Personalized prevention
Of the original cohort, 92 patients died during the follow-up period, with 13 dying of suicide (or suspected suicide).
Over half (60%) of the chronic severe as well as the highly variable groups and almost half (48%) of the fast-remitting group had a history of past suicide attempt – all significantly higher than the low-nonideators (0%).
Despite comparable current ideation severity at baseline, the risk of suicide attempt/death was greater for chronic severe ideators versus fast-remitting ideators, but not greater than for highly variable ideators. On the other hand, highly variable ideators were at greater risk, compared with fast-remitting ideators.
Cognitive factors “did not significantly discriminate between the ideation profiles, although ... lower global cognitive performance predicted suicidal behavior during follow-up,” the authors wrote.
This finding “aligns with prior studies indicating that late-life suicidal behavior but not ideation may be related to cognition ... and instead, ideation and cognition may act as independent risk factors for suicidal behavior,” they added.
“Patients in the fluctuating ideator group generally had moderate or high levels of worst suicidal ideation between visits, but not when asked about current ideation levels at the time of the follow-up assessment,” Dr. Galfalvy noted. “For them, the time frame of the question made a difference as to the level of ideation reported.”
The study “identified several clinical differences among these subgroups which could lead to more personalized suicide prevention efforts and further research into the heterogeneity of suicidal behavior,” she suggested.
New insight
Commenting on the study, Ari Cuperfain, MD, of the University of Toronto said the study “adds to the nuanced understanding of how changes in suicidal ideation over time can lead to suicidal actions and behavior.”
The study “sheds light on the notion of how older adults who die by suicide can demonstrate a greater degree of premeditated intent relative to younger cohorts, with chronic severe ideators portending the highest risk for suicide in this sample,” added Dr. Cuperfain, who was not involved with the current research.
“Overall, the paper highlights the importance of both screening for current levels of suicidal ideation in addition to the evolution of suicidal ideation in developing a risk assessment and in finding interventions to reduce this risk when it is most prominent,” he stated.
The research was supported by the National Institutes of Health. The authors and Dr. Cuperfain disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.