Age Differences in Death and Suicidal Ideation in Anxious Primary Care Patients

Published in: Clinical Gerontologist [Epub July 2017]. doi: 10.1080/07317115.2017.1356893

Posted on RAND.org on August 31, 2017

by Andrew J. Petkus, Julie Loebach Wetherell, Murray Stein, Denise A. Chavira, Michelle G. Craske, Cathy D. Sherbourne, Greer Sullivan, Alexander Bystritsky, Peter Roy-Byrne

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Research Question

  1. How does death and suicide ideation differ by age among primary care patients with anxiety disorders?

Objectives

The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders.

Method

Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and/or social anxiety disorder (SAD).

Results

Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared to younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared to older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association.

Conclusions

Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults. Findings speak to the importance of physical health, social functioning, and MDD in this association.

Clinical Implications

When working with anxious older adults it is important to conduct a thorough suicide risk assessment and teach skills to cope with death and suicidal ideation related thoughts.

Key Findings

  • The older adults in this study sample were in worse physical health, with more chronic conditions and worse physical functioning, than younger participants.
  • One in three older adults reported feeling they were better off dead, and older participants were more than twice as likely as younger participants to endorse suicidal ideation during at least half the week.
  • Age differences in suicidal ideation were seen among participants with social anxiety disorder, but not those with posttraumatic stress disorder or generalized anxiety disorder.
  • After accounting for factors such as social functioning, health conditions, and comorbid major depressive disorder, the association between age and death and suicidal ideation weakened.

Recommendation

Assessing older adults in primary care for suicidality through both self-report questionnaires and interview can be particularly important to reach older adults in urgent distress.

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