title: Alone? Perceived social support and chronic interpersonal difficulties in suicidal elders.
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.
authors.affiliation: Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Katrin E
authors.initials: KE
authors.lastname: Harrison
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Dombrovski
authors.forename: Jennifer Q
authors.initials: JQ
authors.lastname: Morse
authors.forename: Patricia
authors.initials: P
authors.lastname: Houck
authors.forename: Maryann
authors.initials: M
authors.lastname: Schlernitzauer
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Katalin
authors.initials: K
authors.lastname: Szanto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006791:Hostility; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012649:Self Concept; D012944:Social Support; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology; D000092864:Suicide Prevention