The results of a study published in The Journal of Clinical Psychiatry identified 3 subgroups at high risk for suicidal behavior in older individuals with depression, characterized respectively by (1) high levels of cognitive and personality pathology suggestive of pre-clinical dementia, (2) dysfunctional personality traits, and (3) impulsive decision-making and cognitive deficits.

Individuals (n=251) older than 50 participated in a case-control longitudinal study from June 2010 to September 2015. Of the 251 participants, 194 had been diagnosed with depression and 57 non-psychiatric healthy controls were selected for benchmark data. Of 194 participants with depression, 50 had no lifetime history of suicidal behavior or ideation, 46 had contemplated suicide, 49 had made low-lethality suicide attempts, and 49 had made high-lethality suicide attempts.

Investigators subsequently performed cluster analyses for separate demographic, clinical, cognitive, and personality measures in individuals with depression. Cluster 1 (C-1) was defined as marked cognitive deficits with serious psychopathology, and was apparent in 7% of the depressed sample. Poor decision-making and moderate cognitive deficits (C-3), dysfunctional personality (C-4), and framing deficits (C-5) were identified in 16%, 26%, and 14% of the depressed sample, respectively. Of the depressed sample, 38% were found to be intact (C-2), and had uniformly low risk scores on both cognitive and dispositional risk factors.

Between-cluster differences were found in the incidence of suicide attempts during the study follow-up period (P =.010). Fewer follow-up suicide attempts were identified in C-2 (3%) than in C-1 (31%, adjusted P =.002) and C-3 (20%, adjusted P =.012). Of all clusters, C-1 and C-3 had the highest proportion of subjects with ≥1 suicide attempt. Patients in Cluster C-1, with the highest post-study risk for suicide attempt, displayed severe cognitive deficits correlative with early dementia. Suicide ideation scores during the follow-up period differed significantly (P <.001) between clusters; C-2 had lower scores than C-4 (P <.001) and C-5 (P =.024), but not C-1 or C-3.

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Researchers noted that data generalizability was restricted to older adults, and that baseline screening excluded patients with a dementia diagnosis, thus further limiting the sample size and diversity. Still, this study provides benchmark data by which clinicians may identify the risk for suicidal behavior in older patients.


Szanto K, Galfalvy H, Vanyukov PM, et al. Pathways to late-life suicidal behavior: cluster analysis and predictive validation of suicidal behavior in a sample of older adults with major depression. J Clin Psychiatry. 2018;79(2):17m11611.