New research shows the majority of thoughts of death and suicide among older adults were tied to physical, economic and family factors, not depression. Past psychological autopsy studies implicate depression in the majority of late-life suicides; however, when study participants were asked by psychiatrists about thoughts of death and suicide using a standard depression screening tool, elderly adults blamed factors other than depression 75% of the time. These findings recently were presented by a Montefiore Medical Center investigator at the American Association for Geriatric Psychiatry Annual Meeting.  

"The national prevalence of suicide-related death in adults over the age of 65 is nearly 15 per 100,000, and this intractable tragedy is expected to increase with the aging of the baby boomer generation," said Gary Kennedy, M.D., director of Geriatric Psychiatry, Montefiore and professor of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine of Yeshiva University. "Current suicide prevention interventions focus largely on treating depression, and while suicide rates have declined in this population, ideal treatment does not achieve ideal results."

The study was sponsored by the National Institutes of Health (NIH) and included nearly 3,500 New York City seniors. Study participants were screened for depression using the Patient Health Questionnaire-9 (PHQ-9). Question nine of the PHQ-9 explores suicidality and asks patients if they have been bothered in the past two weeks by thoughts that they would be better off dead or hurting themselves. Those who responded "yes" were referred to a psychiatrist who diagnosed suicidal ideas. To elucidate motivations behind suicidality, a psychiatrist asked why participants responded "yes" to this question, and what reasons they had to live.

"We asked this population directly why they had thoughts of suicide and death, and what we found contradicted past study findings – the vast majority of participants said factors other than depression including illness, disability, pain, financial concerns, family problems and bereavement are driving these thoughts," said Dr. Kennedy. "These unexpected findings suggest that efforts to reduce the high rate of suicide among older Americans will need to broaden the approach to prevention."

Participants who had suicidal ideation and those who did not gave similar reasons at similar rates for answering "yes" to question nine of the PHQ-9. Among those with suicidal ideation, 26% cited depression as a reason for sometimes feeling that they would be better off dead while 25% of those without suicidal ideation cited depression. In both groups, family and satisfaction with support were most frequently cited as reasons to live.   

Investigators looked at data from the ongoing, longitudinal New York City Neighborhood and Mental Health Study (NYCNAMES II) of 3,497 New York City residents aged 65-75. Funded by the NIH with support from the World Health Organization (WHO) and institutions in New York City, NYCNAMES II is examining depression risk factors among the elderly.

In addition to Dr. Kennedy, the NYCNAMES II investigative team includes researchers from WHO, the New York Academy of Medicine, the Mailman School of Public Health at Columbia University and New York University.