Clinical determinants of suicidal ideation and behavior in geriatric depression

Background: The aim of this study was to find clinical characteristics that can identify elderly patients with depression at risk for suicidal idea;io n and to determine their prognosis. Method: Suicidal ideation, past suicidal behavior, severi tv of depression, cognitive impairment, medical burden, disability, and social support were studied in 354 patients with depression aged 61 to 93 years. The patients h ad in-person evaluations every 6 months and telephone evaluations for a mea n of 1.8 years (SD, 2.2). Results: During the index episode, suicidal ideation was predicted by previ ous suicide attempts with serious intent (odds ratio [OR]. 2.82; 95% confid ence interval [CI], 1.37-5.80), severity of depression (OR, 1.09; 95% CI, 1 .03-1.16). and poor social support (OR, 1.77; 95% CI. 1.18-2.65). Suicide a ttempts during the year prior to entry were reported by patients with a sev ere index episode (OR, 1.05; 95% CI, 1.00-1.11), impaired instrumental acti vities of daily living (OR, 0.78; 95% CI, 0.67-0.93), and limited impairmen t in activities of daily living (OR, 1.53; 95% CI, 1.10-2.14). At the initi al evaluation, severity of depression, previous attempts, and seriousness o f suicidal intent during previous attempts predicted the course of suicidal ideation (concordance correlation, 0.78). During follow-up, contemporaneou s severity of depression was the most important determinant of suicidal ide ation over tints (concordance correlation, 0.88). Conclusions: Elderly individuals with severe depression, history of suicide attempts with serious intent, and poor social support are most likely to h ave suicidal ideation and should be targeted for appropriate interventions. Severity of depression is the strongest predictor of the course of suicida l ideation.