Current updates in suicide prevention interventions for older adults and the way a novel pill software could present reduction to people at excessive threat of suicide.
Suicide in late life constitutes a significant public well being concern. In 2019, the Facilities for Illness Management and Prevention (CDC) reported that the suicide charge for all ages in the US was 14.5/100,000. Center-aged and older adults have increased charges of suicide than their youthful counterparts (19.41/100,000 for people aged 55 to 64), and the very best charge of suicide stays for older males (39.9/100,000 for males aged 75 and older).1 Regardless of the alarmingly excessive charges, psychosocial interventions for this inhabitants are understudied and urgently wanted.
Cellular gadgets present a novel and highly effective alternative to ship interventions to suicidal people during times of elevated suicide threat.2 With the present COVID-19 pandemic, reliance on digital well being expertise is rising, and growing focused interventions that can be utilized remotely by older adults throughout instances of emotional disaster is of paramount significance.
Traits and Danger Components
To ascertain efficient psychosocial interventions, threat elements for late-life suicide have to be examined. Sociodemographic and scientific elements which can be extra generally present in middle-aged and older people (eg, widowhood, cognitive decline, and so on) play an vital position in suicide threat. Understanding the complicated interplay of those late-life occurrences can information efforts in designing preventative interventions.3
Demographic Components
Based on the CDC, middle-aged and older adults account for the very best variety of suicides in comparison with youthful populations. In 2018, adults aged 65 and older had been reported to make up 16% of the US inhabitants, however had been chargeable for 18.8% of suicides.4 Whereas there are an estimated 25 suicide makes an attempt for each accomplished suicide within the basic inhabitants, roughly 1 in 4 suicide makes an attempt ends in dying for older adults.5 Gender, race, and ethnicity additionally affect suicide threat and conduct. Ladies persistently account for the next variety of suicide makes an attempt than males. There are 3 feminine makes an attempt for every male try, but an estimated 3.6 males die by suicide for each 1 feminine dying. This discrepancy is attributed to the distinction in technique, as a result of males typically use extra deadly strategies when trying suicide.6 Compared to different racial and ethnic teams, non-Hispanic American Indian/Alaska Native and non-Hispanic white individuals account for the very best charges of suicide at 22.3 and 17.6/100,000, respectively.7
Cognitive Functioning and Bodily Sickness
As many as 1 in 9 older adults undergo from some type of cognitive impairment.8 Cognitive impairment is usually chargeable for lowering decision-making capability and affecting emotion regulation skills, doubtlessly contributing to suicidal ideation and conduct.9 Discrepancies in literature relating to suicide threat and cognitive impairment recommend that dementia can both be a threat issue or a protecting issue relying on the development and severity of signs.10 Nonetheless, a evaluate on suicide threat and Alzheimer illness discovered that Alzheimer illness is related to a average suicide threat in older adults, even a number of years after prognosis.11
Bodily sickness and useful incapacity in late life are additionally strongly related to suicide. In a cohort examine by Erlangsen and colleagues,12 investigators discovered that sure cancers and liver illness, particularly, are most intently related to suicidal outcomes. Regardless of robust associations present in analysis, reviewers of the literature advise warning when utilizing bodily sickness to find out threat, many noting that figuring out bodily sickness doesn’t function a predictor for suicide, nor does quantifying the severity of signs.13
Psychiatric Sickness and Suicidal Habits
Psychiatric sickness is famous in as much as 97% of late-life suicides, with main melancholy cited as probably the most strongly related psychiatric dysfunction.3 Retrospective evaluation of psychiatric sickness and suicide mortalities in older adults in Denmark spotlight recurrent melancholy as contributing to the very best charge of suicides in adults aged 60 and older, adopted intently by different affective issues and response to emphasize/adjustment issues. This threat was considerably elevated for people who had been hospitalized for any kind of psychiatric dysfunction, with hospitalized psychiatric sickness accounting for 22.3% of male suicides aged 60 and older.14
One of many predictors of suicidal conduct is suicidal ideation, particularly lively suicidal ideation with intent or plan. Nonetheless, in older adults who’re in search of ageing providers, even passive suicidal ideation is an indicator of suicide threat.15 Regardless of the elevated variety of late-life suicides, suicidal older adults typically go undetected as a result of decrease charges of reporting,16 particularly in major care the place older adults most definitely search medical therapy. This data highlights the necessity for elevated identification methods, in addition to enhanced efforts to forestall the onset of suicidal ideation given the excessive mortality charge in late-life suicide attempters.
Psychosocial Components
Interpersonal losses together with widowhood or dying of family and friends are commonplace in development of age. The accompanying stress, sense of loneliness, and social disconnection in response to loss is related to elevated suicide threat, particularly throughout the first yr after the dying of a detailed relative.17,18 Passive and lively suicidal ideas are significantly frequent amongst older adults in long-term care services, and social isolation and loneliness are a number of the most continuously reported bases for suicidal ideas.19 The connection between perceived social assist and psychiatric sickness, most notably melancholy, is robust even when controlling for different elements, similar to detrimental affectivity and overreporting of experiences.20 This factors towards a necessity for extra dynamic psychosocial interventions.
Present Psychosocial Interventions for Suicide Prevention
Present randomized, managed trials (RCTs) that consider psychosocial interventions for older adults are usually developed to deal with melancholy or different affective issues in younger adults and should not particularly focused towards suicidality.21 Of the few revealed RCTs that measure suicidal ideation as a major final result in older adults, the intervention and evaluation strategies are numerous. Conwell22 investigated the impact of a peer companionship program on socially disconnected older adults, however noticed no important distinction in suicidal ideation outcomes between the therapy and management teams. Two research, carried out by Ecker23 and Kumpula,24 evaluated diversifications of CBT on veterans with suicidal ideation. The primary examine was a 4-month temporary cognitive behavioral remedy (CBT), and the second was CBT for melancholy in contrast towards 2 different evidence-based psychotherapies. Each authors reported a discount in suicidal ideation within the CBT/bCBT teams in comparison with management teams.
Gustavson25 and Lutz26 examined suicidal ideation as a major final result in assessments of problem-solving remedy in older grownup populations. These research each noticed important reductions in suicidal ideation within the therapy teams; nonetheless, 1 examine tailor-made the intervention towards older adults with melancholy and govt dysfunction, and the opposite focused topics with useful incapacity, making the interventions troublesome to match.
Kiosses9 investigated the results of drawback adaptation remedy (PATH) on suicidal ideation, an intervention that makes use of emotion-regulation strategies and compensatory methods in older adults with melancholy and cognitive impairment. The authors noticed a discount in suicidality within the PATH members, however the discount was not considerably completely different from the supportive remedy management group.
The samples within the aforementioned research characterize particular populations (ie, veterans with medical sickness, older adults with useful disabilities), and should not consultant of the final older grownup inhabitants. The heterogeneity of the interventions creates problem in each between-study comparisons and generalizability to the final inhabitants. Furthermore, these research typically exclude those that specific lively suicidal ideation, leaving out those that are at larger threat of suicide. The outcomes are promising; nonetheless, it’s important that findings be replicated with bigger and extra consultant samples to extra precisely study the effectiveness and promote generalizability of the interventions.
Position of Expertise in Remedy
The onset of the COVID-19 pandemic and the related insurance policies have the potential to exacerbate the severity of the beforehand recognized threat elements for suicide in older adults. Social-distancing pointers, stress, and restricted entry to well being care could contribute to elevated emotions of isolation and loneliness, worsening of cognitive and useful skills, and intensification of signs of psychiatric issues.27 Expertise gives the chance to alleviate logistical obstacles to receiving scientific interventions for older adults who could have problem adhering to therapy. Because the reliance on telehealth will increase, extra thorough investigation into distant psychosocial intervention strategies focused particularly for this inhabitants is especially important.
Literature on the position of expertise therapy for suicide prevention in older adults is sparse. Preliminary findings out there on feasibility and acceptability of technology-based cell interventions recommend promising results of enchancment, however additional testing is required.28 In a evaluate of cell well being expertise for suicide prevention, one intervention, Digital Hope Field (VHB), was examined in middle-aged adults. The examine recruited each younger and middle-aged veterans with a imply age of 46 years outdated and examined an augmentation of CBT utilizing smartphone capabilities to reinforce and personalize the expertise with a “hope field.” The examine evaluated the impact of the appliance on depth of suicidal ideation and significance of causes for residing, however the outcomes yielded no statistically important therapy impact on these outcomes between the therapy and management teams.29
Our analysis on the Emotion, Cognition, and Psychotherapy Lab at Weill Cornell Drugs goals to scale back suicide threat by using a simplified, customized, and easy-to-use cell intervention. WellPATH is a pill software that focuses on emotion regulation methods (particularly, cognitive reappraisal methods, which deal with seeing a scenario from a special perspective) to scale back detrimental feelings related to elevated suicide threat. It’s a customized, primarily standalone, cell intervention that comes with patient-specific strategies that may be accessed when the affected person is confronted with detrimental feelings. The affected person and WellPATH interventionist establish conditions, issues, or issues that set off intense detrimental feelings that will result in elevated suicidal ideation or conduct and develop customized cognitive reappraisal methods to scale back the extreme detrimental feelings.
Preliminary outcomes point out that sufferers are capable of make the most of the user-friendly interface with ease and are extremely glad with the assist supplied by WellPATH.30 The WellPATH software takes into consideration traits distinctive to older adults and gives fast entry to an intervention that’s straightforward to make use of. It addresses the necessity for a cell suicide prevention intervention for middle-aged and older adults at excessive suicide threat, which is especially germane, given the elevated reliance on telehealth.
Concluding Ideas
The subject of suicide in older adults requires larger consideration. Identification of threat elements is efficacious in understanding elder suicidality; nonetheless, additional consideration is inspired for the event and analysis of efficient interventions tailor-made to older adults. The few psychosocial interventions talked about present total promising outcomes, however sadly, there may be little out there knowledge past what has been described. The novel WellPATH pill software has the chance to offer reduction to people at excessive threat of suicide by providing an instantaneous intervention to sufferers of their precise atmosphere. With the fast enhance in inhabitants of middle-aged and older adults, the continued exploration of adaptive preventative interventions is important for safeguarding the well-being of this more and more susceptible inhabitants.
Ms Heidenreich is a analysis assistant within the Weill Cornell Drugs Kiosses Lab. Dr Kiosses is affiliate professor of psychology in scientific psychiatry at Weill Cornell Medical School; affiliate attending psychologist at New York-Presbyterian Hospital; and first investigator within the Weill Cornell Drugs Kiosses Lab.
References
1. Deadly harm studies, nationwide, regional and state, 1981-2019. Facilities for Illness Management and Prevention. 2019. Accessed January 10, 2022. https://wisqars.cdc.gov/fatal-reports
2. Torous J, Larsen ME, Depp C, et al. Smartphones, sensors, and machine learning to advance real-time prediction and interventions for suicide prevention: a review of current progress and next steps. Curr Psychiatry Rep. 2018;20(7):51. Revealed 2018 Jun 28.
3. Conwell Y, Van Orden Okay, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451-ix.
4. About underlying explanation for dying, 1999-2020. CDC Marvel On-line Database. 2021. Accessed January 10, 2022. https://wonder.cdc.gov/ucd-icd10.html
5. Drapeau CW, McIntosh JL. U.S.A. Suicide: 2018 Official Ultimate Information. American Affiliation of Suicidology. 2020. Accessed January 10, 2022. https://suicidology.org/wp-content/uploads/2020/02/2018datapgsv2_Final.pdf
6. Callanan VJ, Davis MS. Gender differences in suicide methods. Soc Psychiatry Psychiatr Epidemiol. 2012;47(6):857-869.
7. Disparities in suicide. Facilities for Illness Management and Prevention. 2019. Accessed January 10, 2022. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html
8. Subjective cognitive decline—a public well being problem. Facilities for Illness Management and Prevention. 2019. Accessed January 10, 2022. https://www.cdc.gov/aging/aginginfo/subjective-cognitive-decline-brief.html
9. Kiosses DN, Ravdin LD, Gross JJ, et al. Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry. 2015;72(1):22-30.
10. 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):220-228.
11. Serafini G, Calcagno P, Lester D, et al. Suicide risk in Alzheimer’s disease: a systematic review. Curr Alzheimer Res. 2016;13(10):1083-1099.
12. Erlangsen A, Stenager E, Conwell Y. Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study. Soc Psychiatry Psychiatr Epidemiol. 2015;50(9):1427-1439.
13. Fässberg MM, Cheung G, Canetto SS, et al. A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Growing older Ment Well being. 2016;20(2):166-194.
14. Qin P. The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. J Psychiatr Res. 2011;45(11):1445-1452.
15. Van Orden KA, O’Riley AA, Simning A, Podgorski C, Richardson TM, Conwell Y. Passive suicide ideation: An indicator of risk among older adults seeking aging services?. The Gerontologist. 2015 Dec 1;55(6):972-80.
16. Conwell Y. Suicide and suicide prevention in later life. Focus. 2013;11(1):39-47.
17. Mogensen H, Möller J, Hultin H, et al. Death of a close relative and the risk of suicide in Sweden-a large scale register-based case-crossover study. PLoS One. 2016;11(10):e0164274. Revealed 2016 Oct 11.
18. Lutz J, Van Orden KA, Bruce ML, et al. Social disconnection in late life suicide: an NIMH workshop on state of the research in identifying mechanisms, treatment targets, and interventions. Am J Geriatr Psychiatry. 2021 Aug;29(8):731-744.
19. Mezuk B, Rock A, Lohman MC, et al. Suicide risk in long-term care facilities: a systematic review. Int J Geriatr Psychiatry. 2014;29(12):1198-1211.
20. Kahn JH, Hessling RM, Russell DW. Social support, health, and well-being among the elderly: what is the role of negative affectivity?Pers Individ Differ. 2003;35(1):5-17.
21. Okolie C, Dennis M, Simon Thomas E. A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people. Int Psychogeriatr. 2017;29(11):1801-1824.
22. Conwell Y, Van Orden KA, Stone DM, et al. Peer companionship for mental health of older adults in primary care: a pragmatic, nonblinded, parallel-group, randomized controlled trial. Am J Geriatr Psychiatry. 2021;29(8):748-757.
23. Ecker AH, Johnson AL, Sansgiry S, et al. Brief cognitive behavioral therapy reduces suicidal ideation in veterans with chronic illnesses. Gen Hosp. 2019;58:27-32.
24. Kumpula MJ, Wagner HR, Dedert EA, et al. An evaluation of the effectiveness of evidence-based psychotherapies for depression to reduce suicidal ideation among male and female veterans. Womens Well being Points. 2019;29 Suppl 1:S103-S111.
25. Gustavson KA, Alexopoulos GS, Niu GC, et al. Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction. Am J Geriatr Psychiatry. 2016;24(1):11-17.
26. Lutz J, Mackin RS, Otero MC, et al. Improvements in functional disability after psychotherapy for depression are associated with reduced suicide ideation among older adults. Am J Geriatr Psychiatry. 2021;29(6):557-561.
27. Sheffler JL, Joiner TE, Sachs-Ericsson NJ. The interpersonal and psychological impacts of COVID-19 on risk for late-life suicide [published correction appears in Gerontologist. 2021 Feb 23;61(2):293]. Gerontologist. 2021;61(1):23-29.
28. Beard C, Ramadurai R, McHugh RK, et al. HabitWorks: development of a CBM-I smartphone app to augment and extend acute treatment. Behav Ther. 2021;52(2):365-378.
29. Bush NE, Smolenski DJ, Denneson LM, et al. A virtual hope box: randomized controlled trial of a smartphone app for emotional regulation and coping with distress. Psychiatr Serv. 2017;68(4):330-336.
30. Kiosses DN, Monkovic J, Stern A, et al. An emotion regulation table app for middle-aged and older adults at high suicide risk: feasibility, acceptability, and two case studies. Am J Geriatr Psychiatry. 2021. Accessed January 10, 2022.
