Passive Suicidal Ideation May Be Underestimated Among Older Americans

Older adults reporting passive suicidal ideation may not be depressed, but may be experiencing worse health and functioning.

Between 10.9% and 13.4% of older American adults experienced passive suicidal ideation within a 12-month period, according to a study published in the American Journal of Geriatric Psychiatry. The study also found that both a history of stroke and current functional limitations increase the risk for passive suicidal ideation to a greater extent than depressed mood.

Older adults have the highest incidence of suicide. Recent research indicates that depression is only a modest predictor of completed suicide, and that among older adults, this relationship is even less robust. Thus, screening for depression as a proxy for suicide risk may underestimate the risk for suicidality.

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Liming Dong, PhD, from the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, and colleagues used data from the 2012 Health and Retirement Study (HRS; n=17,434) and the 2004/2005 Baltimore Epidemiologic Catchment Area (ECA) Study (n=755) to determine estimates of the 12-month prevalence of passive suicidal ideation among older adults. Passive ideation was defined as thinking a lot about death, either your own or someone else’s or death in general. In the HRS, the prevalence of suicidal ideation was assessed only in participants reporting dysphoria/anhedonia, whereas in the ECA, it was assessed in all participants. The investigators developed a prediction model based on ECA data and then applied this to HRS data.

In the HRS, among older adults who screened positive for depression, 6% reported passive suicidal ideation in the past year, whereas 5.4% to 9.2% of HRS respondents who screened negative for depression would have reported passive suicidal ideation if they had been assessed based on the ECA prediction model. Once the investigators corrected for selection bias, they determined that between 10.9% and 13.4% of US adults older than 50 years experienced passive suicidal ideation in the last year.

Investigators also determined that older adults who reported passive suicidal ideation had lower self-rated health and more psychological distress and functional limitations than those who did not report ideation.

The study was limited by the selection model.

The investigators concluded that assessing for suicidal ideation only in the context of depression results in selection bias and underestimates the extent of suicidal ideation among older adults.


Dong L, Kalesnikava V, Gonzalez R, Mezuk B. Beyond depression: Estimating 12-months prevalence of passive suicidal ideation in mid- and late-life in the Health and Retirement Study [published online July 2, 2019]. Am J Geriatr Psychiatry. doi:10.1016/j/jagp.2019.06.015