title: Factors associated with suicidal thoughts in a large community study of older adults.
abstract: BACKGROUND
  Thoughts about death and self-harm in old age have been commonly associated with the presence of depression, but other risk factors may also be important.
  
  
  OBJECTIVE
  To determine the independent association between suicidal ideation in later life and demographic, lifestyle, socioeconomic, psychiatric and medical factors.
  
  
  METHODS
  A cross-sectional study was conducted of a community-derived sample of 21 290 adults aged 60-101 years enrolled from Australian primary care practices. We considered that participants endorsing any of the four items of the Depressive Symptom Inventory -Suicidality Subscale were experiencing suicidal thoughts. We used standard procedures to collect demographic, lifestyle, psychosocial and clinical data. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  The 2-week prevalence of suicidal ideation was 4.8%. Male gender, higher education, current smoking, living alone, poor social support, no religious practice, financial strain, childhood physical abuse, history of suicide in the family, past depression, current anxiety, depression or comorbid anxiety and depression, past suicide attempt, pain, poor self-perceived health and current use of antidepressants were independently associated with suicidal ideation. Poor social support was associated with a population attributable fraction of 38.0%, followed by history of depression (23.6%), concurrent anxiety and depression (19.7%), prevalent anxiety (15.1%), pain (13.7%) and no religious practice (11.4%).
  
  
  CONCLUSIONS
  Prevalent and past mood disorders seem to be valid targets for indicated interventions designed to reduce suicidal thoughts and behaviour. However, our data indicate that social disconnectedness and stress account for a larger proportion of cases than mood disorders. Should these associations prove to be causal, then interventions that succeeded in addressing these issues would contribute the most to reducing suicidal ideation and, possibly, suicidal behaviour in later life.
authors.affiliation: Western Australia Centre for Health and Ageing (M573), University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia. osvaldo.almeida@uwa.edu.au
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.forename: Brian
authors.initials: B
authors.lastname: Draper
authors.forename: John
authors.initials: J
authors.lastname: Snowdon
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Lautenschlager
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.forename: Gerard
authors.initials: G
authors.lastname: Byrne
authors.forename: Moira
authors.initials: M
authors.lastname: Sim
authors.forename: Nigel
authors.initials: N
authors.lastname: Stocks
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Pfaff
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D012959:Socioeconomic Factors; D059020:Suicidal Ideation