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Holocaust Experience and Suicidal Ideation in High-Risk Older Adults

Received September 3, 2002; revised November 6, 2002, January 24, 2003; accepted January 29, 2003. From the Departments of Psychiatry and Public Health Sciences (DEC,AC,RH,AR) and the Collaborative Program in Human Development, Life Course, and Aging, Faculty of Medicine (DEC), University of Toronto, the Department of Psychiatry, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada (DEC,DC), the Department of Occupational Therapy, Graduate Departments of Rehabilitation Sciences and Public Health Sciences (AC). Address correspondence to Diana Clarke, Department of Psychiatry, Room 4W04, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, Ontario, Canada M6A 2E1.

Objective: Depression is an identified risk factor for suicidal ideation, a precursor for more serious suicidal behaviors. This risk might be further compounded in individuals who experience negative life events, including traumatic experiences, and those who might have comorbid illnesses. The authors examined the impact of past exposure to the Nazi Holocaust on the development of suicidal ideation in a sample of depressed older adults. Methods: Authors conducted a retrospective cross-sectional study. The study sample comprised data on 530 consecutive eligible first admissions of Jewish patients who were referred and admitted to a geriatric psychiatry day hospital program between September 1986 and December 2000. Results: Multiple logistic-regression analyses, controlling for social support, history of suicide attempts, and other negative life events, showed that severity of depression and exposure to the Holocaust were independently associated with suicidal ideation. Those not showing suicidal ideation were slightly more likely to have reported having a confidant. Conclusions: This is the first empirical study to demonstrate an increased likelihood for suicidal ideation in survivors of the Nazi Holocaust. The chronic stress produced by these traumatic events may have predisposed survivors to cope ineffectively as they age, thus resulting in suicidal ideation. Authors highlight the importance of a multifaceted approach when assessing suicidal behaviors in high-risk groups.

Key Words: Suicide • Posttraumatic Stress Disorder • Holocaust Survivors • Depression

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