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Current Psychiatry Reports
Published in: Current Psychiatry Reports 11/2014

01-11-2014 | Geriatric Disorders (W McDonald, Section Editor)

Suicide in Older Adults: The Role of Emotions and Cognition

Authors: Dimitris N. Kiosses, Katalin Szanto, George S. Alexopoulos

Published in: Current Psychiatry Reports | Issue 11/2014

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Abstract

Suicide in older adults is a significant clinical concern. In this review of recent findings, we concentrate on the role of emotions and cognition in suicide risk and behavior in older adults. We discuss the epidemiology of suicide in older adults, integrate recent findings on non-psychotic major depression, schizophrenia and suicidal ideation, explore the relationship of emotion regulation with suicide, present recent advances on suicide in demented patients, and describe the latest developments on cognition and decision processes in suicide.
Literature
1.
Cerel J, Jordan JR, Duberstein PR. The impact of suicide on the family. Crisis. 2008;29(1):38–44.PubMed
2.
National Action Alliance for Suicide Prevention: Research Prioritization Task Force. A prioritized research agenda for suicide prevention: an action plan to save lives. Rockville: National Institute of Mental Health and the Research Prioritization Task Force; 2014.
3.
4.
Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin N Am. 2011;34(2):451–68.CrossRef
5.
Chan J, Draper B, Banerjee S. Deliberate self-harm in older adults: a review of the literature from 1995 to 2004. Int J Geriatr Psychiatry. 2007;22(8):720–32.PubMedCrossRef
6.
Fung YL, Chan ZC. A systematic review of suicidal behaviour in old age: a gender perspective. J Clin Nurs. 2011;20(15–16):2109–24.PubMedCrossRef
7.
Leadholm AK, Rothschild AJ, Nielsen J, Bech P, Ostergaard SD. Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression. J Affect Disord. 2014;156:119–25.PubMedCrossRef
8.
Li G. The interaction effect of bereavement and sex on the risk of suicide in the elderly: an historical cohortstudy. Soc Sci Med. 1995;40:825–8.PubMedCrossRef
9.
Bartels SJ, Coakley E, Oxman TE, Constantino G, Oslin D, Chen H, et al. Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Am J Geriatr Psychiatry. 2002;10(4):417–27.PubMedCrossRef
10.
Chou KL, Cheung KC. Major depressive disorder in vulnerable groups of older adults, their course and treatment, and psychiatric comorbidity. Depress Anxiety. 2013;30(6):528–37.PubMedCrossRef
11.
Kalmar S, Szanto K, Rihmer Z, Mazumdar S, Harrison K, Mann JJ. Antidepressant prescription and suicide rates: effect of age and gender. Suicide Life Threat Behav. 2008;38(4):363–74.PubMedCrossRefPubMedCentral
12.
Erlangsen A, Conwell Y. Age-related response to redeemed antidepressants measured by completed suicide in older adults: a nationwide cohort study. Am J Geriatr Psychiatry. 2014;22(1):25–33.PubMedCrossRef
13.
14.
Erlangsen A, Eaton WW, Mortensen PB, Conwell Y. Schizophrenia–a predictor of suicide during the second half of life? Schizophr Res. 2012;134(2–3):111–7.PubMedCrossRefPubMedCentral
15.
Cukrowicz KC, Ekblad AG, Cheavens JS, Rosenthal MZ, Lynch TR. Coping and thought suppression as predictors of suicidal ideation in depressed older adults with personality disorders. Aging Ment Health. 2008;12(1):149–57.PubMedCrossRef
16.
Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002;52(3):193–2004.PubMedCrossRef
17.
Vasiliadis HM, Gagné S, Préville M. Gender differences in determinants of suicidal ideation in French-speaking community living elderly in Canada. Int Psychogeriatr. 2012;24(12):2019–26.PubMedCrossRef
18.
Fanning JR, Pietrzak RH. Suicidality among older male veterans in the United States: results from the National Health and Resilience in Veterans Study. J Psychiatr Res. 2013;47(11):1766–75.PubMedCrossRef
19.
Alexopoulos GS, Reynolds 3rd CF, Bruce ML, Katz IR, Raue PJ, Mulsant BH, et al. PROSPECT Group. Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry. 2009;166:882–90.PubMedCrossRefPubMedCentral
20.
Raue PJ, Meyers BS, Rowe JL, Heo M, Bruce ML. Suicidal ideation among elderly home care patients. Int J Geriatr Psychiatry. 2007;22(1):32–7.PubMedCrossRef
21.
Bogers IC, Zuidersma M, Boshuisen ML, Comijs HC, Oude Voshaar RC. Determinants of thoughts of death or suicide in depressed older persons. Int Psychogeriatr. 2013;25(11):1775–82.PubMedCrossRef
22.
Kim S, Ha JH, Yu J, Park DH, Ryu SH. Path analysis of suicide ideation in older people. Int Psychogeriatr. 2014;26(3):509–15.PubMedCrossRef
23.
Cukrowicz KC, Duberstein PR, Vannoy SD, Lynch TR, McQuoid DR, Steffens DC. Course of suicide ideation and predictors of change in depressed older adults. J Affect Disord. 2009;113(1–2):30–6.PubMedCrossRefPubMedCentral
24.
Kang HJ, Stewart R, Jeong BO, Kim SY, Bae KY, Kim SW, et al. Suicidal ideation in elderly Korean population: a two-year longitudinal study. Int Psychogeriatr. 2014;26(1):59–67.PubMed
25.
Batterham PJ, Calear AL, Mackinnon AJ, Christensen H. The association between suicidal ideation and increased mortality from natural causes. J Affect Disord. 2013;150(3):855–60.PubMedCrossRef
26.
Raue PJ, Morales KH, Post EP, Bogner HR, Have TT, Bruce ML. The wish to die and 5-year mortality in elderly primary care patients. Am J Geriatr Psychiatry. 2010;18:341–50.PubMedCrossRefPubMedCentral
27.
Pompili M, Innamorati M, Di Vittorio C, Sher L, Girardi P, Amore M. Sociodemographic and clinical differences between suicide ideators and attempters: a study of mood disordered patients 50 years and older. Suicide Life Threat Behav. 2014;44(1):34–45.PubMedCrossRef
28.
Sachs-Ericsson N, Hames JL, Joiner TE, Corsentino E, Rushing NC, Palmer E, et al. Differences between suicide attempters and nonattempters in depressed older patients: depression severity, white-matter lesions, and cognitive functioning. Am J Geriatr Psychiatry. 2014;22(1):75–85.PubMedCrossRef
29.
30.
Erlangsen A, Zarit SH, Conwell Y. Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data. Am J Geriatr Psychiatry. 2008;16(3):220–8.PubMedCrossRefPubMedCentral
31.
Sabodash V, Mendez MF, Fong S, Hsiao JJ. Suicidal behavior in dementia: a special risk in semantic dementia. Am J Alzheimers Dis Other Demen. 2013;28(6):592–9.PubMedCrossRef
32.
Purandare N, Voshaar RC, Rodway C, Bickley H, Burns A, Kapur N. Suicide in dementia: 9-year national clinical survey in England and Wales. Br J Psychiatry. 2009;194(2):175–80.PubMedCrossRef
33.
Draper B, Peisah C, Snowdon J, Brodaty H. Early dementia diagnosis and the risk of suicide and euthanasia. Alzheimers Dement. 2010;6:75–82.PubMedCrossRef
34.
Haw C, Harwood D, Hawton K. Dementia and suicidal behavior: a review of the literature. Int Psychogeriatr. 2009;21(3):440–53.PubMedCrossRef
35.
Nowrangi MA, Rao V, Lyketsos CG. Epidemiology, assessment, and treatment of dementia. Psychiatr Clin N Am. 2011;34(2):275–94.CrossRef
36.
Kiosses DN, Alexopoulos GS. Suicide ideation in older adults with major depression, cognitive impairment and disability. AAGP 2014 Annual Meeting, Orlando, Florida.
37.
Draper B, Brodaty H, Low LF, Richards V. Prediction of mortality in nursing home residents: impact of passive self-harm behaviors. Int Psychogeriatr. 2003;15(2):187–96.PubMedCrossRef
38.
Conwell Y, Thompson C. Suicidal behavior in elders. Psychiatr Clin N Am. 2008;31(2):333–56.CrossRef
39.
Heisel MJ, Flett GL, Besser A. Cognitive functioning and geriatric suicide ideation: testing a mediational model. Am J Geriatr Psychiatry. 2002;10(4):428–36.PubMedCrossRef
40.
Lynch TR, Cheavens JS, Morse JQ, Rosenthal MZ. A model predicting suicidal ideation and hopelessness in depressed older adults: the impact of emotion inhibition and affect intensity. Aging Ment Health. 2004;8(6):486–97.PubMedCrossRef
41.
Hill RD, Gallagher D, Thompson LW, Ishida T. Hopelessness as a measure of suicide intent in the depressed elderly. Psychol Aging. 1988;3:230–2.PubMedCrossRef
42.
Szanto K, Reynolds III CF, Conwell Y, Begley AE, Houck P. High levels of hopelessness persist in geriatric patients with remitted depression and a history of attempted suicide. J Am Geriatr Soc. 1998;46(11):1401–6.PubMed
43.
Seidlitz L, Conwell Y, Duberstein P, Cox C, Denning D. Emotion traits in older suicide attempters and non-attempters. J Affect Disord. 2001;66(2–3):123–31.PubMedCrossRef
44.
Lynch TR, Johnson CS, Mendelson T, Robins CJ, Ranga K, Krishnan R, et al. Correlates of suicidal ideation among an elderly depressed sample. J Affect Disord. 1999;56(1):9–15.PubMedCrossRef
45.
Marty MA, Segal DL, Coolidge FL. Relationships among dispositional coping strategies, suicidal ideation, and protective factors against suicide in older adults. Aging Ment Health. 2010;14(8):1015–23.PubMedCrossRef
46.
Duberstein PR, Conwell Y, Seidlitz L, Denning DG, Cox C, Caine ED. Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older. J Gerontol B Psychol Sci Soc Sci. 2000;55(1):18–26.CrossRef
47.
Szanto K, Clark L, Hallquist M, Vanyukov P, Crockett M, Dombrovski AY. The cost of social punishment and high-lethality suicide attempts in the second half of life. Psychol Aging. 2014;29(1):84–94.PubMedCrossRef
48.
McGirr A, Renaud J, Bureau A, Seguin M, Lesage A, Turecki G. Impulsive-aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide. Psychol Med. 2008;38(3):407–17.PubMedCrossRef
49.
50.
Jollant F, Bellivier F, Leboyer M, Astruc B, Torres S, Verdier R, et al. Impaired decision making in suicide attempters. Am J Psychiatry. 2005;162(2):304–10.PubMedCrossRef
51.
Clark L, Dombrovski AY, Siegle GJ, Butters MA, Shollenberger CL, Sahakian BJ, et al. Impairment in risk-sensitive decision-making in older suicide attempters with depression. Psychol Aging. 2011;26(2):321–30.PubMedCrossRefPubMedCentral
52.
Andersson L, Allebeck P, Gustafsson JE, Gunnell D. Association of IQ scores and school achievement with suicide in a 40-year follow-up of a Swedish cohort. Acta Psychiatr Scand. 2008;118(2):99–105.PubMedCrossRef
53.
Gunnell D, Löfving S, Gustafsson JE, Allebeck P. School performance and risk of suicide in early adulthood: follow-up of two national cohorts of Swedish schoolchildren. J Affect Disord. 2011;131(1–3):104–12.PubMedCrossRef
54.
Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. ‘Vascular depression’ hypothesis. Arch Gen Psychiatry. 1997;54(10):915–22.PubMedCrossRef
55.
Chan SS, Lyness JM, Conwell Y. Do cerebrovascular risk factors confer risk for suicide in later life? A case-control study. Am J Geriatr Psychiatry. 2007;15(6):541–4.PubMedCrossRef
56.
Denburg NL, Cole CA, Hernandez M, Yamada TH, Tranel D, Bechara A, et al. The orbitofrontal cortex, real-world decision making, and normal aging. Ann N Y Acad Sci. 2007;1121:480–98.PubMedCrossRefPubMedCentral
57.
Fein G, McGillivray S, Finn P. Older adults make less advantageous decisions than younger adults: cognitive and psychological correlates. J Int Neuropsychol Soc. 2007;13(3):480–9.PubMedCrossRefPubMedCentral
58.
Brown SBRE, Ridderinkhof KR. Aging and the neuroeconomics of decision making: a review. Cogn Affect Behav Neurosci. 2009;9(4):365–79.PubMedCrossRef
59.
MacPherson SE, Phillips LH, Della SS. Age, executive function and social decision making: a dorsolateral prefrontal theory of cognitive aging. Psychol Aging. 2002;17(4):598–609.PubMedCrossRef
60.
Raz N, Lindenberger U, Rodrigue KM, Kennedy KM, Head D, Williamson A, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676–89.PubMedCrossRef
61.
Keilp JG, Sackeim HA, Brodsky BS, Oquendo MA, Malone KM, Mann JJ. Neuropsychological dysfunction in depressed suicide attempters. Am J Geriatr Psychiatry. 2001;158(5):735–41.CrossRef
62.
63.
Marzuk PM, Hartwell N, Leon AC, Portera L. Executive functioning in depressed patients with suicidal ideation. Acta Psychiatr Scand. 2005;112(4):294–301.PubMedCrossRef
64.
Nock MK, Park JM, Finn CT, Deliberto TL, Dour HJ, Banaji MR. Measuring the suicidal mind: implicit cognition predicts suicidal behavior. Psychol Sci. 2010;21(4):511–7.PubMedCrossRef
65.
Raust A, Slama F, Mathieu F, Roy I, Chenu A, Koncke D, et al. Prefrontal cortex dysfunction in patients with suicidal behavior. Psychol Med. 2007;37(03):411–9.PubMedCrossRef
66.
67.
McGirr A, Dombrovski AY, Butters M, Clark L, Szanto K. Deterministic learning and attempted suicide among older depressed individuals: cognitive assessment using the Wisconsin Card Sorting Task. J Psychiatr Res. 2012;46(2):226–32.PubMedCrossRefPubMedCentral
68.
Richard-Devantoy S, Jollant F, Kefi Z, Turecki G, Olie JP, Annweiler C, et al. Deficit of cognitive inhibition in depressed elderly: a neurocognitive marker of suicidal risk. J Affect Disord. 2012;140(2):193–9.PubMedCrossRef
69.
McGirr A, Jollant F, Turecki G. Neurocognitive alterations in first degree relatives of suicide completers. J Affect Disord. 2013;145(2):264–9.PubMedCrossRef
70.
Keilp JG, Gorlyn M, Russell M, Oquendo MA, Burke AK, Harkavy-Friedman J, et al. Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt. Psychol Med. 2013;43(3):539–51.PubMedCrossRefPubMedCentral
71.
Richard-Devantoy S, Annweiler C, Beauchet O, Camus V, Le Gall D, Garre JB. P03-470 - cognitive inhibition in suicidal depressed elderly. Eur Psychiatry. 2011;26(1):1640.CrossRef
72.
Dombrovski AY, Clark L, Siegle GJ, Butters MA, Ichikawa N, Sahakian BJ, et al. Reward/Punishment reversal learning in older suicide attempters. Am J Psychiatry. 2010;167(6):699–707.PubMedCrossRefPubMedCentral
73.
Dougherty DM, Mathias CW, Marsh DM, Papageorgiou TD, Swann AC, Moeller FG. Laboratory measured behavioral impulsivity relates to suicide attempt history. Suicide Life Threat Behav. 2004;34(4):374–85.PubMedCrossRef
74.
Klonsky ED, May A. Rethinking impulsivity in suicide. Suicide Life Threat Behav. 2010;40(6):612–9.PubMedCrossRef
75.
Kirby KN, Finch JC. The hierarchical structure of self-reported impulsivity. Personal Individ Differ. 2010;48(6):704–13.CrossRef
76.
Dougherty DM, Mathias CW, Marsh-Richard DM, Furr RM, Nouvion SO, Dawes MA. Distinctions in behavioral impulsivity: implications for substance abuse research. Addict Disord Treat. 2009;8(2):61–73.CrossRef
77.
Dougherty DM, Richard DM, James LM, Mathias CW. Effects of acute tryptophan depletion on three different types of behavioral impulsivity. Int J Tryptophan Res. 2010;3:99–111.PubMedCrossRefPubMedCentral
78.
Kirby KN. Bidding on the future: evidence against normative discounting of delayed rewards. J Exp Psychol-Gen. 1997;126(1):54–70.CrossRef
79.
Dombrovski AY, Szanto K, Siegle GJ, Wallace ML, Forman SD, Sahakian B, et al. Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age. Biol Psychiatry. 2011;70(2):138–44.PubMedCrossRefPubMedCentral
80.•
Dombrovski AY, Szanto K, Clark L, Reynolds CF, Siegle GJ. Reward signals, attempted suicide, and impulsivity in late-life depression. JAMA Psychiatry. 2013. doi:10.​1001/​jamapsychiatry.​2013.​75. A paper highlighting the relationship of neural circuit abnormalities that underlie disadvantageous choices in people at risk for suicide with impulsivity.PubMedPubMedCentral
81.
Jollant F, Lawrence N, Giampietro V, Brammer M, Fullana M, Drapier D, et al. Orbitofrontal cortex response to angry faces in men with histories of suicide attempts. Am J Psychiatry. 2008;165(6):740–8.PubMedCrossRef
82.
Duberstein PR, Conwell Y, Conner KR, Eberly S, Evinger JS, Caine ED. Poor social integration and suicide: fact or artifact? A case-control study. Psychol Med. 2004;34(7):1331–7.PubMedCrossRef
83.
Gibbs LM, Dombrovski AY, Morse J, Siegle GJ, Houck PR, Szanto K. When the solution is part of the problem: problem solving in elderly suicide attempters. Int J Geriatr Psychiatry. 2009;24(12):1396–404.PubMedCrossRefPubMedCentral
84.
Szanto K, Dombrovski AY, Sahakian BJ, Mulsant BH, Houck PR, Reynolds 3rd CF, et al. Social emotion recognition, social functioning, and attempted suicide in late-life depression. Am J Geriatr Psychiatry. 2012;20(3):257–65.PubMedCrossRefPubMedCentral
85.
Delgado MR, Frank RH, Phelps EA. Perceptions of moral character modulate the neural systems of reward during the trust game. Nat Neurosci. 2005;8(11):1611–8.PubMedCrossRef
86.•
Alexopoulos G, Arean P. A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’. Mol Psychiatry. 2014;19(1):14–9. A recent article describing a new psychotherapy linked to RDoC constructs.PubMedCrossRef
Metadata
Title
Suicide in Older Adults: The Role of Emotions and Cognition
Authors
Dimitris N. Kiosses
Katalin Szanto
George S. Alexopoulos
Publication date
01-11-2014
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 11/2014
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-014-0495-3

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