To our knowledge, this is the first study to examine the association between different RFL and suicide ideation in adults 50 years of age or older receiving treatment for a mood disorder. Prior studies have shown that RFL are negatively associated with suicide ideation in younger adults,13-15
with the exception of fear of suicide which was found to have a negative association with suicide ideation in a clinical sample but a positive association in a nonclinical sample.13
Our findings indicated that fear of suicide, construed by the authors of the RFL as an amalgam of the fear of death and fear of the act of killing oneself, diminishes the likelihood of suicide ideation in older adults with a mood disorder. The fear of death and of killing oneself may be an important deterrent of suicide ideation in older depressed adults. None of the other RFL were associated with the presence or severity of suicidal ideation.
Unexpectedly, depressed older adults’ concern that their suicide would hurt family members increased the association between hopelessness and the presence and severity of suicide ideation. These findings require replication; however, there are reasonable post hoc explanations. Depressed and hopeless older adults with a sense of responsibility to family may feel overwhelmed by real or perceived inadequacies, increasing thoughts about suicide to end their own suffering. Their sense of burdening their loved ones may also increase thoughts about killing themselves to bring relief to their family.36
In the presence of hopelessness, cognitions that are thought to reduce risk, such as responsibility to family, may be rendered inert or even harmful.
In general, RFL may reflect a sense of purpose and meaning,37
that enables people to live through difficult circumstances.38
However, our preliminary findings also suggest that RFL involving family obligations may enhance the negative effects of hopelessness. Clearly, more research on the apparently complex relations between responsibility to family, hopelessness, and suicide ideation is warranted.
Clinicians should explore what each RFL means for each patient rather than assume they are protective. Understanding the subjective value of RFL may improve clinicians’ ability to evaluate whether RFL are indicative of resilience or risk. Open-ended questions about specific RFL may encourage patient elaboration and reveal critical details and insights that could improve clinicians’ ability to determine risk. This exploration may also enhance patients’ understanding of their motivation to live. Frank and empathetic discussion with family and friends about patients’ RFL may provide additional information that could be crucial to estimating risk accurately.
Limitations of this study include cross-sectional data analysis, exploratory analysis with multiple independent variables, and exclusive focus on a treatment-seeking sample. Analyses included a relatively small sample of potential participants and may have been biased. Interestingly, 61 (80%) of the 76 participants who were excluded due to missing data were missing BHS scores, perhaps reflecting nonrandom missingness among people who are especially concerned about the future, a phenomenon that has been documented previously.39
In conclusion, this is the first study to investigate different RFL, hopelessness, and presence and severity of current suicide ideation in a sample of depressed older adults. Our findings support the possibility that fear of suicide may decrease suicide risk and responsibility to family may accentuate the pathogenic effects of hopelessness. These preliminary findings underscore the need for prospective research examining the associations among different RFL, hopelessness, and suicide ideation in depressed older adults. Clinicians working with at-risk older adults are encouraged to explore their patients’ RFL.