Protective Factors Against Elderly Suicide

Study Overview
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Brief Summary
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Suicidal intentionality is generally stronger among the elderly, suicidal acts are more violent and are combined with a greater physical fragility. The suicide of an older adult is a situation that often leads to helplessness feelings. Analysis of the literature reveals two types of major interventions in order to reduce suicide rate: reducing risk factors and increasing protective factors. Risk factors are well documented, particularly from studies using psychological autopsies. However, protective factors are much less studied for the elderly. Yet the identification of relevant and available protective mechanisms in a suicidal crisis is essential to effectively guide nurses and health professionals in therapeutic commitment and intervention.

Detailed Description
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France has a suicide rate (16.2 per 100 000 inhabitants) well above the European average rate (10.2 per 100 000 inhabitants). The Poitou-Charentes region is in a situation of excess mortality by suicide compared to France (+ 25%). While the ratio of suicide attempts per suicide is about 200/1 before 25 years, it is estimated to be 4/1 after 65 years, or even 1/1 in elderly men. In France, suicide attempts are not systematically recorded and the frequency of suicidal ideation is poorly understood. The consensus conference on suicidal crisis highlights a number of clinical points specific to the elderly population (suicidal ideas are not always clearly expressed or unidentified, there are various manifestations of the psychic crisis, greater vulnerability of this population), but the complexity of interactions between suicidal risk factors limits our predictive capabilities of suicidal intention in an elderly person. Analysis of the literature reveals two types of major interventions in order to reduce the suicide rate: those aimed at reducing risk factors and those aimed at increasing protective factors. The objective of our research is to determine the effect of protective factor methodical search on post-crisis patient care.

Official Title
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Methodical Search of Protective Factors During Interview of Suicidal Elderly Patients: Effect on the Proposed Care

Conditions
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Suicide, Attempted, Suicide Gesture

Intervention / Treatment
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* Behavioral: Post-suicidal crisis interview


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Attempted suicide and / or suicidal ideas Informed and agreed to participate Exclusion Criteria: Cognitive disorders Refusal to participate

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Suicide attempt or ideas<br>Elderly patients who attempted suicide or who emitted suicidal ideas | Behavioral: Post-suicidal crisis interview<br>* Protective factor exploration during post-suicidal crisis interview<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of outpatients (with a low to moderate risk of suicidal recurrence) | Based on risk, emergency and hazard, patients are classified as being at low, moderate and high risk of suicidal recurrence. Patients with low to moderate risk of suicidal recurrence are either inpatient or outpatient. | 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients considering themselves to be in good health | Score > 0 at Health Status questionnaire (SF36) item 1 | 7 days | 
| Number of patients considering that their physical or mental state did not alter their social life | Score > 50 at Health Status questionnaire (SF36) items 6 or 10 | 7 days | 
| Number of patients maintaining autonomy | Score = 0 at Instrumental Activities of Daily Living scale | 7 days | 
| Number of patients with religious practice | Binary answer from patients (yes/no I have a religious practice) | 7 days | 
| Number of patients with a sense of success and self-esteem | Binary answer from patients (yes/no I have a a sense of success and self-esteem) | 7 days | 
| Number of patients considering their family environment to be satisfactory | Binary answer from patients (yes/no I am satisfied with my family environment) | 7 days | 
| Number of patients with at least one environmental protection factor | Friendly network, associative investment, volunteering, specialized care, recreation, positive image from the entourage, presence of a third party, housekeeper, postman, pet, shopping facilities, doctor, pharmacy ... | 7 days | 
| Number of patients with social protection factors | Easy access to Health facilities, sufficient financial income | 7 days | 
| Number of patients able to adapt to difficult situations | score ≤ 12 at Neo Personality Inventory vulnerability item | 7 days | 
| Number of patients with extraversion capabilities | score ≥ 20 at Neo Personality Inventory extraversion item | 7 days | 
| Number of patients with openness to others | score ≥ 20 at Neo Personality Inventory Openness to feelings item | 7 days | 
| Number of patients considering that their health has improved | Patients will be asked if they feel that their health has improved, has not changed or has worsened | 3 months |