Regular Research Article
Holocaust Experience and Suicidal Ideation in High-Risk Older Adults

https://doi.org/10.1097/00019442-200401000-00009Get rights and content

Objective

Depression is an identified risk factor for suicidal ideation, a precursor for more serious suicidal behaviors. This risk might be further compounded in individuals who experience negative life events, including traumatic experiences, and those who might have comorbid illnesses. The authors examined the impact of past exposure to the Nazi Holocaust on the development of suicidal ideation in a sample of depressed older adults.

Methods

Authors conducted a retrospective cross-sectional study. The study sample comprised data on 530 consecutive eligible first admissions of Jewish patients who were referred and admitted to a geriatric psychiatry day hospital program between September 1986 and December 2000.

Results

Multiple logistic-regression analyses, controlling for social support, history of suicide attempts, and other negative life events, showed that severity of depression and exposure to the Holocaust were independently associated with suicidal ideation. Those not showing suicidal ideation were slightly more likely to have reported having a confidant.

Conclusions

This is the first empirical study to demonstrate an increased likelihood for suicidal ideation in survivors of the Nazi Holocaust. The chronic stress produced by these traumatic events may have predisposed survivors to cope ineffectively as they age, thus resulting in suicidal ideation. Authors highlight the importance of a multifaceted approach when assessing suicidal behaviors in high-risk groups.

Section snippets

Study Design and Setting

The study used data from an existing clinical database in a cross-sectional study design. Data have been routinely collected in the Psychiatric day Hospital (PDH) at Baycrest Centre for Geriatric Care in Toronto, Canada, and entered into a computerized database since September 1986. The program offered treatment for major depression and related disorders, including organic affective disorder, major depressive disorder, atypical depression, dysthymic disorder, adjustment disorder with depressed

RESULTS

Of the available data on 874 admissions, 699 were based on first admissions. Of these, only 75.8% (N=530) met the study's inclusion criteria (Figure 1). There were no statistically significant differences in age and gender between those included in the study and those who were not (N=169). Twenty-two of the excluded individuals were not eligible because of missing information on either the outcome (N=14) or the exposure variable (N=8). These individuals were not statistically different from the

DISCUSSION

The period prevalence of suicidal ideation observed in this sample (34.72%) is consistent with the rates reported in the earlier literature on suicidal ideation in depressed elderly subjects.7, 9 It is also similar to the 38% prevalence rate reported by Waern et al.8 from examination of the medical records of elderly suicide victims. The finding provides confirmation that although suicidal ideation may be less frequent in the elderly population, it is quite prevalent in high-risk groups, such

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      This is consistent with the study conducted by Barak et al. (2005) showing that aging Holocaust survivors were at increased risk of attempting suicide, although the same rates of major depression were found among Holocaust survivors and control subjects. Similarly, Clarke et al. (2004) reported that depressed Holocaust survivors were 52% more likely to suffer suicidal ideation than a depressed non-Holocaust sample. The present study has several limitations.

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      To provide greater specificity regarding suicidal features, we conducted a series of χ2 analyses exploring whether NP status was associated with categorical suicide ideator versus non-ideator and suicidal behavior versus non-behavior status on the HAM-D-SI. The prevalence of suicide ideators (HAM-D-SI ≥2)28 was significantly greater for NPD versus non-NPD patients (χ2(n = 526) = 6.25, p = 0.012), and non-significantly greater for NP versus non-NP patients (χ2(n = 538) = 3.30, p = 0.07). No significant differences emerged for NPD or NP groups in suicidal behavior status whether defined broadly (HAM-D-SI ≥3; n = 72) or more narrowly (HAM-D-SI = 4; n = 0), possibly due to the rarity of recent suicidal behavior and NP diagnoses in older samples.

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    The findings of this paper were presented at the 2001 EpiCongress held in Toronto, Canada, June 13–16, 2001.

    This study was supported by The Leon and Blossom Wigdor Award for Studies in Aging from the Institute for Human Development, Life Course, and Aging at the University of Toronto, the Canadian Institute for Health Research Doctoral Award, Grant #200110MDR-96269-115967, and the Ontario Work Study Program, and the Hy and Bertha Shere and Harry and Sara Gorman Award from the Baycrest Foundation, Baycrest Centre for Geriatric Care.

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