Losing connections: A process of decision-making in late life suicidality

Abstract

Late life suicide is a major public health problem in the U.S. with elderly white men at highest risk of completed suicide. This grounded theory study explored individual perspectives of suicidality with men aged 67 to 83 years. A basic social psychological process, Losing Connections, was identified from interviews. Three stages of this process were identified during which the effect of cumulative losses culminated in depression, prompted suicidal ideation, and led to a decision point for the individual. Loss was the key theme in stage one. Relationship, health, and role losses were identified with professional role loss being the most prominent. The second stage was characterized by depression and despair during which suicidal ideation was prominent. Progressive alienation and the resolution to die characterized this phase. In stage three, the struggle between wanting to die and deciding to do so presented a decision point. The decision point was surrounded by a balance of triggers and barriers, which was modulated by ambivalence. The informant perceived they had reasons to die (triggers), but made the decision not to die because of perceived consequences (barriers). Triggers prompting the decision point were thoughts of a deceased spouse, emotional pain, health problems, and feelings of uselessness and/or hopelessness. The most common barrier to suicide was consequences to family members. Religion was not a significant barrier. Instead, there was a general lack of religious connections among informants. Likewise, social isolation was not prominent, as informants retained connections with family members, friends, and community.