perspectives.Clin Intervent Aging. 2018; 13: 691-699https://doi.org/10.2147/CIA.S130670
- Understanding vulnerability to late-life suicide.Curr Psychiatry Rep. 2021; 23: 58https://doi.org/10.1007/s11920-021-01268-2
- The role of perceived and objective social connectedness on risk for suicidal thoughts and behavior in late-life and their moderating effect on cognitive deficits.Am J Geriatric Psychiatry. 2021; S1064748121004577https://doi.org/10.1016/j.jagp.2021.08.014
- Predictors of serious suicidal behavior in late-life depression.European Neuropsychopharmacology. 2020; 40: 85-98https://doi.org/10.1016/j.euroneuro.2020.06.005
- Diagnostic and statistical manual of mental disorders.4th Ed. American Psychiatric Association, Cham, Switzerland2000 (DSM-IV)
- Assessment of suicidal intention: the scale for suicide ideation.J Consult Clin Psychol. 1979; 47: 343-352
- Positive events and social supports as buffers of life change stress.J Applied Soc Psychol. 1983; 13: 99-125
- Social ties and susceptibility to the common cold.JAMA. 1997; 277: 1940-1944
- Classification of suicidal behaviors: I. Quantifying intent and medical lethality.The American journal of psychiatry. 1975; 132: 285-287https://doi.org/10.1176/ajp.132.3.285
- A rating scale for depression.Journal of neurology, neurosurgery, and psychiatry. 1960; 23: 56-62https://doi.org/10.1136/jnnp.23.1.56
First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient edition (SCID-I/P, Version 2.0), Biometrics Research Department, New York State Psychiatric Institute, 1995.
- “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.Journal of psychiatric research. 1975; 12: 189-198https://doi.org/10.1016/0022-3956(75)90026-6
Mattis, S. Dementia rating scale. Professional manual. Psychological Assessment Resources, Odessa. 1988.
- Successful ageing, depression and resilience research; a call for a priori approaches to investigations of resilience.Epidemiol Psychiatric Sci. 2017; 26: 574-578https://doi.org/10.1017/S2045796017000348
- A comprehensive resiliency framework: theoretical model, treatment, and evaluation.Glob Adv Health Med. 2021; 1021649561211000304https://doi.org/10.1177/21649561211000306
- “Why do they become vulnerable when faced with the challenges of old age?” Elderly people who committed suicide, described by those who knew them.Int Psychogeriatr. 2009; 21: 903-912https://doi.org/10.1017/S1041610209990342
- Personality of late- and early-onset elderly suicide attempters.Int J Geriatric Psychiatry. 2020; 35: 384-395https://doi.org/10.1002/gps.5254
- Complex interplay between health and successful aging: role of perceived stress, resilience, and social support.Am J Geriatric Psychiatry. 2015; 23: 622-632https://doi.org/10.1016/j.jagp.2014.08.004
- Social support, negative life events and mental health.Br J Psychiatry. 1995; 166: 29-34https://doi.org/10.1192/bjp.166.1.29
- Pathways to late-life suicidal behavior: Cluster analysis and predictive validation of suicidal behavior in a sample of older adults with major depression.J Clin Psychiatry. 2018; 79 (11611): 17
- Cognition and late-life suicide: cognitive profiles among depressed suicidal subgroups as a function of medical seriousness and onset of suicidal behavior.Am J Geriatric Psychiatry. 2020; 28: S119-S120
- A lifetime of challenges: Real-life decision outcomes in early- and late-onset suicide attempters.J Affective Disord Rep. 2021; 4100105https://doi.org/10.1016/j.jadr.2021.100105
- Is religiosity a protective factor against attempted suicide: a cross-cultural case-control study.Arch Suicide Res. 2010; 14: 44-55https://doi.org/10.1080/13811110903479052
- Religion and suicide risk: a systematic review.Arch Suicide Res. 2016; 20: 1-21https://doi.org/10.1080/13811118.2015.1004494
Article info
Publication history
Published online: December 29, 2022
Accepted:
December 26,
2022
Received in revised form:
December 12,
2022
Received:
July 27,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
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- CAN EMOTIONAL WELL-BEING MAINTAIN HEALTH AND PREVENT SUICIDE IN LATER LIFE? A NATIONAL PRIORITY FOR RESEARCH: Life-Satisfaction, Engagement, Mindfulness, Flourishing, and Social Support: Do They Predict Depression, Suicide Ideation, and History of Suicide Attempt in Late Life?The American Journal of Geriatric Psychiatry
- PreviewThe study of suicide and its prevention has been dominated by a focus on factors that increase the risk of an individual dying by suicide. Relatively less attention has been paid to protective factors, those that reduce the likelihood or mitigate the impact of suicidal ideation and behavior. [1] Characteristics of older adults suggest that protective factors could play an important role in reducing the toll that suicide takes in later life. Suicidal behavior in older adulthood tends to be more lethal than at younger ages due to the older person's reduced physical reserves (less likely to survive an injury), greater likelihood of social isolation (reduced likelihood of detection and rescue), and because a higher proportion of older adults who do take their own lives use firearms and act with greater planning and intent to die.
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