Is Late-Onset Suicidal Behavior a Distinct Subtype?

This clinical viewpoint article aims to draw attention to a yet unexplored factor influencing suicidal behavior: age of onset of suicidal behavior. To tackle the substantial heterogeneity among depressed older attempters, we suggest consideration of at least two distinct pathways to suicidal behavior in late life based on when the first suicidal crisis occurred. Specifically, we discuss the current state of research and the rationale behind the suggested early-late-onset categorization of late-life suicidal behavior. We summarize available evidence so far on early-onset and late-onset attempters, and the potential heterogeneity in the interplay of risk/precipitating factors. Certain risk factors for suicide, such as impulsivity and borderline traits, decrease with age, while memory and broader cognitive impairments increase with age. Research indicates that familial/social exposure to suicidal behavior, childhood trauma, impulsivity, maladaptive personality traits, longstanding interpersonal difficulties, and legal problems are found predominantly in attempters experiencing their first suicidal crisis between youth and early midlife. In contrast, dementia prodrome is one of the most promising but understudied candidates for late-onset suicide risk, especially in the context of other risk factors. Moreover, personality traits conferring increased vulnerability to late-onset suicidal behavior (such as high conscientiousness) are not the same as ones classically identified in younger attempters and in older suicide attempters who have early-onset suicidal behavior (such as neuroticism and Cluster B traits). We discuss methodological points about studying age of onset of suicidal behavior, outline clinical implications, share ideas for future directions, and call for research on this understudied topic.

Familial and social transmission of suicidal behavior in older adults.

BACKGROUND: Both biological and social mechanisms have been implicated in the transmission of suicidal behavior in younger and middle-aged adults. Yet, while suicide rates rise with age, it is not clear whether such mechanisms operate in late life. Thus, we looked for evidence of social and familial suicidal transmission in elderly with late- vs. early-onset suicidal behavior by examining exposure to suicidal behavior within biological relatives and broader social networks. METHOD: Participants were 356 adults, aged 50 or older (mean: 67), divided into five groups: early-onset suicide attempters (first lifetime attempt before age 60), late-onset attempters, suicide ideators (without attempt history), depressed non-suicidal controls, and non-psychiatric controls. History of suicidal behavior in one's biological relatives and friends/unrelated kin was assessed via clinical interview, and group differences were examined via generalized linear mixed-effects models. RESULTS: There was a main effect of group (χ24 = 18.38, p < 0.001) such that familial or social exposure to suicidal behavior was more prevalent in early- than late-onset attempters. Late-onset attempters' exposure was similar to non-suicidal groups'. However, there was no significant group by relationship interaction, indicating that suicidal behavior was not significantly more prominent among the biological relatives of either attempter group. LIMITATIONS: Participants' report of exposure is subject to awareness and recall biases. CONCLUSION: Suicidal clustering in biological relatives and friends/unrelated kin is associated with early-, but not late-onset suicidal behavior in older adults. Suicidal transmission in older adults follows a pattern of familial and social clustering suggestive of social transmission.