The role of cognitive functioning and distress in suicidal ideation in older adults

OBJECTIVES: To evaluate the role of cognitive functioning and other clinical and demographic characteristics as potential predictors of suicidal ideation in older primary care patients. DESIGN: Cross-sectional. SETTING: Primary care clinics at three Department of Veterans Affairs Medical Centers, three community health centers, and two hospital networks. PARTICIPANTS: Fifteen thousand five hundred ninety older adults without dementia who were receiving primary care (mean age +/- standard deviation 74.0 +/- 6.4; 62.8% men). MEASUREMENTS: Hierarchical logistic regressions were conducted with passive (e.g., thoughts of being better off dead) and active (e.g., thoughts of hurting one self) suicidal ideation as outcome variables. All demographic variables (age, sex, marital status, and ethnicity) were entered in the first block. All clinical variables (distress, cognitive functioning, alcohol consumption, and perceived health) were entered in the second block. RESULTS: In addition to the typical demographic predictors of late-life suicide (age, martial status, and ethnicity), having poorer cognitive functioning, poorer health, and greater mental distress were associated with passive suicidal ideation (chi-square (chi(2)) (14, n=14,618)=1,192.12, P <.001). Younger age, female sex, poorer cognitive functioning, and greater mental distress were associated with active suicidal ideation (chi(2)(14, n=14,605)=205.35, P <.001). CONCLUSION: Distress and cognitive impairment are the only two variables that consistently predicted passive and active suicidal ideation. Primary care providers who work with older adults need to take both into consideration when evaluating suicidal ideation.