Planning of suicide attempts among depressed inpatients ages 50 and over

Suicidal behavior is heterogeneous; suicide attempts can be impulsive (lower planned) or reflect forethought and preparation (higher planned). Lower planned and higher planned attempts may have different correlates that require different prevention strategies. Based on a model of suicide planning relevant to middle-aged and older adults, we tested the following hypotheses: physical illness burden, decreased functional capacity, hopelessness, and living alone are associated with suicide attempts that are more extensively planned; lower cognitive functioning is associated with suicide attempts that are more impulsive.

Subjects were 117 inpatients ages 50 and over diagnosed with major depression based on semi-structured clinical research interviews, the medical record, plus other records when available. All subjects had attempted suicide within 1 month of admission. The degree of planning prior to the suicide attempt was quantified using Beck's Suicide Intent Scale. Multivariate linear regression analysis identified correlates of planning.

As hypothesized, lower cognitive functioning was associated with lower levels of planning. Contrary to the hypothesis, impaired physical self-care was associated with lower (not higher) planning. Results pertaining to living alone were equivocal.

The study was limited by the cross-sectional research design and unclear generalizability to completed suicide or to racial/ethnic minorities.

Depressed patients with lower cognitive functioning and impairments in physical self-care may be especially vulnerable to impulsive suicidal behavior. The potential role of living alone in higher planned suicidal acts requires further investigation.