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Background Older adults have high rates of suicide, necessitating attention to psychological factors that confer risk for suicide. Hopelessness is significantly associated with psychological despair and suicide risk factors; however, research has been limited by unidimensional treatment of the construct. The purpose of the present study was thus to investigate the psychometric properties of the Social Hopelessness Questionnaire (SHQ; Flett et al., 2021), a 20-item measure of hopelessness in the interpersonal domain, in a heterogeneous sample of older adults. Methods Ninety adults 65 years of age or older were recruited from community, residential, or healthcare facilities in the context of a validation study of the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006). Participants voluntarily completed the SHQ, a demographics form, and concurrent measures of global hopelessness, depressive symptom severity, suicide ideation, and subjective well-being. Results The SHQ demonstrated strong internal consistency, construct validity by way of significant positive associations with negative psychological factors and negative associations with positive factors, and differentiated older adults recruited from community and mental health settings. It also explained significant variability in depression, suicide ideation, and subjective well-being beyond that accounted for by an age-specific measure of global hopelessness. Limitations Findings were limited by a small clinical sub-sample, relatively few male participants, cross-sectional analysis, and focus on suicide ideation rather than suicide behavior. Conclusion These findings suggest that the SHQ is a reliable and valid measure of an interpersonal form of hopelessness for use with older adults across diverse settings.

Abstract: Background: The content of suicide-specific social media posts may impact suicide rates, and putatively harmful and/or protective content may vary by the author’s influence. Aims: This study sought to characterize how suicide-related Twitter content differs according to user influence. Method: Suicide-related tweets from July 1, 2015, to June 1, 2016, geolocated to Toronto, Canada, were collected and randomly selected for coding (n = 2,250) across low, medium, or high user influence levels (based on the number of followers, tweets, retweets, and posting frequency). Logistic regression was used to identify differences by user influence for various content variables. Results: Low- and medium-influence users typically tweeted about personal experiences with suicide and associations with mental health and shared morbid humor/flippant tweets. High-influence users tended to tweet about suicide clusters, suicide in youth, older adults, indigenous people, suicide attempts, and specific methods. Tweets across influence levels predominantly focused on suicide deaths, and few described suicidal ideation or included helpful content. Limitations: Social media data were from a single location and epoch. Conclusion: This study demonstrated more problematic content vis-à-vis safe suicide messaging in tweets by high-influence users and a paucity of protective content across all users. These results highlight the need for further research and potential intervention.

Abstract. Background: Many studies have demonstrated suicide contagion through mainstream journalism; however, few have explored suicide-related social media events and their potential relationship to suicide deaths. Aims: To determine whether Twitter events were associated with changes in subsequent suicides. Methods: Suicide-related Twitter events that garnered at least 100 tweets originating in Ontario, Canada (July 1, 2015 to June 30, 2016) were identified and characterized as putatively "harmful" or "innocuous" based on recommendations for responsible media reporting. The number of suicides in Ontario during the peak of each Twitter event and the subsequent 6 days ("exposure window") was compared with suicides occurring during a pre-event period of the same length ("control window"). Results: There were 17 suicide-related Twitter events during the period of study (12 putatively harmful and five putatively innocuous). The number of tweets per event ranged from 121 for "physician-assisted suicide law in Quebec" to 6,202 for the "Attawapiskat suicide crisis." No significant relationship was detected between Twitter events and actual suicides. Notably, a comprehensive examination of the details of Twitter events showed that even the putatively harmful events lacked many of the characteristics commonly associated with contagion. Limitations: This was an uncontrolled experiment in only one epoch and a single Canadian province. Discussion: This study found no evidence of suicide contagion associated with Twitter events. This finding must be interpreted with caution given the relatively innocuous content of suicide-related Tweets in Ontario during 2015–2016.

ObjectivesExplore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).DesignAn online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.SettingInternational.ParticipantsRespondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.Outcome measuresDefinitions of English-language terms for suicidal behaviours.ResultsThe recommended definition of ‘suicide’ describes a fatal act initiated and carried out by the actors themselves. The definition of ‘suicide attempt’ was restricted to non-fatal acts with intent to die, whereas definition of ‘self-harm’ more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of ‘suicidal ideation’, ‘death wishes’ and ‘suicide plan’. ‘Aborted suicide attempt’ and ‘interrupted suicide attempt’ were not considered components of ‘preparatory suicidal behaviour’. There were several differences between representatives from HICs and LMICs.ConclusionThis international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.

The current commentary and review examines the potentially protective role of feelings of mattering among elderly people during typical times and the current atypical times associated with the COVID-19 global pandemic. Mattering is the feeling of being important to others in ways that give people the sense that they are valued and other people care about them. We contrast this feeling with messages of not mattering and being expendable and disposable due to ageism, gaps in the provision of care, and apparently economically focused positions taken during the pandemic that disrespect the value, worth, and merits of older persons. We provide a comprehensive review of past research on individual differences in mattering among older adults and illustrate the unique role of mattering in potentially protecting older adults from mental health problems. Mattering is also discussed in terms of its links with loneliness and physical health. This article concludes with a discussion of initiatives and interventions that can be modified and enhanced to instill a sense of mattering among older adults. Key directions for future research are also highlighted along with ways to expand the mattering concept to more fully understand and appreciate the relevance of mattering among older adults.

Objectives. To investigate the psychometric properties of the five-item Suicidal Behaviors Questionnaire (SBQ-5) and the Geriatric Suicide Ideation Scale-Screen (GSIS-Screen, submitted) among community-residing middle-aged and older men.Methods. The SBQ-5 and GSIS-Screen were administered to 93 men, 55 years or older, who participated in an eligibility assessment (Time 1) for an upstream psychological intervention study to prevent the onset of suicide ideation among men struggling to transition to retirement. Eligible participants later completed the full GSIS and measures of depression and hopelessness at a pre-group assessment (Time 2).Results. The SBQ-5 was positively associated with the GSIS-Screen at the eligibility assessment. Internal consistency for both measures was low but acceptable. Time 1 scores on both screens predicted suicide ideation at Time 2, controlling for the intervening time lag and for baseline cognitive and physical functioning. Only the GSIS-Screen uniquely predicted future depression and hopelessness ratings.Conclusions. The SBQ-5 and the GSIS-Screen have acceptable psychometric properties among middle-aged and older community-residing men; the GSIS-Screen is more closely associated with later-life suicide risk factors.Clinical Implications. Brief screening tools may be of use in effectively identifying suicide ideation in community-residing middle-aged and older men.

To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen).A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings.Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.

Abstract. Background: Media guidelines can influence suicide-related reporting quality and may impact suicide rates. Aim: Our study aimed to investigate the quality of suicide-related reporting after the release of the 2009 Canadian Psychiatric Association (CPA) guidelines and their impact on suicides. Method: A random sample of suicide-related articles ( n = 988) were retrieved from 12 major Canadian print/online publications (2002–2015). Articles were coded for quality of content before and after guidelines release. Suicide mortality data were obtained from Ontario coroner records. Time series analyses were used to identify associations between guideline publication and subsequent suicides. Results: The CPA guidelines were associated with improvements in reporting quality with 10 putatively harmful elements being less frequent after their publication. These included less frequent front-page articles, monocausal (simplistic) explanations for suicide, and depictions of suicide methods. Two putatively protective factors, alternatives to suicide and messages of hope, were twice and four times as common, respectively, after the guidelines. The guidelines were not associated with a change in suicide counts. Limitations: This study could not prove exposure to suicide reporting. Conclusion: Publication of Canadian media guidelines was associated with significant, moderate-sized improvements in reporting quality but not with decreased suicides. The latter finding may reflect only modest dissemination and implementation of the guidelines.

Background Patients who present to emergency departments after intentional self-harm are at an increased risk of dying by suicide. This applies particularly to men, who represent nearly two-thirds of those who die by suicide in Ontario. One way of potentially addressing this gap is to offer a course of blended problem-solving therapy, comprised of a brief course of evidence-based psychotherapy for individuals at risk for suicide, facilitated by the use of a patient-facing smartphone application and a clinician-facing “dashboard.” This approach has the potential to combine the benefits of face-to-face therapy and technology to create a novel intervention. Methods This is a cohort study nested within a larger pragmatic multicentre pre- and post-design cluster randomised trial. Suicidal ideation assessed by the Beck Scale for Suicide Ideation is the primary outcome variable. Secondary outcome measures include depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder 7-item scale), post-traumatic stress disorder (Primary Care PTSD Screen), health-related quality of life (EuroQol 5-dimension 5-level questionnaire), meaning in life (Experienced Meaning in Life Scale), perceived social supports (Multidimensional Scale of Perceived Social Support), alcohol use (Alcohol Use Disorders Identification Test), drug use (Drug Abuse Screening Test Short Form 10), problem-solving skills (Social Problem-Solving Inventory–Revised Short Form), and self-reported healthcare costs, as well as health service use measured using Ontario administrative health data. A process evaluation will also be conducted following study completion. Discussion The cohort study will test whether better adherence to the intervention results in better outcomes. The value of the cohort study design is that we can examine in more detail certain subgroups or other variables that are not available in the larger cluster randomised trial. This trial will aim to improve standards by informing best practice in management of men who self-harm and present to hospitals in Ontario. Trial registration ClinicalTrials.gov, NCT03473535. Registered on March 22, 2018.

Objective: A growing body of research has established that specific elements of suicide-related news reporting can be associated with increased or decreased subsequent suicide rates. This has not been systematically investigated for social media. The aim of this study was to identify associations between specific social media content and suicide deaths. Methods: Suicide-related tweets ( n = 787) geolocated to Toronto, Canada and originating from the highest level influencers over a 1-year period (July 2015 to June 2016) were coded for general, putatively harmful and putatively protective content. Multivariable logistic regression was used to examine whether tweet characteristics were associated with increases or decreases in suicide deaths in Toronto in the 7 days after posting, compared with a 7-day control window. Results: Elements independently associated with increased subsequent suicide counts were tweets about the suicide of a local newspaper reporter (OR = 5.27, 95% CI = [1.27, 21.99]), ‘other’ social causes of suicide (e.g. cultural, relational, legal problems; OR = 2.39, 95% CI = [1.17, 4.86]), advocacy efforts (OR = 2.34, 95% CI = [1.48, 3.70]) and suicide death (OR = 1.52, 95% CI = [1.07, 2.15]). Elements most strongly independently associated with decreased subsequent suicides were tweets about murder suicides (OR = 0.02, 95% CI = [0.002, 0.17]) and suicide in first responders (OR = 0.17, 95% CI = [0.05, 0.52]). Conclusions: These findings largely comport with the theory of suicide contagion and associations observed with traditional news media. They specifically suggest that tweets describing suicide deaths and/or sensationalized news stories may be harmful while those that present suicide as undesirable, tragic and/or preventable may be helpful. These results suggest that social media is both an important exposure and potential avenue for intervention.

Supplemental material, Appendix_1 for The association between Twitter content and suicide by Mark Sinyor, Marissa Williams, Rabia Zaheer, Raisa Loureiro, Jane Pirkis, Marnin J Heisel, Ayal Schaffer, Donald A Redelmeier, Amy H Cheung and Thomas Niederkrotenthaler in Australian & New Zealand Journal of Psychiatry

Objectives: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over.Method: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded.Results: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures.Conclusion: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Background Blended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm. Objective To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy. Methods After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach. Findings Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments. Conclusions In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people. Clinical implications Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions. Trial registration number NCT02718248

Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.

Objectives: To derive a brief late-life suicide resiliency scale from the 69-item Reasons for Living Scale-Older Adult version (RFL-OA).Methods: We conducted a series of secondary analyses of RFL-OA data (N = 204) from a dataset combining: 1. A follow-up assessment of nursing home residents in the Geriatric Suicide Ideation Scale (GSIS) development study; 2. A trial of Interpersonal Psychotherapy (IPT) with suicidal older adults; 3. A longitudinal study of risk and resiliency to late-life suicide ideation. We specifically assessed the distributions of RFL-OA items and their associations with suicide ideation and behavior to create an RFL-Suicide Resiliency subscale (RFL-SR); we then tested the psychometric properties of this measure's items drawn from the larger RFL-OA.Results: Nine RFL-OA items were significantly associated with suicide ideation and history of suicide behavior and were not highly correlated with social desirability. Psychometric analyses supported the internal consistency, test-retest reliability, and construct validity of this scale.Conclusions: The items of the RFL-SR demonstrated strong psychometric properties with older adults in clinical and community settings.Clinical Implications: The RFL-SR may make a useful addition to suicide risk assessment in gerontological research and clinical practice.

Objective To test a theoretical model of the onset and/or exacerbation of late-life suicide ideation, incorporating consideration of risk, resiliency, and precipitating factors. Design A longitudinal study investigating whether recognition of meaning in life (MIL) at baseline confers resiliency to the onset and/or exacerbation of suicide ideation over a 6- to 22-month period of follow-up, controlling for baseline depression, self-rated health, and physical functioning, and for frequency and intensity of intervening daily hassles. Setting Mental health research offices in an urban academic health sciences center. Participants 173 community-residing older adults (mean: 73.9 years, SD: 6.1 years, range: 65–93 years) recruited from health, wellness, and interest programs, and from newspaper ads and flyers posted in London, Ontario, a mid-sized Canadian city. A total of 126 (73%) completed follow-up assessments. Measurements Participants completed a demographics form, a cognitive screen, and measures of suicide ideation and of risk (depressive symptom severity, self-rated health problems, and physical functioning) and potential resiliency (recognition of MIL) factors at baseline and follow-up assessment points, and a measure of intervening daily hassles. Results MIL at baseline was negatively associated with the onset and/or exacerbation of suicide ideation over time, controlling for risk factors and intervening precipitating factors. The extent and relative significance of this finding differed with the manner in which MIL and suicide ideation were operationalized. Conclusions Study findings add to a growing body of knowledge suggesting that MIL may play an important role in promoting mental health and well-being and potentially conferring resiliency to contemplations of suicide in later life.

Older adults have high rates of suicide and employ highly lethal means of self-harm (WHO, 2014). The aging of the population necessitates tools that quickly identify suicide risk and resiliency processes (Heisel & Duberstein, 2016). Linehan and colleagues (1983) initially identified Reasons for Living (RFL) as an adaptive psychological construct potentially preventive of suicide thoughts and behavior. Age-specific RFL scales have since been developed, including for older adults. The purpose of the present study was to develop and evaluate a brief version of the Reasons for Living Scale-Older Adults version (RFL-OA; Edelstein et al., 2009) for use in clinical and research contexts. A series of secondary analyses was conducted of a combined dataset (N=204) derived from three studies of late-life suicide ideation (Heisel & Flett, 2006; Heisel et al., 2015; Heisel, Neufeld, & Flett, 2016). We specifically assessed RFL-OA item distributions, and their contribution to internal consistency, construct validity, and social desirability. Thirty RFL-OA items were significantly associated with lifetime history of suicide attempt. Of these, 13 items were also associated with current suicide ideation. No item was highly correlated with social desirability. Findings supported the internal consistency, test-retest reliability, and construct and criterion validity of this abbreviated RFL scale. This study’s findings support the reliability and validity of a 13- item Reasons for Living-Suicide Risk scale (RFL-SR) for use with clinical and/or community-residing samples of older adults. These findings suggest promise for this abbreviated measure in assessing a psychological construct potentially protective against later-life suicide risk.

Objective Only a minority of suicide decedents leave a suicide note. Typically, the notes are handwritten on paper; however, electronic suicide notes have been reported with increasing frequency. This emerging phenomenon remains generally under-researched. The aim of this study was to compare the psychosocial and clinical antecedents of suicide decedents who left E-notes with those who left paper notes or no notes. Method The study was embedded in the Southwestern Ontario Suicide Study (SOSS). The SOSS was a three-year case series of consecutive deaths by suicide that occurred in the region between 2012 and 2014. Data on psychosocial and clinical antecedents were collected with a modified version of the Manchester questionnaire used in the UK. Results Of the 476 suicides files reviewed, 45.8% contained a suicide note. A total of 383 separate suicide notes were left: 74.3% were paper notes and 25.7% were E-notes. The results of the multivariate regression analyses indicate that the likelihood of leaving a suicide note was negatively associated with a history of admissions to a mental health unit, while the likelihood of leaving an E-note was negatively associated with age, positively associated with presence of a mental disorder, and negatively associated with history of hospital admissions. Conclusions Future studies with larger samples need to consider the timing of the text messages, and appraise whether there was the intent of seeking help or rescue in the text messages.

Abstract. Background and Aims: Given the effectiveness of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) in the UK, the present study evaluated this approach in Southwestern Ontario. A systematic confidential examination of suicides in Ontario was developed to guide quality improvement of services and suicide prevention. Method: A 3-year case series of consecutive suicides in Southwestern Ontario identified by the Office of the Chief Coroner was compiled. Clinicians who provided care to suicide decedents completed an online confidential suicide questionnaire offered through a secured portal. Results: A total of 476 suicide cases were analyzed. In all, 270 invitations to clinicians were sent, 237 (87.8%) responded to the invitation and 187 (69.3%) completed the online questionnaire. The majority of the suicide decedents (54.6%, n = 260), were between the ages of 40 and 64 (x = 47.2, SD = 17.1), White (91.4%, n = 416), single (34.2%, n = 439), and male (74.4%, n = 476). Of the 86 cases of self-poisoning, prescription medications were used in 66.3%. Almost two thirds of decedents visited the clinician in the month prior to their death. Limitations: The results of the survey were drawn from suicides in Southwestern Ontario and generalizing these findings should be done with caution. Conclusion: This study highlights (a) the value of the clinicians' survey to identify gaps in clinical services and (b) the necessity of improvements in suicide risk assessment/management and restriction of prescription medications.

Objective To describe sociodemographic and clinical characteristics of suicide decedents and to explore the pattern of clinical and suicide risk assessment in primary care settings. Methods A 3-year case series of consecutive suicides (January 1, 2012, to December 31, 2014) in Southwestern Ontario, Canada, identified by the Office of the Chief Coroner of Ontario and Ontario Forensic Pathology Service (OCC/OFPS) was conducted. Clinicians who provided care to suicide decedents completed a confidential suicide questionnaire offered online through a secured portal or by hardcopy. Results A total of 476 suicide cases were analyzed using data extracted from the OCC/OFPS files or provided by clinicians who had completed the survey. Hanging (42.8%) was the most common method of suicide, followed by self-poisoning (17.9%). More than half of the decedents (51.8%) used psychotropic medications, and 29.4% used opiates to self-poison. Typically, these self-poisonings involved prescribed medications (70.6%). Over two-thirds (67.4%) of suicide decedents had consulted their primary care physician prior to their deaths, and 63.6% had been seen by a physician within 28 days of their death. Suicide risk assessments were reportedly conducted in 87.1% of these visits. Of those who were assessed, the immediate risk of suicide was deemed to be absent in 39.8%, low in 50.0%, moderate in 8.3%, and high in only 1.9%. Conclusion The findings from this confidential survey may be important for the formulation of recommendations that could improve suicide prevention in primary care practice.

Older men have the highest suicide rates worldwide, yet few interventions have been shown effective in reducing suicide risk in middle-age or older men (Lapierre et al., 2011). We developed and tested a novel, 12-session Meaning-Centered Men’s Group (MCMG) intervention with 100–120 cognitively-intact, community-residing men 55 years or older who were struggling to adjust to retirement, a transition associated for some with increased suicide risk. The intervention draws on research demonstrating negative associations of Meaning in Life (MIL) with depression and suicide ideation (Heisel & Flett, 2014, 2016), and aims to build camaraderie through group discussions about finding meaning in work, leisure, relationships, and generativity. This paper summarizes findings from this on-going study, including controlled analyses comparing MCMG with a current-events discussion group, and experiences disseminating MCMG to distant sites. Discussion will focus on helping men adjust meaningfully to retirement and preventing the onset or exacerbation of suicide ideation.

Across age groups, bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions; 25%-50% of those with BD will make one or more suicide attempt. Psychometrically sound instruments are required to reliably measure suicide ideation and risk of self-harm for older adults with BD. For this study, we validate the geriatric suicide ideation scale (GSIS) with adults 50+ years with BD.We recruited a global sample of 220 older adults with BD (M = 58.50 years of age) over 19 days using socio-demographically targeted, social media advertising and online data collection. To demonstrate the construct validation of GSIS responses by older adults with BD, we computed correlations and performed regression analyses to identify predictors of suicide ideation.Our analyses support a four-factor model of responses to the GSIS (ideation, death ideation, loss of personal and social worth, and perceived meaning in life) measuring a higher order latent construct. Older adults with BD reporting low satisfaction with life and current depressive symptoms, and who misuse alcohol, report significantly higher levels of suicide ideation. Sleep quality and cognitive failures are also correlated with GSIS responses.Results support the factorial validity of the GSIS with older adults with BD. Similar to other populations, the GSIS measures a four-factor structure of suicide ideation. Across BD subtypes, the GSIS appears to reliably measure suicide ideation among older adults with BD.

Objectives Bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions as 25%–50% of those with BD will make one or more suicide attempt, and about 15% will intentionally end their lives. Among young adults with BD, substance misuse, medication non-adherence, age at onset, and comorbid psychiatric conditions each predict self-harm. It is currently unclear if these same factors or others predict suicide ideation among older adults with BD. Methods We recruited a global sample of 220 older adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection (Mean = 58.50, SD = 5.42; range 50 to 81 years). Path analyses allowed us to identify direct and indirect predictors of suicide ideation among older adults with BD. Results Cognitive failures (perception, memory, and motor function), depressive symptoms, alcohol misuse, and dissatisfaction with life as direct predictors of suicide ideation; duration of BD symptoms and medication non-adherence emerged as indirect predictors. Of note, the significant impact of sleep on suicide ideation is indirect via depressive symptoms, cognitive failures, medication non-adherence and life dissatisfaction. Conclusions As with young adults with BD, alcohol misuse and medication non-adherence emerged as significant predictors of suicide ideation. In addition, cognitive failures directly and indirectly predict suicide ideation in this sample of older adults with BD. Population aging and treatment efficacy are leading to ever growing numbers of older adults with BD. Both direct and indirect predictors of suicide ideation need to be considered in future BD research and treatment planning.

Although perfectionism is recognized as a factor that is linked with suicide, we maintain that the role of perfectionism as an amplifier of the risk of suicide has been underestimated due to several factors. In the current article, contemporary research on the role of perfectionism in suicide is reviewed and summarized. Several themes are addressed, including: (a) consistent evidence linking suicide ideation with chronic exposure to external pressures to be perfect (i.e., socially prescribed perfectionism); (b) the roles of perfectionistic self-presentation and self-concealment in suicides that occur without warning; and (c) how perfectionism contributes to lethal suicide behaviors. We also summarize data showing consistent links between perfectionism and hopelessness and discuss the need for a person-centered approach that recognizes the heightened risk for perfectionists who also tend to experience hopelessness, psychache, life stress, overgeneralization, and a form of emotional perfectionism that restricts the willingness to disclose suicidal urges and intentions. It is concluded that when formulating clinical guidelines for suicide risk assessment and intervention and public health approaches to suicide prevention, there is an urgent need for an expanded conceptualization of perfectionism as an individual and societal risk factor. We also discuss why it is essential to design preventive programs tailored to key personality features with specific components that should enhance resilience and reduce levels of risk among perfectionists who hide behind a mask of apparent invulnerability.

Older adults have the highest rates of suicide globally, necessitating theory and research investigating suicide and its prevention in later-life. The experience of loneliness is significantly associated with depression, hopelessness, negative health outcomes, and mortality among older adults. Yet, relatively little research has focused on the role of loneliness in conferring suicide risk in later life. The purpose of the present study was thus to investigate the potential associations between loneliness and suicide ideation and behavior in a sample of community-residing older adults recruited into a larger two-year longitudinal study of psychological risk and resiliency to later-life suicide ideation. We specifically recruited 173 adults, 65 years or older, from community locations in a medium-sized Canadian city, for a study on “healthy aging.” Participants completed measures of positive and negative psychological variables, including depression, loneliness, and suicide ideation at a baseline assessment, and again at 2-4 week, 6-12 month, and 1-2 year follow-up points. Findings indicated that loneliness (UCLA Loneliness Scale) was significantly positively associated with concurrent depression and suicide ideation, negatively associated with psychological well-being and perceived social support, and differentiated between participants who endorsed or denied having ever engaged in suicide behavior. Baseline loneliness also explained significant variability in the onset of suicide ideation over a 1-2 year period of follow-up, controlling for age, sex, and baseline depression and suicide ideation. These findings will be discussed in the context of the need for increased focus on psychosocial factors when assessing and intervening to reduce suicide risk in older adults.

Suicide is a uniquely human phenomenon, necessitating a human response. Suicide disproportionately claims the lives of older adults, and men in particular. Effective clinical practice with at-risk older adults requires sensitivity to contributing developmental, intrapersonal, social, and existential factors. Whereas the presence of suicide thoughts and behavior may be conceptualized as potential signs of an incipient mental health emergency, demanding quick and decisive action, working clinically with at-risk older adults nevertheless extends temporally beyond moments of behavioral crisis and conceptually beyond risk assessment and management. The field of later-life suicide prevention is in its relative infancy; however, progress is being made in investigating associated risk and resiliency factors and in developing, testing, and disseminating approaches to assessment and intervention. We provide an overview of the literature and call for a more sensitive, compassionate, and effective approach to suicide prevention among older adults, drawing on individually tailored and humanistic-existential approaches to care.

Media reporting on suicide may have harmful and/or protective effects on deaths by suicide, depending on the nature of the coverage. Canada’s first forum on this important issue was held in Toronto on November 6, 2015. Participating in the forum were public health policy-makers, mental health and suicide prevention experts and senior media representatives. This commentary summarizes the content of the forum and highlights the need for ongoing collaboration between suicide prevention experts and media professionals aimed at safe and respectful reporting that maintains the public’s need to be informed.

Older men have the highest suicide rates worldwide, necessitating focused interventions (WHO, 2014). We have developed and are testing a 12-session community-based group intervention for men over 55 who are concerned, struggling, or worried about the transition to retirement. Meaning-Centered Men’s Groups (MCMG) draw on theory, research, and practice implicating existential considerations in contributing to or warding off thoughts of suicide (Heisel & Flett, 2016), and aim to build camaraderie through discussions about finding meaning in work, leisure, relationships, and generativity. We now present analyses investigating personality moderators of treatment outcomes in our trial of MCMG. Conscientiousness appears to significantly moderate the reduction in suicide ideation, and is negatively associated with Neuroticism and depression and positively associated with psychological well-being and life satisfaction. Findings will be discussed with reference to theory and research on personality, masculinity, and suicide prevention, and implications for mental health outreach to older men.

Background: The capacity of friends and family member informants to make judgments about the presence of a mood disorder history in an older primary care patient has theoretical, clinical, and public health significance. This study examined the accuracy of informant-reported mood disorder diagnoses in a sample of primary care patients aged 65 years or older. We hypothesized that the accuracy (sensitivity and specificity) of informant reports would vary with the patient's personality.Methods: Hypotheses were tested in 191 dyads consisting of patients and their friends or relatives (informants) recruited from primary care settings. Gold-standard mood disorder diagnoses were established at consensus conferences based on a review of medical charts and data collected in a structured interview with the patient. Patients completed an assessment battery that included the NEO-Five Factor Inventory.Results: Sensitivity and specificity of informant-derived mood disorder diagnoses were related to patient personality. Sensitivity of informant-derived lifetime mood disorder diagnoses was compromised by higher Extraversion and higher Agreeableness. Specificity of informant-derived lifetime mood disorder diagnoses was compromised by lower Agreeableness and higher Conscientiousness.Conclusion: Patient personality has implications for the accuracy of mood disorder histories provided by friends and family members. Given that false negatives can have grave consequences, we recommend that practitioners be particularly vigilant when interpreting collateral information about their extraverted, agreeable patients.

Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients' initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring. Language: en

Older adults have high rates of suicide and typically seek care in primary medical practices. Older adults often do not directly or spontaneously report thoughts of suicide, which can impede suicide prevention efforts. Therefore, the use of additional approaches to suicide risk detection is needed, including the use of screening tools. The objective of this study was to assess whether brief screens for depression have acceptable operating characteristics in identifying suicide ideation among older primary care patients and to examine potential sex differences in the screen's accuracy.We administered the 15-item Geriatric Depression Scale (GDS), which includes a 5-item GDS subscale (GDS-SI) designed to screen for suicide ideation, to a cross-sectional cohort of 626 primary care patients (235 men, 391 women) 65 years of age or older in the Northeastern United States. We assessed presence of suicide ideation with items from the Hamilton Rating Scale for Depression and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.Patients expressing suicide ideation (n = 69) scored higher on the GDS and GDS-SI than those who did not (n = 557). A GDS cut score of 4 maximized sensitivity (0.754) and specificity (0.815), producing an area under the curve of 0.844 (P.001) and positive and negative predictive values of 0.335 and 0.964, respectively. Optimal cut scores were 5 for men and 3 for women. A GDS-SI cut score of 1 was optimal for the total sample and for both men and women.The GDS and GDS-SI accurately identify older patients with suicide ideation. Research is needed to examine their acceptability and barriers to routine use in primary care.

Objectives Alexithymia is a characteristic style of thinking and feeling involving deficits in the recognition of emotions. It is associated with depression onset and severity in younger adults, but researchers have not yet examined the association between alexithymia and depression severity in clinically depressed older adults. Design Cross-sectional. Participants One hundred thirty-four patients aged 50 years or older with a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I mood disorder and currently receiving mental health treatment. Measures Alexithymia was measured using the Toronto Alexithymia Scale-20, a 20-item measure with subscales assessing difficulty identifying feelings, difficulty describing feelings (DDF), and externally oriented thinking. Depression symptom severity was measured using the Beck Depression Inventory, Second Edition (BDI-II). Results Total alexithymia scores were independently related to depressive symptom severity after controlling for demographics, cognitive functioning, and illness burden. DIF and DDF subscale scores were also independently associated with BDI-II scores. Conclusion The association between alexithymia and depression symptom severity could be attributed to difficulties in recognizing and describing negative emotions and resulting delays in seeking mental health treatment. Future research should focus on modifiable risk factors related to difficulties identifying and describing feelings.

Purpose: The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale — Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide. Design and Methods: Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in one ’ s life, and current mental status and physical functioning. Results: Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach’s alpha coeffi cient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior. Implications: These fi ndings provide preliminary support for the validity and reliability of the RFL-OA. The fi ndings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.

We report preliminary findings of the first ever study testing a 16-week course of Interpersonal Psychotherapy (IPT) modified for older outpatients at elevated risk for suicide. Participants were referred from inpatient and outpatient medicine and mental health services. Psychotherapy sessions took place in a therapist’s office in a teaching hospital. Twelve adults 60 years or older (M=70.5, SD=6.1) with current thoughts of suicide (suicide ideation) or a wish to die (death ideation) or with recent self-injurious behavior were recruited into weekly sessions of IPT; one was subsequently excluded due to severe cognitive impairment. Participants completed measures of suicide ideation, death ideation, and depressive symptom severity at pre-treatment, mid-treatment, post-treatment, and at 3-month follow-up periods, and measures of therapeutic process variables. Preliminary findings of this uncontrolled pre-post-treatment study support the feasibility of recruiting and retaining older adults at-risk for suicide into psychotherapy research and suggest that adapted IPT is tolerable and safe. Findings indicate a substantial reduction in participant suicide ideation, death ideation, and depressive symptoms; controlled trials are needed to further evaluate these findings. We discuss implications for clinical care with at-risk older adults.

Objective Adults with mood disorders are at elevated risk for suicide. Psychological features such as hopelessness increase their risk for suicide ideation. Few studies have examined psychological constructs posited to lower risk for suicide ideation. The authors tested the hypothesis that reasons for living (RFL) are inversely related to suicide ideation. Design This report is a secondary analysis of cross-sectional data. Setting Participants were recruited from the clinical services of three teaching hospitals in Rochester, NY. Participants The sample consisted of 125 adults 50 years or older receiving treatment for a mood disorder. Measurements A diagnostic interview and measures of suicide ideation, depression, hopelessness, and RFL were included in the assessment battery. Dependent variables were presence and severity of suicide ideation. Data were analyzed using multivariate logistic and linear regressions. Results Patients who reported higher levels of fear of suicide were less likely to report suicide ideation. The relationships between hopelessness and both the presence and severity of suicide ideation were stronger among those who reported greater levels of responsibility to family. Conclusions Clinicians working with at-risk older adults are encouraged to explore their patients' RFL. These cross-sectional findings point to the need for prospective research examining the associations among different RFL, hopelessness, and suicide ideation in depressed older adults.

We investigated associations between suicide ideation and a set of potential risk and resiliency factors in a heterogeneous sample of 107 older adults (mean age = 81.5 years, SD = 7.7 years; range, 67 to 98 years; 76% female) recruited in community, residential, and healthcare settings. Participants completed the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006) and measures of depression, perceived physical health problems, domains of psychological well-being, perceived meaning in life, and indices of social network and of religious affiliation and observance. The main findings indicated that suicide ideation was associated positively with depression and with number of self-reported physical health problems and negatively with domains of psychological well-being including positive relations with others and self-acceptance, and with perceived meaning in life. Hierarchical multiple regression analyses indicated that the resiliency factors in general, and perceived meaning in life in pa...

Background A deeper understanding of the influences on self-reported mood symptoms could inform the debate about the utility of self-report instruments and enhance the assessment and treatment of affective disorders. We tested the hypotheses that higher Neuroticism is associated with the over-reporting of affective symptoms and lower Openness to Experience is associated with the under-reporting of affective symptoms. Methods Subjects were 134 inpatients of ages 50 and over diagnosed with a mood disorder. Personality was assessed with the Revised NEO Personality Inventory. Self-reported depression was assessed with the Beck Depression Inventory-II; observer-rated depression was assessed via the Hamilton Depression Rating Scale. Symptom-reporting was defined as the ratio of self-reported to observer-rated symptoms. Results As hypothesized, multivariate linear regression analyses revealed that high Neuroticism contributed to patients' over-reporting of mood symptoms. Contrary to the hypothesis, low Openness was associated with high ratios of self-reported to observer-rated mood symptoms. Limitations Cross-sectional design and unclear generalizability to racial/ethnic minorities. Conclusions Traits are important correlaters of self-reported vs. observer-rated symptoms in patients with affective disorders. To the extent that economic imperatives and other pressures impel greater reliance on self-report data in mental health research and services, there will be a corresponding need for prospective research on the determinants and clinical implications of discrepancies between self-reports and observer ratings.

Objective Narcissistic personality (NP) has been implicated as a potential vulnerability factor for late-life suicide. The present study investigated whether NP increases vulnerability to suicidal ideation and behavior among geriatric depression day-hospital patients. Methods Using a retrospective database analysis, the authors examined demographic data, diagnostic information, and scores on self-report (Geriatric Depression Scale [GDS]) and clinician-rated depression measures (Hamilton Rating Scale for Depression [HAM-D]), for 608 geriatric psychiatry patients 65 years or older. Results Of the 538 patients meeting study inclusion criteria, 20 had NP, defined as either narcissistic personality disorder (n = 13) or narcissistic personality traits (n = 7). Patients with NP were rated significantly higher on the HAM-D suicide item than those without NP, controlling for age, sex, depression (GDS), and cognitive functioning. Conclusion Findings suggest that NP may be a clinical marker of elevated suicide risk among depressed older adults. Clinicians are advised to assess the presence of self-pathology and its potential impact upon psychological functioning in depressed older patients, and to incorporate discussions of life transitions into therapeutic work with those at-risk for suicide.

The psychological assessment of older adults is often challenging due to the frequent co-morbidity of mental and physical health problems, multiple medications, interactions among medications, age-related sensory and cognitive deficits, and the paucity of assessment instruments with psychometric support for use with older adults. First, psychological assessment instruments for examining five important clinical areas (suicide ideation, sleep disorders, anxiety, depression, and personality) are discussed in light of the most current research regarding their psychometric properties and suitability for use with older adults. Instruments developed specifically for older adults are distinguished from instruments developed for younger adults that have some psychometric support for their use with older adults. Second, the potential sensory deficits that could compromise assessment, factors to consider in light of these deficits, and accommodations that can be made to minimize their effects are discussed.

To investigate the roles of reasons for living (RFL) and meaning in life (MIL) in potentially promoting mental health and well-being and protecting against suicide ideation among community-residing older adults and to investigate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA).Of 173 older adults initially recruited into a longitudinal study on late-life suicide ideation, 109 completed the RFL-OA and measures of cognitive and physical functioning and positive and negative psychological factors at a two-year follow-up assessment. We tested a model in which RFL and MIL protect against suicide ideation, controlling for demographic and clinical factors. We also assessed the psychometric properties of the RFL-OA in community-residing older adults, investigating its internal consistency and its convergent (MIL, perceived social support, and life satisfaction), divergent (loneliness, depressive symptom severity, and suicide ideation), and discriminant validity (cognitive and physical functioning).RFL-OA scores explained significant variance in suicide ideation, controlling for age, sex, depressive symptom severity, and loneliness. MIL explained significant unique variance in suicide ideation, controlling for these factors and RFL, and MIL significantly mediated the association between RFL and suicide ideation. Psychometric analyses indicated strong internal consistency (α = .94), convergent, divergent, and discriminant validity for the RFL-OA relative to positive and negative psychological factors and cognitive and physical functioning.These findings add to a growing body of literature suggesting merit in investigating positive psychological factors together with negative factors when assessing suicide risk and planning psychological services for older adults.

Objectives: To examine criterion and construct validity of the five-item Mental Health Index (MHI-5) of the 36-item Short Form health survey (SF-36) in relation to the presence of major depression in functionally impaired, community-dwelling elderly patients and of eight subsamples defined by cognitive functioning, levels of functional impairment, and proxy report versus self-report. Design: Cross-sectional observational. Setting: Nineteen counties in western New York, West Virginia, and Ohio. Participants: One thousand four hundred forty-four functionally impaired, community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Primary and Consumer-Directed Care Demonstration. Measurements: MHI-5, Mini-International Neuropsychiatric Interview Major Depressive Episode (MINI-MDE) module. Results: The MHI-5 demonstrated sufficient criterion validity (area under the receiver operating characteristic curve=0.837; sensitivity=78.7% and specificity=72.1% using a cutpoint of 59/60) with respect to the presence of depression for the entire sample. A significant correlation between MHI-5 scores and presence of major depression as identified using the MINI-MDE (Spearman correlation=−0.426, P

OBJECTIVES: To examine the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15), a brief depression screening measure. DESIGN: Cross-sectional. SETTING: Nineteen counties in western New York, West Virginia, and Ohio. PARTICIPANTS: Nine hundred sixty functionally impaired, cognitively intact, community-dwelling primary care patients aged 65 and older. MEASUREMENTS: The GDS-15, major depression as measured using the Mini-International Neuropsychiatric Interview, depressed mood, life satisfaction, suicidal ideation, and reported suicide attempts. RESULTS: Exploratory factor analyses suggested a two-factor structure for the GDS-15 in this category of patients, with component subscales assessing depression and positive affect. Cronbach alpha coefficients provide evidence for moderate, although acceptable, internal consistency reliability. Significant associations between the GDS-15 and measures of depressed mood, life satisfaction, and suicidal ideation demonstrated construct validity, whereas acceptable sensitivity and specificity to discriminate between depressed and nondepressed patients demonstrated criterion validity. Internal consistency reliability and construct validity did not differ significantly between patients with low and high functional impairment. A significant weakness of the scale is its low correlation with suicide attempt status. CONCLUSION: In general, this study provides evidence of impressive psychometric properties of the GDS-15 when administered to a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.

Depression decreases the quality of life and hinders efforts to palliate symptoms of adults with terminal or life-threatening illness. Nevertheless, depression often may go undetected and untreated in palliative care and hospice settings due to a number of factors, including the overlap of depressive symptoms with those of serious medical illness and concern that frail elderly patients cannot tolerate psychotherapy or antidepressant treatment. In this paper we review the available research regarding assessment and treatment of depression in older adults with terminal or life-threatening illness, focusing on patients who are seen in palliative care, cancer treatment, or hospice settings. Although the prevalence of depression is relatively high in these settings in mixed-age adult samples, studies focused exclusively on older adults are rare and there appear to be no randomized controlled trials of psychotherapy conducted to date that specifically address their needs. There are, however, promising psychological approaches featured in case reports and pilot studies that are consistent with empirically supported therapies for the general treatment of depression in older adults. Based on these preliminary findings and reports, we offer tentative recommendations for the assessment and treatment of depression in terminally ill older adults. We conclude that controlled research on psychotherapy for late-life depression is both feasible and urgently needed in palliative care, cancer care, and hospice settings.

This study examined the role of purpose in life and satisfaction with life in protecting against suicide ideation in a clinical psychiatric sample. Forty-nine psychiatric patients completed self-report measures of suicide ideation, purpose in life, satisfaction with life, neuroticism, depression, and social hopelessness. Zero-order correlations indicated significant associations between suicide ideation and the various predictors, in the hypothesized directions. Regression analyses illustrated that purpose in life and satisfaction with life accounted for significant additional variability in suicide ideation scores above and beyond that accounted for by the negative psychological factors alone. Purpose in life also mediated the relation between satisfaction with life and suicide ideation and moderated the relation between depression and suicide ideation. These findings demonstrate the potential value of attending to both resilience and pathology when building predictive models of suicide ideation and of attending to key existential themes when assessing and treating suicidal individuals.