Suicide Among Older Adults in Mexico: Identification of the Critical Role of Perceived Isolation

Background and Purpose:

Suicide is a public health concern among adults in Mexico (Borges et al., 2010). Suicidal behaviors and mortality have increased at an alarming rate since the 1970s particularly among older adults. Studies show that approximately 90% of individuals who die by suicide have depression. Prior suicide attempts are the strongest predictors of complete suicide. However, extremely limited attention has been paid to the mental health of a rapidly growing geriatric Mexican population; no studies have examined modifiable predictors that may contribute to suicidal ideation and attempts. Thus, guided by Joiner’s Interpersonal Theory of Suicide (2005) we examined multiple indicators of “thwarted belongingness” and their association with suicidal ideation and attempts using a national probability sample of Mexican elders.

Methods:

We drew from the Mexico component of the WHO Study on Global AGEing and Adult Health (SAGE). The survey used a multi­stage, stratified clustered sample design, with household clusters sampled to reflect age, sex, level of wealth/local economic development, and urban/rural status in the Mexico Census. We based our analyses on a subset of 289 participants aged ≥ 50 years in Wave 1 (2007­ 2010) who reported at least one core symptom of depression and completed a full depression inventory (ICD-10, DSM-IV). Through our analyses we examined both suicidal ideation and suicide attempts. Independent variables included 1) widowhood; 2) community integration; 3) difficulties with interpersonal activities and 4) perceived isolation. We conducted logistic regression analyses to identify associations between our independent variables and suicidal ideation and attempts while controlling for important sociodemographics (i.e. age, gender, education, income); physical health (i.e., functioning); and total number of depressive symptoms (excluding loneliness).

Results:

The mean age of this sample was 67years (SD=9) with 22% older than 75 years. About 75% were female, 29% were widowed, and 86% had less than 6 years of schooling. Approximately 30% of this sample reported suicidal ideation and 7% reported attempts in the previous 12-months. Results from our logistic regression models indicate that among older adults in Mexico, even after accounting for depressive symptoms, those reporting perceived isolation were more than twice as likely to report suicidal ideation compared to those who did not. Regarding suicide attempts, only suicidal ideation predicted suicide attempts; those who reported suicidal ideation were more than nine times more likely to report a suicide attempt compared to those without suicidal ideation.

Conclusion and Implications:

Geriatric suicide is a critical public health concern in Mexico. Findings indicated that feeling disconnected from others predicted suicidal ideation beyond and above depressive symptoms. We recommend collaborations between U.S. and Mexican mental health associations to offer supportive resources for training in screening for depression, including perceived isolation and suicidal ideation.  There may be any number of culturally relevant protective factors to draw upon for preventive interventions, including guidelines for practitioners to share upon any client screening positive. Future research should identify protective factors and explore the role of culture (e.g., familism, perceptions of aging, ageism, stigma) to inform the development and implementation of effective suicide prevention strategies.