Do Factors Associated with Suicidal Behavior Change Over the Course of a Person’s Life?

BACKGROUND:

Imagine a future where we understand the interplay of factors that contribute to someone’s risk for suicidal behavior so well that we can catch warning signs early and step in before a crisis happens. Suicide risk is complex and ever changing, and stress can precipitate a suicidal crisis for a person with multiple potential contributors. Researchers have identified many different types of contributors (e.g., biological, psychological, social, and environmental). Now, researchers are turning their attention to how age and the process of aging may play a role in risk. Knowing this could guide opportunities for effective treatments.

In previous studies, most researchers have zoomed in on specific age groups, like teenagers, middle-aged adults, or older adults. Some contributing factors, like past suicide attempts, current suicidal thoughts, or mood disorders, tend to be relevant across all ages. But researchers believe that many factors might affect people differently at different ages. Because the way we think, feel, and interact with the world changes over time, it makes sense that the relationship between these contributors to risk and suicidal behavior could also shift over time.

One area of particular interest when it comes to aging is neurocognitive function, which is the brain’s ability to manage tasks like memory, language, concentration, and comprehension. Researchers are studying how these mental abilities connect to different brain regions and how changes in neurocognition over the lifespan may impact underlying suicide risk.

STUDY:

As part of an AFSP Linked Standard Research Grant involving three separate research groups, Drs. Jeffrey Bridge, John Keilp, and Katalin Szanto set out to understand how certain thinking skills and clinical risk factors relate to suicidal behavior across different ages.

The study had two main goals. First, the team wanted to see if any cognitive and clinical factors were consistently associated with suicidal behavior across all ages or if certain factors mattered more at specific ages.Second, they wanted to identify which specific cognitive and clinical characteristics were better at distinguishing people who had a history of suicidal behavior from those who did not. The team recruited 309 participants, aged 16 to 80, from three distinct groups:

1. People experiencing depression with at least one past suicide attempt
2. People experiencing depression without any history of suicide attempts
3. People with no history of mental health diagnoses or suicidal thoughts or behaviors

Each person took tests to measure different aspects of neurocognitive function, like memory, language, decision-making, and executive functioning. These tests helped the researchers see how people process information and make decisions.

In addition to these cognitive assessments, the researchers also measured several clinical factors often linked to suicidal behavior. These included:

• Depression severity
• Feelings of hopelessness
• Traits of borderline personality disorder, like emotional instability and identity issues
• A tendency for impulsive problem-solving
• Aggressive behavior
• Depressive rumination, or the habit of repeatedly focusing on negative thoughts
• Feelings of being trapped

The findings from this study could provide a clearer picture of how thinking patterns and potential risk for suicidal behavior may evolve over a person’s life, helping to inform age-specific prevention and intervention strategies.

RESULTS:

The research team found that the contributions of cognitive and clinical factors to suicide attempt change as people get older. Some clinical risk factors, like borderline personality traits, impulsive problem-solving, and aggression, were consistently higher in people with a history of suicide attempts, regardless of age. However, cognitive skills –– especially memory –– showed different patterns. While memory declined naturally with age in all groups, this decline was more pronounced in older adults who had previously attempted suicide compared to those who had not. Older adults with a history of suicide attempts also scored lower in category fluency, a measure of verbal skills and cognitive flexibility, which suggests that cognitive differences between attempters and non-attempters increase with age.

Notably, two clinical factors stood out in distinguishing attempters from non-attempters starting in middle age: depressive rumination and feelings of entrapment. Rumination involves dwelling on negative thoughts or past events, and it became a stronger marker for suicide attempter status as people got older. Entrapment (the feeling of being trapped by inescapable life stresses) followed a similar pattern, showing up more in older adults with a history of attempts than in younger ones.

The researchers believe that, in older adults, these feelings of entrapment may interact with rumination, intensifying suicidal thoughts and raising potential risk. Rumination itself is linked to worsening depression and hopelessness and has even been associated with biological markers related to dementia and faster brain aging. These factors may relate to the loss of flexible thinking and problem solving during a suicidal crisis.

The study assessed only one point in time, so we don’t know if the differences were always present, or changed with time. The findings indicate a need for further research. Nonetheless, these findings support the idea that aging may significantly change the influence of various factors for suicidal behavior, either increasing or reducing their impact. This insight highlights the importance of uncovering age-specific contributors to risk to improve suicide prevention efforts.

As we often say at AFSP, “The more we understand suicide, the more we can do to prevent it.” This study deepens our understanding of how risk factors vary across the lifespan, and provides valuable information for clinicians assessing suicide risk, especially among older adults: an age group with the highest rate of suicide.

TAKEAWAYS:

• Contributors to suicidal behavior may vary or remain consistent across different life stages.
• Researchers are investigating contributors that persist throughout the lifespan and those that distinguish suicide attempters from non-attempters.
• Key factors like borderline traits, impulsive problem-solving, and aggression were found to be consistently higher in suicide attempters across all ages.
• Depressive rumination and feelings of entrapment strongly differentiated suicide attempters, especially in older adults.
• These findings suggest that aging alters the impact of various risk factors, highlighting the need for more research and tailored interventions.

Grant Type: 2014 Linked Standard Research Grant — $187,168

Grant Page: Neurocognitive Markers of Vulnerability to Suicidal Behavior Across the Life-Cycle

Grant Related Publication:

1. Buerke, M., Galfalvy, H., Keilp, J. G., Sheftall, A. H., Burke, A. K., Bridge, J. A., Mann, J. J., & Szanto, K. (2021). Age effects on clinical and neurocognitive risk factors for suicide attempt in depression — Findings from the AFSP lifespan study. Journal Of Affective Disorders, 295, 123-130, http://dx.doi.org/10.1016/j.jad.2021.08.014
2. Wang, C., Keilp, J. G., Galfalvy, H., Bridge, J. A., Sheftall, A. H., & Szanto, K. (2023). Entrapment and social problem-solving in suicidal behavior across the adult lifespan. Journal of affective disorders, 329, 176–183. https://doi.org/10.1016/j.jad.2023.02.099