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Suicidal and Death Ideation in Older Primary Care Patients With Depression, Anxiety, and At-Risk Alcohol Use

Received March 18, 2002; revised April 1, 2002; accepted April 8, 2002. From the Department of Psychiatry, Dartmouth Medical School, Lebanon, NH (SJB,TEO), John Snow, Inc., Boston, MA (EC), Sunset Park Family Health Center, Brooklyn, NY (GC), Philadelphia VA Medical Center, Philadelphia, PA (DO), the Department of Psychiatry, New York University School of Medicine, New York, NY (HC), University of Pennsylvania, Department of Psychiatry, Philadelphia, PA (CZ), Brigham and Women's Hospital, Department of Psychiatry, Boston, MA (KC,HS), VA Chicago Health Care Systems and Department of Psychiatry, University of Illinois, Chicago, IL (UNBD), the Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, PA (JJG), and Miami VA Medical Center; Geriatric Research, Education and Clinical Center; University of Miami School of Medicine, Miami Beach, FL (ML). Address correspondence to Dr. Bartels, New Hampshire–Dartmouth Psychiatric Research Center, 2 Whipple Place, Suite 202, Lebanon, NH 03766. e-mail: stephen.j.bartels{at}dartmouth.edu

The authors identified correlates of active suicidal ideation and passive death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Participants included 2,240 older primary care patients (age 65+), who were identified in three mutually exclusive groups on the basis of responses to the Paykel suicide questions: No Ideation, Death Ideation, and Suicidal Ideation. Chi-square, ANOVA, and polytomous logistic regression analyses were used to identify characteristics associated with suicidal ideation. The highest amount of suicidal ideation was associated with co-occurring major depression and anxiety disorder (18%), and the lowest proportion occurred in at-risk alcohol use (3%). Asians have the highest (57%) and African Americans have the lowest (27%) proportion of suicidal or death ideation. Fewer social supports and more severe symptoms were associated with greater overall ideation. Death ideation was associated with the greatest medical comorbidity and highest service utilization. Contrary to previous reports, authors failed to find that active suicidal ideation was associated with increased contacts with healthcare providers. Accordingly, targeted assessment and preventive services should be emphasized for geriatric outpatients with co-occurring depression and anxiety, social isolation, younger age, and Asian or Caucasian race.

Key Words: Suicide • Primary Care • Depression • Alcohol Abuse

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