Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-24T06:58:25.364Z Has data issue: false hasContentIssue false
  • English
  • Français

Alone? Percieved social support and chronic interpersonal difficulties in suicidal elders

Published online by Cambridge University Press:  15 December 2009

Katrin E. Harrison ,
Alexandre Y. Dombrovski ,
Jennifer Q. Morse ,
Patricia Houck ,
Maryann Schlernitzauer ,
Charles F. Reynolds III  and
Katalin Szanto
Katrin E. Harrison
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
Alexandre Y. Dombrovski*
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
Jennifer Q. Morse
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
Patricia Houck
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
Maryann Schlernitzauer
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
Charles F. Reynolds III
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
Katalin Szanto
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, U.S.A.
*
Correspondence should be addressed to: Alexandre Y. Dombrovski, MD; 3811 O'Hara Street; 754 Bellefield Tower; Pittsburgh, PA, 15213, U.S.A. Phone: +1 412-246-6143; Fax: +1 412-246-5991. Email: dombrovskia@upmc.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Social networks may protect depressed elders against suicidal behavior. However, conflict in important relationships may undermine the sense of social support, potentially negating the protective effects. Thus, we investigated the role of chronic interpersonal difficulties and perceived social support in depressed elders with and without suicidal thoughts and attempts.

Methods: 106 individuals aged 60 years and older participated in this cross-sectional, case-control study. They were placed in three groups: suicidal depressed, non-suicidal depressed and non-depressed. Following a detailed clinical characterization, we assessed perceived social support (Interpersonal Support Evaluation List), and chronic interpersonal difficulties (Inventory of Interpersonal Problems). Using general linear models, we explored the relationship between suicidal thoughts/attempts, social support, and chronic interpersonal difficulties. We also examined whether lower perceived social support explained the relationship between chronic interpersonal difficulties and suicidal thoughts/attempts.

Results: Suicidal depressed elders reported the lowest levels of perceived social support (belonging, tangible support, and self-esteem) and higher levels of chronic interpersonal difficulties (struggle against others and interpersonal hostility), compared to both non-suicidal depressed and non-depressed elders. The relationship between chronic interpersonal difficulties and suicidal behavior was partially explained by low perceived social support.

Conclusions: The experience of strong affects, interpersonal struggle, and hostility in relationships may undermine the sense of social support in depressed elders, possibly leading them to contemplate or attempt suicide. Depressed elders with a history of interpersonal difficulties need to be carefully monitored for suicidal behavior.

Keywords

agedaged 80 and oversuicideattempted suicidesocial isolationsocial supportinterpersonal relationspersonalitypsychological stress
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 3 , May 2010 , pp. 445 - 454
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appleby, L., Cooper, J., Amos, T. and Faragher, B. (1999). Psychological autopsy study of suicides by people aged under 35. British Journal of Psychiatry, 175, 168–174.CrossRefGoogle ScholarPubMed
Beautrais, A. L. (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32, 1–9.CrossRefGoogle ScholarPubMed
Beck, A. T., Beck, R. and Kovacs, M. (1975a). Classification of suicidal behaviors: I. Quantifying intent and medical lethality. American Journal of Psychiatry, 132, 285–287.Google ScholarPubMed
Beck, A. T., Kovacs, M. and Weissman, A. (1975b). Hopelessness and suicidal behavior: an overview. JAMA, 234, 1146–1149.CrossRefGoogle ScholarPubMed
Beck, A. T., Kovacs, M. and Weissman, A. (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352.CrossRefGoogle ScholarPubMed
Bolton, J. M., Belik, S. L., Enns, M. W., Cox, B. J. and Sareen, J. (2008). Exploring the correlates of suicide attempts among individuals with major depressive disorder: findings from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69, 1139–1149.CrossRefGoogle ScholarPubMed
Cohen, S., Mermelstein, R., Kamarck, T. and Hoberman, H. (1985). Measuring the functional components of social support. In: Sarason, I. G. and Sarason, B. (eds.), Social Support: Theory, Research and Applications (pp. 73–94). The Hague: Martinus Nijhoff.CrossRefGoogle Scholar
Conwell, Y., Duberstein, P. R. and Caine, E. D. (2002). Risk factors for suicide in later life. Biological Psychiatry, 52, 193–204.CrossRefGoogle ScholarPubMed
de Leo, D., Dello Buono, M. and Dwyer, J. (2002). Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. British Journal of Psychiatry, 181, 226–229.CrossRefGoogle ScholarPubMed
Duberstein, P. R., Conwell, Y. and Caine, E. D. (1994). Age differences in the personality characteristics of suicide completers: preliminary findings from a psychological autopsy study. Psychiatry, 57, 213–224.CrossRefGoogle ScholarPubMed
Duberstein, P. R., Conwell, Y. and Cox, C. (1998). Suicide in widowed persons: a psychological autopsy comparison of recently and remotely bereaved older subjects. American Journal of Geriatric Psychiatry, 6, 328–334.CrossRefGoogle Scholar
Duberstein, P. R., Conwell, Y., Seidlitz, L., Denning, D. G., Cox, C. and Caine, E. D. (2000). Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55, P18–26.Google ScholarPubMed
Duberstein, P. R., Conwell, Y., Conner, K. R., Eberly, S. and Caine, E. D. (2004a). Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain. Psychological Medicine, 34, 137–146.CrossRefGoogle ScholarPubMed
Duberstein, P. R., Conwell, Y., Conner, K. R., Eberly, S., Evinger, J. S. and Caine, E. D. (2004b). Poor social integration and suicide: fact or artifact? A case-control study. Psychological Medicine, 34, 1331–1337.CrossRefGoogle ScholarPubMed
First, M. S. R., Gibbon, M. and Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P). New York: New York State Psychiatric Institute.Google Scholar
Freedman, L. S. and Schatzkin, A. (1992). Sample size for studying intermediate endpoints within intervention trials or observational studies. American Journal of Epidemiology, 136, 1148–1159.CrossRefGoogle ScholarPubMed
Gibbs, L. M., Dombrovski, A. Y., Morse, J., Siegle, G. J., Houck, P. R. and Szanto, K. (2009). When the solution is part of the problem: problem solving in elderly suicide attempters. International Journal of Geriatric Psychiatry, 24, 1396–1404.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Harwood, D., Hawton, K., Hope, T. and Jacoby, R. (2001). Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. International Journal of Geriatric Psychiatry, 16, 155–165.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Harwood, D. M., Hawton, K., Hope, T., Harriss, L. and Jacoby, R. (2006). Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study. Psychological Medicine, 36, 1265–1274.CrossRefGoogle ScholarPubMed
Heikkinen, M. E. and Lonnqvist, J. K. (1995). Recent life events in elderly suicide: a nationwide study in Finland. International Psychogeriatrics, 7, 287–300.CrossRefGoogle ScholarPubMed
Heisel, M. J., Duberstein, P. R., Conner, K. R., Franus, N., Beckman, A. and Conwell, Y. (2006). Personality and reports of suicide ideation among depressed adults 50 years of age or older. Journal of Affective Disorders, 90, 175–180.CrossRefGoogle ScholarPubMed
Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureno, G. and Villasenor, V. S. (1988). Inventory of interpersonal problems: psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 885–892.CrossRefGoogle ScholarPubMed
Joiner, T. (2005). What roles do genetics, neurobiology, and mental disorders play in suicide behavior? In Joiner, T., Why People Die by Suicide (pp. 172–202). Cambridge, MA: Harvard University Press.Google Scholar
Krause, N. and Jay, G. (1991). Stress, social support, and negative interaction in later life. Research on Aging, 13, 333–363.CrossRefGoogle Scholar
Lang, F. R. and Carstensen, L. L. (2002). Time counts: future time perspective, goals, and social relationships. Psychology and Aging, 17, 125–139.CrossRefGoogle ScholarPubMed
Luoma, J. B. and Pearson, J. L. (2002). Suicide and marital status in the United States, 1991–1996: is widowhood a risk factor? American Journal of Public Health, 92, 1518–1522.CrossRefGoogle ScholarPubMed
Marttunen, M., Henriksson, M. M., Aro, H. M., Heikkinen, M. E., Isometsä, E. T. and Lönnqvist, J. K. (1995). Suicide among female adolescents: characteristics and comparison with males in the age group 13 to 22 years. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1297–1307.CrossRefGoogle ScholarPubMed
Miller, M. D., Frank, E., Cornes, C., Houck, P. R. and Reynolds, C. F. III (2003). The value of maintenance interpersonal psychotherapy (IPT) in older adults with different IPT foci. American Journal of Geriatric Psychiatry, 11, 97–102.CrossRefGoogle ScholarPubMed
Miller, M. D. et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237–248.CrossRefGoogle ScholarPubMed
Morse, J. P. and Pilkonis, P. A. (2007). Screening for personality disorders. Journal of Personality Disorders, 21, 179–198.CrossRefGoogle ScholarPubMed
Motto, J. A. and Bostrom, A. G. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52, 828–833.CrossRefGoogle ScholarPubMed
O'Carroll, P., Berman, A. L., Maris, R. W., Mosciki, E. K., Tanney, B. L. and Silverman, M. M. (1996). Beyond the Tower of Babel: a nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26, 237–252.CrossRefGoogle Scholar
Raue, P. J., Meyers, B. S., Rowe, J. L., Heo, M. and Bruce, M. L. (2007). Suicidal ideation among elderly homecare patients. International Journal of Geriatric Psychiatry, 22, 32–37.CrossRefGoogle ScholarPubMed
Rowe, J. L., Conwell, Y., Schulberg, H. C. and Bruce, M. L. (2006). Social support and suicidal ideation in older adults using home healthcare services. American Journal of Geriatric Psychiatry, 14, 758–766.CrossRefGoogle ScholarPubMed
Sheldon Cohen, H. M. H. (1983). Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology, 13, 99–125.CrossRefGoogle Scholar
Szanto, K. et al. (2007). Emergence, persistence, and resolution of suicidal ideation during treatment of depression in old age. Journal of Affective Disorders, 98, 153–161.CrossRefGoogle ScholarPubMed
Turvey, C. L. et al. (2002). Risk factors for late-life suicide: a prospective, community-based study. American Journal of Geriatric Psychiatry, 10, 398–406.CrossRefGoogle ScholarPubMed
Wilson, S. T., Fertuck, E. A., Kwitel, A., Stanley, M. C. and Stanley, B. (2006). Impulsivity, suicidality and alcohol use disorders in adolescents and young adults with borderline personality disorder. International Journal of Adolescent Medicine and Health, 18, 189–196.CrossRefGoogle Scholar
Wilson, S., Stanley, B., Oquendo, M. A., Goldberg, P., Zalsman, G. and Mann, J. J. (2007). Comparing impulsiveness, hostility, and depression in borderline personality disorder and bipolar II disorder. Journal of Clinical Psychiatry, 68, 1533–1539.CrossRefGoogle ScholarPubMed