Identifying suicidal ideation among older adults in a general practice setting

Background: Up to 70% of older people who commit suicide consult a general practitioner (GP) in the month prior to their death. The purpose of this study was to identify the clinical and demographic characteristics of older adults who are contemplating suicide and are in contact with a GP. Methods: We utilised a cross-sectional study to investigate the association between suicidal ideation and clinical/demographic variables of 504 consecutive patients aged 60 years or over, attending I of 54 randomly selected Western, Australian GPs. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about suicidal ideation (Depressive Symptom Inventory-Suicidality Subscale, DSI-SS), demographic factors, lifestyle factors, physical health and mental health, including depression (Center for Epidemiologic Studies-Depression Scale, CES-D). Results: Within our sample of older patients, 6.3% acknowledged current suicidal ideation. Multivariate analyses indicated that current suicidal ideation was strongly associated with being depressed at least occasionally during the previous week (OR = 7.3, 95% CI = 2.3-23.0), CES-D scores of 16 points or greater (OR = 3.6, 95% CI = 1.0-12.1), and a prior history of attempted suicide (OR = 15.5, 95% CI = 4.0-60.6). Limitations: Our results and conclusions are limited to suicidal ideation, and may not apply to suicidal behaviour. Conclusions: Depressive symptomatology is strongly associated with suicidal ideation in later life. Strategies that enhance GPs' identification and treatment of affective illness in older patients should have the greatest impact on suicide rates within this age group. (C) 2004 Elsevier B.V. All rights reserved.