Conference Agenda

Suicide prevention is difficult in older people partly because of the broad presentation of phenotypes. Age at first suicide attempt helps us understand heterogeneity of suicidal behavior. I will present results from the Pittsburgh longitudinal studies of late-life suicide in over 400 older depressed adults. We showed that when suicidal behavior emerges during youth or midlife (early-onset suicidal behavior), it is often linked to adverse childhood experiences, recurrent psychiatric disorders, a family history of depression and/or suicidal behavior, interpersonal difficulties, poor real-life and laboratory decision making, and cluster B traits. In contrast, late-onset suicidal behavior is associated with a broad range of cognitive deficits, including memory, processing speed, and executive dysfunction and personality traits of orderliness and need for closure.

Fluctuations in, and interrelationships among, indicators of affect, social, cognitive, and sleep health may predict short-term suicidal ideation. Our studies indicate that depressed older adults with chronic insomnia are more likely to have chronic and severe suicidal ideation over time, relative to those with fast-remitting and low ideation. We now report data between sleep duration, irregular sleep and wake times, and sleep quality and suicidal ideation using actigraphy and digital sleep diaries via a 3-week ecological momentary assessment protocol in 68 depressed older adults (M±SD = 65.3 years ± 6.5 years). Mixed effect regression models revealed within-day associations of greater positive affect with greater social satisfaction (b=0.24, SE=0.04, z=6.24, p<.001), and better sleep quality (b=0.19, SE=0.02, z=7.98, p<.001). Suicidal ideation was negatively associated with sleep quality on the previous night (OR=0.71, 95%CI: 0.51-0.99, z=-2.03, p=0.043). Moreover, irregularity of sleep duration and timing were associated with suicidal ideation.

Understanding the clinical/cognitive and broader biological heterogeneity of suicidal behavior gives information about subtypes of attempters that have different risk factors. Poor sleep is suicide risk factor for both short-term and a long-term.

Introduction

Loss of social status and interpersonal conflicts are two forms of social defeat identified as precipitators of suicidal behavior during aging. They are closely linked to narcissism, a personality construct with status pursuit at its core. However, behavioral evidence of hypersensitivity to social defeat is lacking in older adults with suicidal behavior and/or narcissistic traits. It remains unclear whether late-onset attempters (with suicidal behavior starting in old age) and their early-onset counterparts are sensitive to similar forms of social defeat.

Methods

The Competitive Behavioral assessment of Rivalry and Admiration-seeking (CoBRA) stages a rigged video game tournament where participants lose two-thirds of the time. Outcomes include stealing points from opponents before face-offs to prevent one-on-one defeat and buying extra ranks to increase one’s standing in the leaderboard. Study 1 assessed associations with self-reported narcissism and depression in predominantly depressed older adults (N=85, mean age=62.6 years) and psychology undergraduates (N=70, mean age=21.5 years). Study 2 (N=245, mean age=63.2 years) compared early- and late-onset suicide attempters, non-suicidal depressed comparisons, and non-psychiatric comparisons on task outcomes.

Results

In Study 1, both undergraduates and older adults stole more points and purchased more rank over time, as defeat experiences accumulated. These effects increased with narcissism, whereas depression mitigated point stealing from high-ranked opponents. In Study 2, early-onset suicide attempters stole more points over time than other groups, whereas late-onset attempters purchased more rank after losing trials than early-onset attempters and non-psychiatric comparisons.

Conclusions

Early-onset attempters’ hypersensitivity to one-on-one defeat aligns with prior findings linking their long suicidal trajectory to repeated interpersonal difficulties, whereas late-onset attempters’ exaggerated response to status loss corroborates the central role of age-related losses and decline in late-life suicide without prior suicidal history. Yet, these behavioral patterns differ from those observed with narcissism or depression and suggest additional underlying traits and states.

Introduction: Despite older adults having the highest suicide rates globally, regional variation exists. In Ireland, research shows elevated suicide risk among individuals presenting with self-harm, with older age identified as a key risk factor. However, the latest research examining characteristics of older adults who die by suicide is from 2010, highlighting the need for updated evidence. This study assesses the demographic and psychosocial factors of older adults who die by suicide in Ireland.

Methods: A retrospective national study of suicide by older adults aged 60 years and older was conducted during 2015-2020 using coronial data from the Irish Probably Suicide Deaths Study. A comparison group of adults aged 18-59 was included for comparison. Descriptive statistics summarised deaths by age and sex, and logistic regression compared suicide methods between age groups.

Results: In Ireland, 654 older adults died by suicide from 2015-2020, of which 74.2% (n=485) were males and 64.1% (n=419) aged 60-69 years. Compared to younger age groups (18-59 years) older adults (≥60 years) had significantly higher odds of dying by drowning (OR=2.42, 95% CI 1.92–3.05), firearms (OR=2.09, 95% CI 1.41–3.10), and poisoning (OR=1.52, 95% CI 1.20–1.92), and lower odds of dying by hanging (OR=0.43, 95% CI 0.36–0.51). Older adults were more likely to have recent contact with healthcare professionals (66% vs. 53%, p<0.001) and prior self-harm history was slightly more common among younger adults (24% vs. 20%, p=0.026). Other sociodemographic and clinical characteristics, including sex distribution, presence of a suicide note, and mental health history, did not differ by age group.

Conclusions: Older adults who die by suicide in Ireland display distinct patterns compared with adults, particularly in healthcare contact and method of suicide. These findings highlight the need for age-tailored suicide prevention strategies, particularly those strengthening healthcare engagement, reducing stigma and addressing method-specific risk.

Background: Older adults have among the highest rates of suicide worldwide, necessitating effective suicide risk detection initiatives (WHO, 2021). North American accreditation bodies have mandated routine screening for suicide ideation in Long-Term Care Homes (LTC); however, many homes do not routinely assess suicide risk among their residents, given relatively little experience in assessing suicide risk, use of non-validated tools for older adults, and concerns about high levels of cognitive impairment. The current multi-stage study was designed to overcome these limitations.

Aim: To improve pragmatic suicide risk detection and response in Canadian LTC Homes.

Method: In carrying out this on-going multi-phase study, we are:

1. Conducting interviews and focus groups with LTC personnel assessing perceived limitations and proposed remedies for screening for suicide risk in LTC;
2. Refining, delivering, and evaluating a focused educational training program designed to enhance provider knowledge, skills, and competence in assessing and responding to resident suicide risk;
3. Investigating the real-world response characteristics of suicide screening tools, administered by on-site LTC personnel, and investigating the prevalence of resident suicide ideation and behaviour;
4. Testing our conceptual model of late-life suicide risk, incorporating consideration of risk and resiliency factors; and
5. Broadly disseminating study findings.

Results/Discussion: We will present and discuss initial findings, focusing on outreach efforts to LTC Homes, findings of multiple focus groups and of online and in-person trainings to frontlne providers in Long-Term Care Homes in Ontario, Canada, aimed at enhancing the detection and response to resident suicide risk.

Background: Middle-aged and older men have high rates of suicide, and the older adult population is growing rapidly, necessitating upstream interventions to enhance psychological well-being and reduce risk for suicide (Lapierre et al., 2011). We developed Meaning-Centered Men’s Groups (MCMG; Heisel et al., 2016), a 12-session upstream psychological group intervention, to respond to this need.

Methods: We recruited 97 men over the age of 55 into an intervention study designed to develop and initially evaluate MCMG for those struggling with the transition to retirement. Two uncontrolled courses of MCMG were offered initially, followed by three courses of a non-randomized controlled trial of MCMG as compared with Current-Events Discussion Group or Wait-List Controls; control participants could elect to join a course of MCMG following post-group assessments. This session focuses on MCMG-related pre-post change in positive and negative outcomes.

Results: Eighty participants took part in one of eight courses of MCMG. Five groups took place in-person in a community centre, one in-person group pivoted online during the COVID lockdown, and two groups were offered fully online. Whereas most participants endorsed moderate to high levels of physical and psychological well-being, 10-15% endorsed clinical levels of depression, hopelessness, or suicide ideation, and seven reported a lifetime history of suicidal behaviour. Pre-post assessments revealed significant reductions in suicide ideation (t₍₇₃₎=2.94, p=.004), hopelessness (t₍₇₂₎=3.37, p=.001), depression (t₍₇₃₎=2.89, p=.005), and loneliness (t₍₇₃₎=3.17, p=.002), and significant improvement in life satisfaction (t₍₇₃₎= -4.33, p<.001), psychological well-being (t₍₇₂₎= -3.57, p<.001), and meaning in life (t₍₇₃₎= -2.67, p=.009) over the course of MCMG. Participants additionally reported high levels of group satisfaction and a strong working alliance with group facilitators.

Conclusions: Findings indicate significant improvement in psychological well-being among MCMG participants, suggesting the effectiveness of MCMG as an upstream psychological group intervention for middle-aged and older men facing a challenging life transition.