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Suicide Prevention

April 1, 2010
by David M. W. Denton
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Hauling in the anchor of mental illness

My mom and her good friend, Marion, just returned from their annual weeklong winter cruise in the Caribbean. Their adventure ended with some uncertainty as to whether the ship would make it back to their destination as scheduled. Due to mechanical problems with the winch, the cruise line was forced to drag the anchor through the sea on the final leg of the trip. Much to their chagrin, their respite in the tropical wonderland aboard an otherwise fabulous ship finally ended.

Unfortunately, the story often does not play out this way for many older adults who go about their daily routines intentionally or unthinkingly pursuing a lifestyle that brings meaning and purposefulness into their lives. The anchor drifts under the radar, so to speak. Many times, it is overlooked or discounted by those we rely on for detecting and diagnosing our ailments. It seems as though a built-in filter naturally protects us from confronting the complex, troubling issues in our lives that, for any number of reasons, we are not prepared to address. To complicate matters, the anchor of clinically significant depression symptoms is often labeled as being part and parcel to aging. How many times have we heard it ourselves, “Of course I'm depressed!”

Healthy doses

For those of us who have committed our professional lives to aging services, we understand and embrace the notion that living well requires positive engagement in a balanced life that includes a healthy dose of each dimension of wellness: physical, nutritional, social, spiritual, emotional, intellectual, vocational, and environmental. The antithesis of wellness could be labeled as depression. In many cases, depression and other mental health conditions have paralyzing implications that can lead to suicidal ideations or the act of suicide itself, silently or in unmistaken ways.

Research finds that suicide is complex, with a variety of causes and contributors. These factors may be conceptualized according to a social ecological model, which recognizes that causes occur at multiple levels:

  • Individual factors (e.g., biology, individual beliefs)

  • Group/family factors (e.g., family and/or peer influences)

  • Institutional factors (In this context, the policies and structures of the senior living community, and the programs or services it offers)

  • Community factors (attributes of the community in which the facility is located; for example, community-based resources or services)

  • Public policy and societal factors (factors outside the immediate community, including state or federal policy and larger cultural forces)

Myths and Misconceptions Pose Barriers to Help-Seeking

  • Depression is inevitable with aging.

  • Depression is really laziness, weakness, or a character fault.

  • Treatment for depression does not work because it does not change or eliminate the depressing circumstances.

Studies show that 15 to 20% of elders who reside in the general community and 25-35% of residents in long-term care facilities have depression.

Sources: Koenig HG, Blazer DG. Epidemiology of geriatric affective disorders. Clinics in Geriatric Medicine 1992;8(2):235-51; Fabacher DA, Raccio-Robak N, McErlean MA, et al. Validation of a brief screening tool to detect depression in elderly ED patients. American Journal of Emergency Medicine 2002;20(2):99-102; Koenig HG, George LK, Peterson BL, Pieper CF. Depression in medically ill hospitalized older adults: Prevalence, characteristics, and course of symptoms according to six diagnostic schemes. Journal of Gerontology 1997;44(1):1376-83; Parmelee PA, Katz IR, Lawton MP. Depression among institutionalized aged: Assessment and prevalence estimation. Journal of Gerontology 1989;44(1):M-22-9.

The nonpassive cases of suicide I have witnessed, the most recent one in particular, led to my crusade of sorts to do something broad-reaching and call upon aging services professionals to join the campaign. It was in the aftermath of a shocking suicide between Christmas and New Year's Day 2005 that I came to grips with how ill-prepared I was to deal with the full spectrum of issues surrounding suicide and mental health concerns.

No good answers

In the midst of crisis, I was flooded with questions that had no good answers. “How could this have happened? Why didn't I see it coming…I was just talking with him six hours ago? Where is his wife? How will we console her? What will the family tell his grandchildren? How will I explain this to my residents and associates? Will the media be looking for a story? How will we prevent this from happening again?”

So many tough questions and there was no playbook to guide me out of this dark tunnel. Most providers, when faced with such devastating circumstances, have probably asked similar questions to those I grappled with on the eve of yet another suicide on my watch.

Fortunately, I was in a place where the resources, talent, and one remarkable resident in particular, Dr. James T. Clemons, DD, PhD, inspired the decision to pursue this mammoth challenge and ultimately help liberate seniors from the burdens of mental illness. Dr. Clemons, founded and served as executive director of OASSIS, Organization for Attempters and Survivors of Suicide in Interfaith Services, is an ordained minister for the United Methodist Church and was named professor emeritus by Wesley Theological Seminary.

Major Risk Factors for Suicide Among Elders

  • Depression, both major depression and other categories

  • Prior suicide attempt

  • Co-occurring general medical condition

  • Often experience pain and decline of role function

  • Social dependency or isolation

  • Family discord

  • Losses