A Sense of Meaning Key to Curbing Late-Life Suicide

Megan Brooks

February 17, 2016

A sense of meaning in life may be a critical factor in curbing suicidal thoughts in older adults, new research shows.

It is important for healthcare providers to ask older adults about positive psychological factors, said lead investigator Marnin Heisel, PhD, of the Lawson Health Research Institute, London, Ontario, Canada.

"We should not exclusively be looking at the negative side of things ― depression, hopelessness, psychopathology. Of course, all of those things need to be evaluated, especially in older adults. But even for older adults who are struggling with these sorts of issues, we found that people who were able to identify some sort of meaning in life or particular things that give them a reason for living were significantly less likely to feel depressed, lonely, or suicidal," Dr Heisel told Medscape Medical News.

The study was published in the February issue of Aging and Mental Health.

Buffering Effects

Suicide claims more than 800,000 lives annually, accounting for about 2% of all deaths worldwide, according 2014 data from the World Health Organization. Adults older than 65 years are particularly vulnerable. Although the study of late-life suicide and its prevention is in its "relative infancy," the mitigating effects of resilience and positive psychological factors in buffering suicide risk are receiving increasing attention, the investigators note in their article.

As part of a longitudinal study on late-life suicide, they had 109 reasonably healthy and well-adjusted older adults (mean age, 74.8 years) living in the community complete the Reasons for Living–Older Adult (RFL-OA) and measures of cognitive and physical functioning and positive and negative psychological factors at a 2-year follow-up assessment. The sample included 80 women and 29 men. Roughly half were married and living with a spouse; the remainder were living alone.

Most participants had moderate to high levels of cognitive and physical functioning on measures of activities of daily living, and relatively low levels of suicidal ideation, depressive symptom severity, and loneliness. However, two participants scored 23 or higher on the Mini-Mental State Examination–2, indicating cognitive impairment; five had depressive symptoms, scoring 17 or higher on the Center for Epidemiologic Studies Depression Scale–Revised; and four had suicidal ideation, scoring 65 or higher on the Geriatric Suicide Ideation Scale.

The researchers found that having reasons for living and meaning in life were each significantly negatively associated with suicidal ideation after controlling for demographic and negative psychological factors. Both factors were strongly intercorrelated. Having meaning in life significantly mediated the association between reasons for living and suicidal ideation.

Although reasons for living and meaning in life are theoretically related constructs, they are conceptually distinct, the researchers note. Meaning in life refers to the sense that one's life has a deeper significance, whereas reasons for living refer to things that that make life worthwhile.

Accentuate the Positive

The findings, they say, support a "growing evidence base for positive psychological factors in helping to enhance psychological resiliency, promote mental health and well-being, and prevent, buffer or otherwise mitigate risk for suicide among older adults."

The findings also support incorporating a "positive psychological perspective when working with suicidal older adults."

"Depression and other mental health issues are clearly big problems facing older adults, but the majority of depressed older adults don't kill themselves or even think about it," Dr Heisel commented. "It really is a combination of challenges people are experiencing, their attitudes or approaches towards them, and the things that help to balance that out or keep them more buoyant."

He also noted that asking questions about positive factors ― "Do you feel that your life is still meaningful? What are the things that give you a sense of purpose in life, that give you reason to get up in the morning or go on living?" ― in many ways is much easier to start with than asking about negative factors.

"If the patient insinuates that their life has no meaning or they have no sense of purpose, then the focus should switch much more quickly to challenges they are facing, because there is a good likelihood that they are struggling," he said.

Dr Heisel noted that the 69-item RFL-OA scale was developed to be used for both clinical purposes and research purposes. Efforts are underway to see whether it can be shortened so that it might be used more commonly in clinical practice.

The RFL-OA is "on the lengthier side, and unless someone is explicitly conducting research focusing on reasons for living, in which case having a more nuanced and longer scale would be beneficial, for those just adding it in as another factor to look at, having something that is a little bit shorter but that can still tap into those important issues but not take as much time to administer would be of great value," he explained.

Commenting on the findings for Medscape Medical News, Kenneth France, PhD, professor of psychology, Shippensburg University of Pennsylvania, said the study "reinforces the central role of perceiving meaning in life as a factor associated with decreased risk of suicidal ideation. Whether asking a patient about perceived meaning in life is a productive activity is not specifically addressed in the research. If the patient perceives lots of meaning in life, though, the likelihood of having suicidal ideation is lessened," said Dr France.

This research was funded in part by the Ontario Mental Health Foundation, the Lawson Health Research Institute, and the Sam Katz Foundation. The authors have disclosed no relevant financial relationships.

Aging Ment Health. 2016;20:195-207. Abstract


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