Depression often plays a role in suicide by seniors

Seniors, many of them depressed, commit suicide at an alarming rate. White men 85 and older are more likely to commit suicide than Americans in any other age group - taking their lives at four times the rate of the general population.

According to 2012 statistics from the Centers for Disease Control and Prevention, about 51 of every 100,000 white men age 85 and older committed suicide, compared with the national average for all ages of 12.6. Of the 40,600 Americans who took their own lives in 2012, 6,648 were older than 65.

About one in five suicide attempts in the elderly ends in death, and firearms are the most common cause. The frailty of some seniors means they may be less likely to survive suicide attempts: A young person might survive an overdose that proves lethal in an older adult, said James Ellison, director of the geriatric psychiatry program at McLean Hospital in Belmont, Mass.

The reasons why older men are at highest risk for suicide are complex and still being researched, but they often include depression.

"Depression … is an almost necessary condition" in geriatric suicide, said Alexandre Dombrovski, a psychiatrist at the University of Pittsburgh. "Depression clouds the person's view of self and the future."

But, he said, "depression almost never leads to suicide by itself." People who attempt or die by suicide can have a variety of problems: relationships breaking down; physical illness; psychosis, which is often overlooked in older patients with depression; pain and disability; financial trouble; legal difficulties; and alcohol or, increasingly in baby boomers, drugs.

"It is the combination of one or several of these problems with depression that leads the person to feel trapped, making suicide appear like the best solution," Dombrovski said.

Impulsivity may also play a part. Impulsivity, which can help produce decisiveness in younger adults, is often dysfunctional in older people who are confronted with loss and disability and who face limited options, Dombrovski said. Impulsive people tend to see suicide as a solution to their situation.

Studies have found two types of behavior that mark an impulsivity in older adults that may lead to suicide, he said: focusing on immediate outcomes instead of delayed ones and neglecting important information in making decisions. This behavior can stem from a disruption in the part of the older person's brain that integrates information.

Suicidal behavior in older men can be a reaction to perceived loss of social status. Such reactions might be triggered by eviction, financial losses that force people to scale down their lifestyle or rob them of their dreams, and loss of control of family assets.

Signs of seniors who may be at risk for suicide include withdrawal from activities that they ordinarily enjoy; negative thoughts; frequent talk about death, impoverishment or physical decline; and behaviors such as getting wills or finances in order.

For more information:

• National Institute of Mental Health, nimh.nih.gov/health/topics/suicide-prevention

• National Suicide Prevention Lifeline,www.suicidepreventionlifeline.org.

• Suicide Prevention Resource Center, www.sprc.org.

• American Foundation for Suicide Preventionwww.afsp.org.