Deborah Brauser

March 31, 2015

NEW ORLEANS ― Receiving a diagnosis of a life-threatening illness may be a significant determinant of suicidal ideation in older adults, new research suggests.

Matthew Beristianos

A nationally representative study of more than 3000 adults aged 55 years or older showed that those who had a traumatic accident/illness were three times more likely to also have suicidal ideation than those who did not experience that type of trauma.

Interestingly, within this trauma category, only life-threatening illness was significantly associated with late-life suicidal ideation; a life-threatening accident or toxic chemical/substance exposure did not have significant associations.

"The association with illness wasn't as surprising as not finding a significant association between suicidal ideation and such well-known categories as assault/interpersonal trauma or childhood maltreatment," lead author Matthew Beristianos, from the San Francisco VA Medical Center and the University of California, San Francisco, told Medscape Medical News.

He noted that because of the age of the patient population in this study, "this could really be talking about a resilience factor that could be occurring in later life to earlier life trauma. That's definitely a rich area for further research to determine why that's happening."

The study was presented here in a poster session at the American Association for Geriatric Psychiatry (AAGP) 2015 Annual Meeting.

Greater Monitoring Needed

"There's a lot known about the relationship between PTSD and suicidal behavior, but there is little known about trauma exposure ― and even less known about posttrauma exposure and suicidal behavior in older adults," said Beristianos.

"Just the general exposure of trauma in older adults and suicidal behavior is something that is in strong need of research," he added.

The investigators examined data for 3282 adults (60% women; mean age, 66.3 years) from the Collaborative Psychiatric Epidemiology Surveys (CPES), which consists of three nationally representative studies: the National Survey of American Life, the National Comorbidity Survey Replication, and the National Latino and Asian American Study.

Questions from the World Mental Health Composite International Diagnostic Interview were used to ask about traumatic experiences, focusing on seven categories of trauma exposure, and late-life suicidal ideation in all CPES participants.

A total of 2.0% of the included adults reported having late-life suicidal ideation. Interestingly, "unadjusted models" showed that the only trauma category significantly linked to this type of condition was serious accident/illness (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.72 - 7.43; P < .001). After adjusting for major depression and demographic factors, the OR remained significant at 2.96 (95% CI, 1.39 - 6.31; P < .001).

Unadjusted and adjusted models showed no significant associations between suicidal ideation and the main categories of war zone exposure, disaster exposure, child maltreatment, assaultive trauma, trauma to someone close, or witnessing a serious trauma.

When examining subcategories under the serious accident/illness umbrella, only experiencing a life-threatening illness was significantly associated with late-life suicidal ideation (unadjusted OR, 3.34; adjusted OR, 2.63; both, P < .001).

Beristianos noted that the findings suggest a call for greater monitoring in this patient population.

"Being told you have a life-threatening illness is so loaded, especially in an older population, that clinicians really need to assess for suicidal ideation even more than they might realize," he said.

Real Life Example

"This study captured in data what we actually saw this past year in the real-life example of Robin Williams, someone who was diagnosed with a life-threatening condition and who ended up taking his own life," session moderator Julie Wetherell, PhD, professor of psychiatry at University of California, San Diego, who is also a psychologist at the San Diego VA, told Medscape Medical News.

Dr Julie Wetherell

It was reported that Williams was in the early stages of Parkinson's disease at the time of his death in August 2014.

"To be able to see this in a research sense, in a nationally representative dataset, really does suggest this is a major problem," she said.

Dr Wetherell, who was not involved with this research, noted that it can be difficult and complicated when clinicians give a diagnosis of a life-threatening or life-altering illness.

"Patients are often given that [diagnosis] by a cardiologist or an oncologist or a pulmonologist, specialties that might not be used to asking, 'have you thought about ending your life?' And then saying, 'I know this is a shock, it's hard to hear right now," before asking more questions and having a discussion," said Dr Wetherell.

She added that the current study did not examine what was driving the suicidal ideation, which is something that should be the focus of future research.

"Was it that people were afraid of pain? Are they afraid of disability or being a burden? Also, is there a palliative care team available to talk with the patient and the family to ensure them that there are a lot of ways that things can be done so they're not going to be in unbearable pain?” she asked.

"Then, we can talk about what a 'good death' or death with dignity is and how this person would like the end of their life to play out. We really don't spend a lot of time asking people what their vision is for end of life, even though it's something we're all going to experience," said Dr Wetherell.

"If people can have some sense that there's a plan in place, that their wishes and needs are going to be accommodated, they may be less inclined to choose the horrible, traumatic, devastating- on-family-and-friends option of ending their own life prematurely."

The study authors and Dr Wetherell have reported no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2015 Annual Meeting. Abstract EI-12. Presented March 28, 2015.

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