Studies have found that elderly individuals have higher rates of psychiatric disorder than those in the general population, while at the same time encountering difficulties in accessing mental health services. These factors might increase the risk of suicide. These risks are greater for men than for women. However, females (especially adolescents) take part in self-harm more often than males. Suicide risks also increase as socioeconomic status decreases but the burden of suicidal behavior when these factors combine is currently unknown.
The aim of the present review was to provide a summary of literature on suicidal behavior with specific reference to gender, age, previous attempts/self-harm, and socioeconomic status. The objectives of the review were to establish the incidence and prevalence of suicidal behavior in men; describe risk factors for suicidal behavior in low socioeconomic populations; discuss how the elderly are disproportionately likely to attempt suicide; and describe how a previous attempt makes success more likely at a later point in time.
Studies have found that individuals in the United State have a significantly high rate of suicide (it’s the tenth leading cause of death) when compared to other countries, and that this is especially true of elderly individuals. If mental health professionals are to prevent suicide, they must first identify the causes and risk factors. There are many risk factors for suicide, including the male gender, older age, previous suicidal behavior, and psychiatric personality disorders.
Innamorati et al. (2009) have estimated that suicide rates for the elderly are up to three times as high as for the rest of the population. Within the elderly population, men are more affected by socioeconomic factors than women are. Most studies have indicated that women appear to be less vulnerable to social factors than men. This is interesting, because research by Klonsky, May, and Gordon (2013) suggests that the relationship between non-suicidal self-injury (NSSI) and attempted suicide is higher for females (.46) than for males (.22). NSSI is defined as a harmful behavior that can serve several intrapersonal and interpersonal functions.
Suicide rates in the elderly also vary by ethnicity. De Leo (1999) found that elderly suicide rates for the elderly are higher in Latin American countries than in Anglo-Saxon ones. The study also found that males have higher rates of suicide, because they have “coping with old-age problems, especially at very late stages of life.”
Elderly adults who have previously attempted suicide are more likely to succeed in their latter attempts. May, Klonsky, and Klein (2013) did a ten year study on the relationship between depressive disorders and future suicide attempts. They found that past suicide attempts predicted future attempts up to 69% of the time. They also found that cluster A, B, and C personality disorders and symptoms predicted the occurrence of an attempt. May, Klonsky, and Klein then examined which individual personality disorders predicted an attempt when they controlled for previous attempts. They found that borderline personality disorder, narcissistic, antisocial, paranoid, and schizotypal symptoms all predicted future attempts, with borderline personality disorder being the strongest. Innamorati at al. (2009) also identified personality and mood disorders as one of the leading causes of elderly suicide. It is hypothesizes that the elderly suffer from these disorders because they are limited in visiting mental health professionals.
“Cultural Issues in Suicide and Old Age” by Diego De Leo compares suicide rates between Latin countries, such as Portugal and Spain, to rates in Anglo-Saxon countries, such as the United States and Ireland. He used statistics from the World Health Organization to draw his conclusions. He also found that men have much higher suicide rates over all, but that this is more prominent in Latin nations. De Leo hypothesized that elderly men of Anglo-Saxon countries are being treated better by “their women”.
“Socioeconomic Risk Factors in the Precipitation of Suicide in the Elderly” by Innamorati et al. studied how elderly suicide rates are a public health issue. In their study, they examined peer reviewed journals related to suicide in the elderly. 4511 articles were located through their search, and the most relevant articles were selected for their overview. They found no significant associations between elderly suicide rates and unemployment, even though suicide rates are correlated to socioeconomic status. They found that the relationship between SES and suicide rates is complicated and varies by gender. Living in an urban environment, having access to health care, and having family support also correlates with suicide rates in individuals over the age of sixty-five.
May, Klonsky, and Klein wrote the very interesting article “The Relationship Between Nonsuicidal Self-Injury and Attempted Suicide: Converging Evidence From Four Samples.” Their study examined the correlation between NSSI and attempted suicide in four samples: adolescent psychiatric patient, adolescent high school students, university undergraduates, and a random sample of United States adults. All of the samples but the adults were given measures of depression and other disorders as well. NSSI had a very strong correlation with suicide attempts, which was outnumbered only be previous attempts. The researchers realized that NSSI was an important suicide indicator, because its presence indicated a desire for suicide and the capability to commit the act.
May, Klonsky, and Klein also did the study “Predicting future suicide attempts among depressed suicide ideators: A 10-year longitudinal study,” in which they followed forty-nine individuals for ten years. They used questionnaires to determine risk factors for suicide attempts, including personal and environmental factors. The researchers found six life-long indicators of suicide attempts: personality disorders (clusters A, B, and C), substance abuse, a poor relationship with a maternal figure, anxiety disorder, and poor social adjustment.
There were many limitations to these studies, mainly because they mostly studied Caucasian individuals within the United States. I believe that more cross cultural research needs to be done on suicide risk factors, especially in the elderly. One idea for future research could involve individuals from collectivistic cultures, such as Japan. I believe that it would be interesting to review the correlation between suicide rates and attempts and socioeconomic factors, because of the cultural display rules in these cultures. They also have stigmas related to mental health, and usually only see licenses doctors as a last result, so it would be interesting to see how these factors influence suicide rates and ideologies. In relation to suicide, I also think that it would be interesting to find out how suicidal death relate to family members seeking help regarding mental illness in countries with high stigmas. I believe that to help lower the suicide rates, attention needs to be paid to the elderly, especially to males. They need to have access to affordable healthcare.
De Leo, D. (1999). Cultural issues in suicide and old age. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 20(2), 53-55. doi:10.1027//0227-5910.20.2.53
Innamorati, M., Tamburello, A., Lester, D., Rigucci, S., Amore, M., Vittorio, C. D., et al. (2009). Socioeconomic Rick Factors in the Precipitation of Suicide in the Elderly. The Open Geriatric Medicine Journal, 2, 28-33.
Klonsky, D., May, A., & Gordon, C. (2013). The Relationship Between Nonsuicidal Self-Injury and Attempted Suicide : Converging Evidence From Four Samples. Journal of Abnormal Psychology, 122(1), 231-237.
May, A., Klonsky, D., & Klein, D. (2012). Predicting future suicide attempts among depressed suicide ideators: A 10-year longitudinal study. Journal of Psychiatric Research, 46(7), 946-952.