Suicidal ideation in older New Zealand males (1991-2000).The present study investigated correlates of suicidal ideation suicidal ideation Suicidality Psychiatry Mental thoughts and images which hinge around committing suicide. See Suicide. in a nonclinical sample of 217 older men. Participants completed a self-report questionnaire including a suicidal ideation (SI) scale and other health and well-being measures. Suicidal ideation was related to income, stress, loneliness, hopelessness, depression, and negative affect, but was unrelated to age, self-reported health, or social support. Those reporting a previous psychological problem had significantly higher suicidal ideation scores. The scores on the SI scale were restricted to a narrow range, suggesting for the majority of participants thoughts of suicide were rare; however, ideation ideation /ide·a·tion/ (i?de-a´shun) the formation of ideas or images.idea´tional i·de·a·tion n. The formation of ideas or mental images. was related to other indices of well-being which have relevance for the older adult. Keywords: older men, suicidal ideation ********** The prevention of suicide and the identification of those at risk is receiving increased public attention as well as being a growing public health issue. However, much research and associated media attention has focused mainly on the increased incidence of suicide among the adolescent and young adult population (e.g., Beautrais, Joyce, & Mulder, 1994). Little emphasis, at least in the media, has been placed on suicide and/or suicide ideation in the older person. Suicide is the second leading cause of death from injury in New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. , and attempts at committing suicide constitute the seventh leading cause of injury requiring hospitalisation (Coggan, 1997). Males accounted for more than three-quarters of suicide deaths in 1997 (440 males, 121 females), and internationally, between 1978 and 1998, New Zealand males had the second highest suicide rate of 12 selected countries, behind Finland (Ministry of Health, 2001). Recent New Zealand data shows suicide rates for adults aged 65 years and over have been variable between 1988 and 1997. Suicide rates for adults aged 65 years and over actually decreased by 39 percent between 1988 and 1997; however, the male rate for 65 years and over was more than seven times higher than the female rate in 1997 (Ministry of Health, 2001). There is some suggestion that suicide is underreported in older adults (Melding, 1997). Melding (1997) suggests that underreporting in this age group reflects society's attitude that older people have lived their lives and have a moral right to end their lives. Another notion is that suicide ill this age group is a result of a rational and carefully thought-out plan. This implies that the consequence of such a death is less of a burden on society and therefore is somewhat justifiable jus·ti·fi·a·ble adj. Having sufficient grounds for justification; possible to justify: justifiable resentment. jus (Kerkhof, Visser, Diekstra, & Hirschhom, 1991). Ideas or behaviour that suggest a possibility of a threat to the individual's life are collectively known as suicidal ideation. The occurrence of suicidal ideation is higher than attempted or completed suicide with general population estimates of rate of occurrence ranging from 5.4% (Vandivort & Locke, 1979) to between 14 and 16% (Hintikka, Pesonen, Saarinen, Tanskanen, Lehtonen, & Viinameaeki, 2001; Schwab, Warheit, & Holzer, 1972). Kirby, Bruce, Radic, Coakley, and Lawlor (1997) in a community sample of older adults (65-95 years) found that serious suicidal su·i·cid·al adj. 1. Of or relating to suicide. 2. Likely to attempt suicide. feelings were rare, with only 0.2% of subjects expressing a pervasive wish to die; however, 15.5% reported that life was not worth living. Feelings of hopelessness or suicidality were present in 18.4% of subjects aged 65-74 compared with 14.8% of those over 75 years. Barnow and Linden Linden, city, United States Linden, city (1990 pop. 36,701), Union co., NE N.J., in the New York metropolitan area; inc. 1925. During the first half of the 20th cent. (1997) in a group of 70- to 105-year-old Germans found 5% of people wished to die and 0.5-1.0% showed suicidal behaviour or gestures. These figures increased with age. In a Swedish sample of older adults with a mean age of 84.3 years, Forsell, Jorm, and Winblad (1997) found 13.3% of subjects had had suicidal thoughts during the past two weeks (10.8% fleetingly fleet·ing adj. Passing quickly; ephemeral: a fleeting glimpse; a fleeting interest in the campaign. fleet and 2.5% frequently). Suicidal thoughts were associated with increased disability in daily living, institutionalisation This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. , visual problems, and use of psychotropic drugs psychotropic drug Psychoactive drug Pharmacology A drug that affects brain activities associated with mental processes and behavior Categories Anti-psychotics; antidepressants; antianxiety drugs or anxiolytics; hypnotics. . Mireault and de Man (1996) found suicidal ideation related to high levels of depression, high social isolation, and dissatisfaction with health and social support in both men and women aged 65 to 100 years in Montreal, Canada. The present study investigates a number of correlates of suicidal ideation in a nonclinical sample of older men. DATA AND METHODS PARTICIPANTS Participants were obtained via a nonprobability convenience sample drawn from a small New Zealand city as part of a larger study of well-being in older males (Neville & Alpass, 1999). Three hundred men over the age of 65 years were invited to participate. Of these, 83 declined participation in the study, giving a response rate of 72.3%, resulting in a net pool of 217 participants. Age ranged from 65 to 89 years (M = 75.4, SD = 4.96). Sixty-five percent were married, 24% were widowed, and 10% had either, divorced, separated, or never married. Twenty-eight percent of participants lived alone. Incomes ranged from $NZ 1,000 to $NZ 120,000 per annum Per annum Yearly. with a median income of $NZ 15,700. MEASURES PHYSICAL HEALTH Participants in the study were asked to identify any illnesses or disabilities they had. They were also asked to provide a self-rating of their health on a seven-point scale comparing their present health status to a person in excellent health, ranging from one (terrible) to seven (excellent). DAILY STRESS The Revised Hassles Scale (DeLongis, 1985) was used to measure levels of daily stress. This scale contains 53 items that identify common everyday concerns including family, intimacy, exercise, socialisation and economic sustainability. Items were scored on a five-point Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc measuring the extent to which each was perceived as being a hassle ranging from 0 (not at all) to four (very much). HOPELESSNESS The Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974) comprises 20 true/false items that measure how much a person's psychological state is governed by negative expectations of the future. Total scores vary from zero to 20 with higher scores indicative of increased feelings of hopelessness. SOCIAL SUPPORT Social support was measured using the six-item Social Support Questionnaire (SSQ SSQ Society for Software Quality SSQ La Sarre, Quebec, Canada (Airport Code) SSQ Sun Red Capital Corporation (stock symbol) SSQ Space Station Quality SSQ Standardized Safety Questionnaire SSQ Single Server Queue 6) (Sarason, Sarason, Shearin, & Pierce, 1987). Each item is made up of two parts. Part one asks the participant to list the number of others they feel they can seek support from in a variety of situations. Part two asks participants to identify the level of satisfaction received from this support, ranging from very dissatisfied (1) to very satisfied (6). DEPRESSION The Geriatric Depression Scale The Geriatric Depression Scale (GDS) is a 30-item self-report assessment used to identify depression in the elderly. Description The GDS questions are answered "yes" or "no", instead of a five-category response set. (GDS GDS Global Distribution System GDS Google Desktop Search (Google) GDS Goodie Domain Service (Vienna University of Technology, Austria) GDS Guards ; Brink, Yesavage, Lum n. 1. A chimney. 2. A ventilating chimney over the shaft of a mine. 3. A woody valley; also, a deep pool. , Heersema, Adey, & Rose, 1982) is a 30-item, self-report, yes/no response questionnaire. Participants were asked to choose the best answer that represented how they felt over the previous week. The items seek information representing depression in the older person and include lowered affect, decreased activity levels, irritability irritability /ir·ri·ta·bil·i·ty/ (ir?i-tah-bil´i-te) the quality of being irritable. myotatic irritability the ability of a muscle to contract in response to stretching. , withdrawal, distressing thoughts, and negative judgments about the past, present and future. Total scores can range from 0 to 30 with authors suggesting a normal range for the "aged" of 0 to 10. LONELINESS The present study used a 12-item form of the revised UCLA UCLA University of California at Los Angeles UCLA University Center for Learning Assistance (Illinois State University) UCLA University of Carrollton, TX and Lower Addison, TX (University of California, Los Angeles UCLA comprises the College of Letters and Science (the primary undergraduate college), seven professional schools, and five professional Health Science schools. Since 2001, UCLA has enrolled over 33,000 total students, and that number is steadily rising. ) Loneliness Scale developed by Maxwell and Coeburgh (1986). Total scores can range from 12 (low levels of loneliness) to 60 (high levels of loneliness). SUICIDAL IDEATION The Suicidal Ideation Questionnaire (Reynolds, 1987) is a 30-item, self-reporting instrument designed to assess thoughts of suicide. Participants score items on a seven-point Likert scale indicating the frequency with which each thought occurred over the past month. Scores from these items were rated from "I have never had this thought" (0) to "I have had this thought almost every day" (6). The scale has a potential range of 0 to 180 with lower scores indicating lower levels of suicidal ideation. DESIGN AND PROCEDURE Data was collected by the cross-sectional survey method. Each participant was given an introductory letter and information sheet outlining the purpose of the study. A week later a trained volunteer visited each prospective participant. Those who agreed to participate signed a consent form and were given a questionnaire to complete and a pre-paid envelope in which to return their questionnaire. Ethical approval for the study was given by the Massey University Massey University (Māori: Te Kunenga ki Purehuroa) is New Zealand's largest university with approximately 40,000 students. It has campuses in Palmerston North (sites at Turitea and Hokowhitu), Wellington (in the suburb of Mt Cook) and Human Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. . RESULTS Suicidal ideation scores ranged from 0 to 106 (Mean = 4.33, SD = 13.32), with an item mean of. 178 (based on a range of 0 to 6). An inspection of the items within the suicidal ideation scale revealed that 12 (5.5%) participants had wished they were dead at least once in the past month, and a further 9 (4.1%) had thought life not worth living at least once in the past month. Table 1 presents correlations between study variables. Suicidal ideation was significantly related to income (r = -.174, p < .05) and stress (r = .248, p < .001). The most frequently reported daily stressors (hassles) were those relating to relating to relate prep → concernant relating to relate prep → bezüglich +gen, mit Bezug auf +acc health and financial issues, with political/social/news issues and the weather also featuring. Suicidal ideation was also significantly correlated with loneliness (r = .498, p < .001), hopelessness (r = .236, p < .01), depression (r = .323, p < .001), and negative affect (r = .319, p < .001) but was unrelated to age (r = -.080, p = .280), self-reported health (r = .077, p = .294), number of social supports or satisfaction with social support (r = -.011, p = .882, and r = -.122, p = .099, respectively). Those men reporting a previous psychological problem had significantly higher suicidal ideation scores, t(160) = 4.526, p < .001. DISCUSSION The scores on the suicidal ideation scale for the present sample were restricted to a very narrow range, suggesting that, for the majority of people, thoughts of suicide were rare. Those items that were scored more frequently reflected the life span context of this group in that they may be more likely to contemplate issues relating to death and dying as they age. The mean suicidal ideation score in this sample was somewhat lower than those reported for other samples. For instance, Beaumont (1994) reported a mean of 21.77 (SD = 10.02) for university students. Osman, Kopper, Linehan, Barrios Barrios is a name of Hispanic origin. The name may refer to: Persons
adj. Of or relating to psychiatry. psychiatric adjective Pertaining to psychiatry, mental disorders controls, respectively, and Reynolds (1991) found a mean of 52.53 (SD = 33.88) in a mixed psychiatric and community suicide attempter group. In addition, the item mean on the suicidal ideation scale was .178 (based on a range of 0 to 6), somewhat lower than those item means reported elsewhere (range from .346 to 2.11) in younger-age clinical and nonclinical groups. The relatively low levels of suicidal ideation in this group do not appear to reflect reported suicidal behaviour in this age group (e.g., Melding, 1997) and this may be a function of the sampling procedure in the present study. It should be noted that although attempts were made to reach a cross-section of men, the majority of participants lived independently, and those with major health problems and cognitive impairments requiring hospitalisation were less likely to be sampled. In addition, no attempt was made to include homeless or itinerant ITINERANT. Travelling or taking a journey. In England there were formerly judges called Justices itinerant, who were sent with commissions into certain counties to try causes. men. It is possible that the population of older men with suicidal thoughts or intentions was undersampled in the present study. Suicidal ideation was significantly related to income and stress. The most frequently reported daily stressors (hassles) were those relating to health and financial issues. Clearly, the locus of stressors that impinge im·pinge v. im·pinged, im·ping·ing, im·ping·es v.intr. 1. To collide or strike: Sound waves impinge on the eardrum. 2. on daily living change as we age when issues relating to financial security and continued good health become more salient. Participants in the present research were also asked "what would make a difference in their lives at the present time" (see Neville & Alpass, 1999). The most frequent responses were more money (30.4% of participants) and better health for themselves or family (28.6% of participants). For instance, one man responded that to have enough money to put the heater on in winter would make the most difference in his life. The preoccupation with financial resources is understandable given the often reduced economic circumstances encountered with ageing (Koopman-Boy-den, 1993). Poor physical health, severe enough to limit a person's daily activities, might be expected to subject that person to psychological stress. Suicidal ideation was significantly correlated with loneliness, hopelessness, depression, and negative affect. Those who lived alone were lonelier, had higher scores on the depression and hopelessness scales, and rated their health more poorly than those who lived with others. These findings suggest that the presence of others in the home may serve to maintain well-being, and these others may not necessarily be a spouse or partner, though other research has shown that men get most of their social support from their wives (Antonucci & Akiyama, 1987). For instance, Campbell (1981) notes, in nearly all measures of affect, those men and women living with another person are more positive than those living alone and are less likely to report feeling "lonely," especially the men. Suicidal ideation was not related to social support levels and satisfaction with social support. Given the relationship to loneliness, this was surprising, but may be a result of the way social support was measured. Brissette, Sheldon, and Seeman (2000) argue that the choice of social support measurements should consider characteristics of the population under study and reflect how the social environment might influence health outcomes for this group. It could be argued that the conceptualisation (artificial intelligence) conceptualisation - The collection of objects, concepts and other entities that are assumed to exist in some area of interest and the relationships that hold among them. of social contact in the present study may not adequately capture the true meaning or value of social interaction for older participants. Suicidal ideation was not related to age or sell-reported health. Previous studies have been equivocal EQUIVOCAL. What has a double sense. 2. In the construction of contracts, it is a general rule that when an expression may be taken in two senses, that shall be preferred which gives it effect. Vide Ambiguity; Construction; Interpretation; and Dig. on the relationship between age and ideation, and the narrow range of age in the present study (65 to 89 years) may have served to underestimate this relationship. The relationship to self-rated health is surprising given the main stressors were those relating to health. Only one item was used to measure self-reported health. Idler and Kasl (1991) suggest the simplicity of these types of scales does not necessarily mean the responses are less valid than more complex health status indicators; however, future research might benefit from the inclusion of more sophisticated and more commonly used sell-report measures (e.g., SF36-Ware, 1993). Not surprisingly, those reporting a previous psychological problem had significantly higher suicidal ideation scores. The predictive validity In psychometrics, predictive validity is the extent to which a scale predicts scores on some criterion measure. For example, the validity of a cognitive test for job performance is the correlation between test scores and, for example, supervisor performance ratings. of previous psychological disorders Noun 1. psychological disorder - (psychiatry) a psychological disorder of thought or emotion; a more neutral term than mental illness folie, mental disorder, mental disturbance, disturbance for suicidal ideation has been demonstrated elsewhere (Linden, Zaeske, & Ahrens, 2003). In summary, levels of suicidal ideation in the present study were relatively low; however, they were related to a number of indices of well-being. Although suicide ideation is more common in attempters than nonattempters, Schmid, Manjee, and Tulshi (1994) found that suicidal ideation in the older adults, rather than sparking an attempt, may initiate a process of smouldering. This process may impact on other important aspects of well-being for the older adult (e.g., loneliness), and health professionals need to be aware of the possibility of concomitant symptoms concomitant symptom n. See accessory symptom. of psychopathology psychopathology /psy·cho·pa·thol·o·gy/ (-pah-thol´ah-je) 1. the branch of medicine dealing with the causes and processes of mental disorders. 2. abnormal, maladaptive behavior or mental activity. . REFERENCES Antonucci, T., & Akiyama, H. (1987). An examination of sex differences in social support among older men and women. Sex Roles, 17(11/12), 737-749. Barnow, S., & Linden, M. (1997). Suicidality and tiredness of life among very old persons: Results from the Berlin Aging Study. Archives of Suicide Research, 3(3), 171-182. Beaumont, G.M. (1994). Suicidal ideation in a non-clinical sample: Cross-sectional and longitudinal relationships with minor stressors, depression, hopelessness and coping behaviour. Unpublished doctoral dissertation. Massey University, New Zealand. Beautrais, A., Joyce, P., & Mulder, R. (1994). The Canterbury suicide project: Aims, overview and progress. Community Mental Health in New Zealand, 8(2), 32-39. Beck, A.T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism pessimism, philosophical opinion or doctrine that evil predominates over good; the opposite of optimism. Systematic forms of pessimism may be found in philosophy and religion. : The hopelessness scale. Journal o[" Consulting and Clinical Psychology, 42, 861-865. Brink, T.L., Yesavage, J.A., Lure, O., Heersema, P.H., Adey, M., & Rose, T.L. (1982). Screening tests for geriatric geriatric /ger·i·at·ric/ (jer?e-at´rik) 1. pertaining to elderly persons or to the aging process. 2. pertaining to geriatrics. ger·i·at·ric adj. 1. depression. Clinical Gerontologist ger·on·tol·o·gy n. 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The branch of psychiatry that deals with the relationship between social environment and mental illness. & Psychiatric Epidemiology Psychiatric Epidemiology is a field which seeks to measure the prevalence of mental illness in society. It is a subfield of the more general epidemiology. It is very difficult to accurately measure such a thing as mental illness prevalence, and current techniques are relatively , 36(12), 590-594. House, J.S., & Kahn, R.L. (1985). Measures and concepts of social support. In S. Cohen & L. Syme (Eds.), Social support and health (pp. 83-106). New York: Academic Press. Idler, E.L., & Kasl, S. (1991). Health perceptions and survival: Do global evaluations of health status really predict mortality? Journal of Gerontology gerontology: see geriatrics. , 46, 555-565. Kasl, S.V. (1978). Epidemiological contributions to the study of work stress. In C. L. Cooper & R. L. Payne (Eds.), Stress at work (pp. 3-48). Chichester: Wiley. 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Validation of the Adult Suicidal Ideation Questionnaire and the Reasons for Living Inventory in an adult psychiatric inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay. in·pa·tient n. sample. Psychological Assessment, 11(2), 115-123. Pennebaker, J.W., & Watson, D. (1988). Self-reports and physiological measures in the workplace. In J.J. Hurrell, Jr., L.R. Murphy, S.L. Sauter, & C.L. Cooper (Eds.), Occupational stress: Issues and developments in research (pp. 184-196). London: Taylor & Francis. Reynolds, W.M. (1987). Suicidal ideation questionnaire. Florida: Psychological Assessment Resources. Sarason, I.G., Sarason, B.R., Shearin, E N., & Pierce, G.R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social and Personal Relationships, 4, 497-510. Schwab, J., Warheit, G., & Holzer, C. (1972). Suicidal ideation and behavior in a general population. Diseases of the Nervous System, 33, 745-748. Schmid, H., Manjee, K., & Shah, T. (1994). On the distinction of suicide ideation versus attempt in elderly psychiatric inpatients. Gerontologist, 34(3), 332-339. Vandivort, D., & Locke, B. (1979). Suicide ideation: Its relation to depression, suicide and suicide attempt suicide attempt, suicide bid n → intento de suicidio suicide attempt, suicide bid n → tentative f de suicide . Suicide and Life-Threatening Behavior, 9, 205-218. Veit, C., & Ware, J. (1983).The structure of psychological distress psychological distress The end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology. and well-being in general populations. Journal of Consulting and Clinical Psychology The Journal of Consulting and Clinical Psychology (JCCP) is a bimonthly psychology journal of the American Psychological Association. Its focus is on treatment and prevention in all areas of clinical and clinical-health psychology and especially on topics that appeal to a broad , 51(5), 730-742. Ware, J.E., Jr. (1993). SF-36 Health survey SF-36 Health Survey, n.pr a widely used, valid, and standardized questionnaire used to measure an individual's overall subjective health status. The eight concepts measured by the survey are body pain, general mental health, perception of general health, . Manual & interpretation guide. Boston, MA: The Health Institute, New England New England, name applied to the region comprising six states of the NE United States—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. The region is thought to have been so named by Capt. Medical Center. Correspondence concerning this article should be sent to Dr Fiona Alpass, School of Psychology, Private Bag 11-222, Massey University, Palmerston North, New Zealand. Electronic mail: f.m.alpass@ massey.ac.nz FIONA M. ALPASS Massey University Palmerston North, New Zealand STEPHEN J. NEVILLE Massey University Auckland, New Zealand
Table 1
Correlates of Suicidal Ideation
Suicidal ideation
Income -.174 *
Stress .248 **
Loneliness .498 ***
Hopelessness .236 **
Depression .323 ***
Negative affect .319 ***
Age -.080
Health .077
Number of social supports -.011
Satisfaction with supports -.122
* p <.05, ** p <.01, *** p <.001
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