Anxiety symptoms preceding suicide: A Swedish nationwide record review.

BACKGROUND: The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide. METHODS: Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity. RESULTS: Anxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months - 1 week). Two-thirds had been prescribed antidepressants at time of death. LIMITATIONS: Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents. CONCLUSIONS: Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.

Overlapping Patterns of Suicide Attempts and Non-suicidal Self-Injuries in Adults: A Prospective Clinical Cohort Study.

Objective: An overlap of non-suicidal self-injuries (NSSIs) and suicide attempts (SAs) is observed in young cohorts, but there are few robust prospective studies for adults. We compared 1-year outcomes in adults with different self-harm patterns: NSSI only, NSSI + SA, and SA only.Methods: 793 patients (67% women) consecutively presenting with NSSI (17%) or SA (83%) at 3 Swedish hospitals took part in face-to-face interviews. Past and current self-harm was characterized by the Columbia-Suicide Severity Rating Scale. Clinical records and national register data were employed to determine 1-year outcomes.Results: At inclusion, over half of the participants had engaged in both NSSI and SA; 41% had SA only and 5%, NSSI only. During follow-up, non-fatal SAs were observed in approximately one-third of the total group (n = 269). Suicides occurred in 2% of those with NSSI + SA; the same proportion was seen in the SA only group. No suicides were observed in those with NSSI only. In a multiple logistic regression analysis, the NSSI + SA pattern was associated with a more than 3-fold risk of subsequent fatal/non-fatal suicidal behavior compared to "pure" NSSI; risk was not elevated in those with "pure" SA. Neither sex nor age group predicted subsequent suicidal behavior.Conclusions: Switching between behaviors with and without suicidal intent was common in this adult clinical cohort. Risk of subsequent suicidal behavior was tripled in the combined group. Clinicians who assess adults with NSSI must evaluate not only current but also previous episodes when assessing future risk of suicidal behavior.

Attention deficit hyperactivity disorder in adults who present with self-harm: a comparative 6-month follow-up study.

BACKGROUND: ADHD is common in psychiatric populations. This study aimed to compare clinical characteristics in adults with and without ADHD who presented with self-harm, and to compare later risk of suicidal behaviour within 6 months. METHODS: Eight hundred four adults presented with self-harm (with and without suicidal intent) at psychiatric emergency services at three Swedish hospitals. Persons with a discharge ICD-10 diagnosis F90.0-F90.9 or a prescription for ADHD medication were considered to have ADHD (n = 93). Medical records were reviewed for evidence of subsequent suicide attempts (SA) within 6 months; suicides were identified by national register. RESULTS: Recent relationship problems were more prevalent in the ADHD group. While the index episodes of those with ADHD were more often non-suicidal, and actual SAs more often rated as impulsive, medical lethality at presentation did not differ in attempters with and without ADHD. Subsequent SAs (fatal or non-fatal) were observed in 29% of the ADHD group and 20% in all others (P = .005). A logistic regression model showed elevated risk of suicidal behaviour during follow-up in the ADHD group (OR = 1.70, CI 1.05-2.76), although a final regression model suggested that this association was partly explained by age and comorbid emotionally unstable personality disorder. CONCLUSIONS: Findings highlight the need for clinicians to take self-harm seriously in adults with ADHD.

Accuracy of 12 short versions of the Geriatric Depression Scale to detect depression in a prospective study of a high-risk population with different levels of cognition.

OBJECTIVES: To determine the accuracy of 12 previously validated short versions of the Geriatric Depression Scale (GDS) to detect major depressive disorder (MDD) in a high-risk population with and without global cognitive impairment. DESIGN: Cross-sectional study. SETTING: Five hospitals, Western Sweden. PARTICIPANTS: Older adults (age ≥70 years, n = 60) assessed at a home visit 1 year after hospital care in connection with suicide attempt. MEASUREMENTS: Depression symptoms were rated using the established 15-item GDS. Eleven short GDS versions identified by a recent systematic review were derived from this administered version. Receiver operating characteristic curves and area under the curve (AUC) for the identification of MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were obtained for each version. The Youden Index optimal criterion was used to determine the appropriate cutoffs. Analyses were repeated after stratification by cognitive status (Mini Mental State Examination score ≤24 and >24) for the best performing GDS short versions and the established 15-item GDS. RESULTS: The 7-item GDS according to Broekman et al. (), with a cutoff 3, was the most accurate among the 12 short versions (AUC 0.90, 95% confidence interval 0.80-1.00), identifying MDD with sensitivity 88% and specificity 81%. The cutoff score remained consistent in the presence of global cognitive impairment, which was not the case for the standardized 15-item GDS. CONCLUSION: The Broekman 7-item GDS had high accuracy to detect MDD in this prospective clinical cohort at high risk for MDD. Further testing of GDS short versions in diverse settings is required.

Clinical Characteristics in Older, Middle-Aged and Young Adults Who Present With Suicide Attempts at Psychiatric Emergency Departments: A Multisite Study.

OBJECTIVES: To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). DESIGN: Cross-sectional cohort study. SETTING: 3 Swedish university hospitals. PARTICIPANTS: 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18-44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). MEASUREMENTS: Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). RESULTS: Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. CONCLUSIONS: While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians' assessments of the needs of older adults with intentional self-harm.

'I wanted to talk about it, but I couldn't', an H70 focus group study about experiencing depression in early late life.

BACKGROUND: Knowledge about experiences of depression among younger-old adults from the general population is limited. The aim was to explore experiences of depression in early late life. METHODS: Sixteen participants in the population-based Gothenburg H70 Birth Cohort Studies (12 women and 4 men) who had reported a history of depression between ages 60-70 took part in focus group discussions (n = 4). Data were analyzed using focus group methodology. RESULTS: The analysis resulted in the overall theme 'I wanted to talk about it, but I couldn't'. The participants expressed unmet needs of communication about depression with family, friends, and healthcare staff. Participants wanted to know more about the causes and effects of depression, available treatment options and how to avoid recurrence. Lack of knowledge was a source of frustration; trust in health care providers was diminished. Being retired meant that opportunities for communication with co-workers were no longer available, and this made it harder to break negative thought and behavioral patterns. Being depressed meant losing one's normal self, and participants were grieving this. Thoughts of death and suicide were experienced in solitude; knowing that there was an escape could generate a feeling of comfort and control. CONCLUSIONS: Younger-old adults have expressed a need to talk about their experiences of depression. They would like to know more about available treatments, potential side effects, and how to avoid recurrence. Care providers also need to be aware there is a need for an existential dialogue about death.

A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study.

OBJECTIVE: To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm. METHODS: This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable. RESULTS: At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%. CONCLUSIONS: Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors.

Few Sex Differences in Hospitalized Suicide Attempters Aged 70 and Above.

Relatively little research attention has been paid to sex issues in late life suicidal behaviour. The aim was to compare clinical characteristics of women and men aged 70+ who were hospitalized after a suicide attempt. We hypothesized higher depression and anxiety scores in women, and we expected to find that men would more often attribute the attempt to health problems and compromised autonomy. Participants (56 women and 47 men, mean age 80) were interviewed by a psychologist. In addition to psychiatric and somatic health assessments, participants responded to an open-ended question concerning attributions of the attempt. There were no sex differences in depression and anxiety. Forty-five percent of the men and 14% of the women had a history of substance use disorder (p = 0.02). At least one serious physical disability was noted in 60.7% of the women and 53.2% of the men (p = 0.55). Proportions attributing their attempt to somatic illness did not differ (women, 14.5% vs. men 17.4%, p = 0.79), and similar proportions attributed the attempt to reduced autonomy (women, 21.8% vs. men, 26.1%, p = 0.64). We found strikingly similar figures for depression scores, functional disability and attributions for attempting suicide in older men and women. Larger studies are needed in diverse settings as sex differences might be influenced by cultural context.

Cognitive Function in Older Suicide Attempters and a Population-Based Comparison Group.

OBJECTIVE: The aim was to compare cognitive function in older suicide attempters with a population-based comparison group. METHODS: Hospitalized suicide attempters aged 70 years and older were assessed cognitively at baseline (n = 99) and 1-year follow-up (n = 59). Depression symptoms were rated with the Montgomery-Åsberg Depression Rating Scale (MADRS). Results of cognitive assessments in attempters were compared with results in nonattempter comparison subjects (n = 115) selected among participants in our population-based health studies to yield a similar distribution of MADRS scores. RESULTS: Suicide attempters scored lower on Mini-Mental State Examination (MMSE) than comparison persons. Among attempters, the mean MMSE score was lower in those with medically serious attempts. Attempters displayed poorer performance on tests of pentagon drawing and abstract thinking compared to comparison persons, and the results remained also after exclusion of those with medically serious attempts. At 1-year follow-up, significant improvement in MADRS scores was observed in the attempters. No evidence of improvement could be shown regarding cognitive deficits. CONCLUSION: Older suicide attempters may have cognitive deficits, which may in part be related to the attempt itself. This needs to be taken into account when designing intervention strategies.

Assessing the role of physical illness in young old and older old suicide attempters.

OBJECTIVES: Attributions for attempting suicide were explored in older adults with and without serious physical illness. METHODS: An open-ended question was used to explore attributions for attempting suicide in 101 hospitalized persons aged 70+. Serious physical illness was defined as a score of 3 or 4 on any of the 13 non-psychiatric organ categories in the Cumulative Illness Rating Scale for Geriatrics. RESULTS: Roughly one-third of hospitalized persons with (22/62) and without (12/39) serious physical illness attributed the suicide attempt to somatic distress. Among 70- to 79-year-olds, seriously physically ill patients were more likely than healthier patients to attribute their attempt to psychological pain (84% vs. 48%, p = 0.013). There were no significant differences in attributions in persons with and without serious health problems in the 80+ group. CONCLUSIONS: The processes by which physical illness confers risk for attempted suicide in older adulthood may be age dependent. Interventions are needed to mitigate psychological pain in physically ill older patients, especially those in their seventies. Research is needed to understand how the psychological processes that influence the desire for suicide change across older adulthood. Copyright © 2015 John Wiley & Sons, Ltd.

Medically Serious and Non-Serious Suicide Attempts in Persons Aged 70 and Above.

High rates of suicide are observed among older adults in many countries worldwide. In clinical settings, those who make a medically serious suicide attempt are generally considered to be at higher risk of subsequent suicide than those who make less serious attempts. Medically serious attempts in older clinical cohorts are, however, relatively understudied. The aim was to compare older adult suicide attempters (70+) who did or did not make medically serious attempts. We hypothesized, in line with the Interpersonal Model of suicide, that social problems and feelings of being a burden would be associated with medical seriousness. Participants (n = 101) were recruited in hospitals in the aftermath of a suicide attempt; they took part in an interview with a research psychologist. Attempters with (n = 28) and without (n = 73) medically serious attempts were compared. Major depression was common in both groups, and scores on the Geriatric Depression Scale did not differ. However, older adults who made medically serious attempts scored higher on the Brief Scale of Anxiety and lower on the Mini Mental State Examination than their peers who made less serious attempts. Medically serious attempters more often attributed the attempt to social problems as well as problems with functioning and autonomy, but perceived burdensomeness was not associated with seriousness. Findings may help to inform clinicians who meet and treat older suicidal persons.

Beliefs about antidepressants among persons aged 70 years and older in treatment after a suicide attempt.

BACKGROUND: The use of antidepressants is associated with decreased suicide risk in late life, and these drugs are often prescribed after a suicide attempt. Yet little is known about attitudes to antidepressants in older persons with suicidal behavior. The aim of this study was to assess beliefs about antidepressant medicines in older persons in treatment one year after a suicide attempt. METHODS: Forty-four individuals aged 70 years and older, who were treated in emergency wards at five hospitals in western Sweden in connection with a suicide attempt, were interviewed at index attempt and one year later. Beliefs about medicines questionnaire (BMQ) specific for antidepressants were analyzed one year after index attempt, in relation to sociodemographic variables, medication use, psychiatric evaluation, and personality traits. RESULTS: The majority of participants perceived the necessity of their antidepressant medicine to outweigh their concerns. Lower perceived necessity of antidepressants was observed in those who were not on antidepressants at the time of the attempt as well as those with no prior history of suicide attempt before the index attempt. Individuals reporting hopelessness at follow-up had a higher perceived concern about using medication. CONCLUSIONS: Beliefs about antidepressants tended to be more positive than negative in older persons taking these drugs in the aftermath of a suicide attempt. Further studies are called for, and should include objective measures of medication adherence.

Reasons for attempted suicide in later life.

OBJECTIVE: Using the Interpersonal Theory of Suicide as a guiding framework, we investigated older adults' causal attributions for suicidal behavior. We hypothesized that older adults who attributed their suicidal behavior to thwarted belongingness or perceived burdensomeness would be more likely to use more immediately lethal means and to re-attempt suicide during the 12-month follow-up. DESIGN: Prospective cohort study in western Sweden. PARTICIPANTS: A total of 101 older adults who presented to medical emergency rooms for suicide attempts. MEASUREMENTS: Participants were asked why they attempted suicide. RESULTS: Attributions included: a desire to escape (N = 29), reduced functioning and autonomy (N = 24), psychological problems, including depression (N = 24), somatic problems and physical pain (N = 16), perceived burdensomeness (N = 13), social problems that reflected either thwarted belongingness or family conflict (N = 13), and lack of meaning in life (N = 8); 41 participants provided more than one reason. No specific reason was given by 28 participants, 15 of whom reported not understanding or remembering why they attempted suicide and 13 reported simply wanting to die (or go to sleep and not wake up). As hypothesized, patients who attributed the attempt to thwarted belongingness were more likely to use more immediately lethal means for their index attempt and were more likely to re-attempt during follow-up. This was not the case for those reporting burdensomeness. CONCLUSION: People who attribute suicide attempts to thwarted belongingness use more lethal methods and have a poorer prognosis. Replications across diverse cultural settings are needed to determine whether attributing suicide attempts to thwarted belongingness may warrant increased monitoring.

Alcohol use disorder in elderly suicide attempters: a comparison study.

OBJECTIVES: To compare lifetime prevalence of alcohol use disorder (AUD) in older adults who were hospitalized in connection with a suicide attempt and in a population comparison group, as well as to compare previous suicidal behavior in attempters with and without AUD. DESIGN: Case-comparison. SETTING: Five hospitals in Western Sweden. PARTICIPANTS: Persons 70 years or older, who were treated in a hospital because of a suicide attempt during 2003-2006 were recruited. Of 133 eligible participants, 103 participants were enrolled (47 men, 56 women, mean age 80 years, response rate 77%). Four comparison subjects per case were randomly selected among participants in our late-life population studies. MEASUREMENTS: Lifetime history of AUD in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was discerned on the basis of interview data, case record review, and the hospital discharge register. Depression symptoms were rated using the Montgomery-Åsberg Rating Scale. RESULTS: AUD was observed in 26% of the cases and in 4% of the comparison group (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 4.9-22.5). Associations were noted in men (OR: 9.5; 95% CI: 4.0-22.8) and women (OR: 12.0; 95% CI: 2.4-59.5). More than half of the cases with AUD and a third of those without AUD had made at least one prior suicide attempt. In these, AUD was associated with a longer interval between the first attempt and the index attempt. CONCLUSIONS: A strong association between AUD and hospital-treated suicide attempts was noted in both sexes in this northern European setting. Given the high rates of suicide worldwide in this fast-growing and vulnerable group, comparison studies in other settings are needed.

Neuroticism and extroversion in suicide attempters aged 75 and above and a general population comparison group.

Personality traits have been shown to influence suicidal behaviour but the literature on 'older' elderly is sparse. The aim was to compare neuroticism and extroversion in hospitalized suicide attempters aged 75 and above and a general population comparison group. Seventy-two hospitalized suicide attempters (mean age 81 years) were interviewed. Comparison subjects were drawn from participants in population studies on health and ageing. Participants completed the Eysenck Personality Inventory (EPI) and symptoms of depression were rated with the Montgomery-Asberg Depression Rating Scale (MADRS). Depression diagnoses were made in accordance with Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Attempters scored higher on the neuroticism scale than comparison subjects (mean = 9.9 vs. 7.6, t = 3.74, df = 358, p < 0.001) and lower on the extroversion scale (mean = 10.8 vs. 12.0; t = -2.76, df = 358, p = 0.006). While these differences did not remain after adjustment for major depression, attempters with minor depression were less neurotic than comparison subjects with this diagnosis (mean = 6.6 vs. 11.1, t = -3.35, df = 63, p = 0.001) and a negative association with neuroticism remained in a multivariate model. In conclusion cases scored higher on neuroticism and lower on extroversion compared to comparison subjects. The finding that attempters with minor depression were less neurotic than comparison subjects with this diagnosis was unexpected and needs to be examined in larger samples.

Prospective cohort study of suicide attempters aged 70 and above: one-year outcomes.

BACKGROUND: Most elderly persons who attempt suicide suffer from depression. This study aimed to investigate one-year outcomes in suicide attempters aged 70+, and to identify predictors of these outcomes. METHODS: 101 persons (mean age 80) who were hospitalized after a suicide attempt were interviewed at baseline and followed for one year by record linkage. Face-to-face interviews were carried out with 71% of those who were alive after one year (60 out of 85). Outcome measures included major/minor depression, Montgomery-Asberg Depression Rating Scale (MADRS) score, repeat non-fatal/fatal suicidal behavior and all-cause mortality. RESULTS: One half (52%) of all those who were interviewed scored <10 on the MADRS at follow-up. Among those with major depression at baseline, two thirds (26 out of 39) no longer fulfilled criteria for this disorder. Factors associated with non-remission of major depression (MADRS ≥ 10) included higher baseline depression and anxiety scores, higher suicide intent and lower Sense of Coherence. There were two suicides and six non-fatal repeat attempts. The relative risk of death (any cause) was 2.53 (95% CI = 1.45-4.10, p<0.001). LIMITATIONS: This is a naturalistic study; participants received non-uniform treatment as usual. The proportion with repeat suicidal behavior was lower than anticipated and the study was thus underpowered with regard to this outcome. CONCLUSIONS: Half of the surviving attempters were free from depressive symptoms at one-year follow-up and there were relatively few repeat attempts. However, all cause mortality remained high in this elderly cohort.

Sense of coherence in elderly suicide attempters: the impact of social and health-related factors.

BACKGROUND: An association between sense of coherence (SOC) and suicidal behavior has been suggested. The aim of this study was to identify factors associated with low SOC in elderly suicide attempters. METHODS: Eighty non-demented hospital-treated suicide attempters aged 70 years and older (38 men, 42 women, mean age 79.4 years) took part in an interview with a research psychologist and completed the 29-item SOC questionnaire. The interview included questions regarding social situation and health-related factors. The Comprehensive Psychopathological Rating Scale (CPRS) provided symptom ratings that were used in a diagnostic algorithm for DSM-IV major depression. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to identify individuals with serious physical illness. RESULTS: There was a strong relationship between major depression and SOC. While we could show no relationship between severe physical illness and SOC, associations were demonstrated with social variables including too little time spent with children, too little time spent with grandchildren and having moved within the past five years. These associations remained significant in regression models adjusted for sex, age and major depression. CONCLUSIONS: A number of social variables were independently related to SOC in elderly suicide attempters. Prospective studies are needed in order to determine whether SOC-strengthening interventions can reduce the risk of suicidal behavior in seniors.

Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group.

OBJECTIVE: To identify factors associated with attempted suicide in the elderly. DESIGN: Social, psychological, and psychiatric characteristics were compared in suicide attempters (70 years and older) and a representative population sample. SETTINGS: Emergency departments at five hospitals in western Sweden and a representative sample of the elderly population. PARTICIPANTS: Persons with Mini Mental State Examination (MMSE) score <15 were excluded. One hundred forty persons who sought hospital treatment after a suicide attempt were eligible and 103 participated (57 women, 46 men, and mean age 80 years). Comparison subjects matched for gender and age group (N = 408) were randomly selected among participants in our general population studies. MEASUREMENTS: Symptoms were rated with identical instruments in cases and comparison subjects. The examination included the MMSE and tests of short- and long-term memory, abstract thinking, aphasia, apraxia, and agnosia. Depressive symptomatology was measured using the Montgomery-Asberg Depression Rating Scale, and major and minor depressions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, using symptom algorithms. RESULTS: Factors associated with attempted suicide included being unmarried, living alone, low education level, history of psychiatric treatment, and previous suicide attempt. There was no association with dementia. Odds ratios were increased for both major (odds ratio [OR]: 47.4, 95% confidence interval [CI]: 19.1-117.7) and minor (OR: 2.6, 95% CI: 1.5-4.7) depressions. An association was observed between perceived loneliness and attempted suicide; this relationship was independent of depression (OR: 2.8, 95% CI: 1.3-6.1). CONCLUSIONS: Observed associations mirrored those previously shown for completed suicide. Results may help to inform clinical decisions regarding suicide risk evaluation in this vulnerable and growing age group.