Alone? Perceived social support and chronic interpersonal difficulties in suicidal elders

Abstract

Background: Social networks may protect depressed elders against suicidal behavior. However, conflict in important relationships may undermine the sense of social support, potentially negating the protective effects. Thus, we investigated the role of chronic interpersonal difficulties and perceived social support in depressed elders with and without suicidal thoughts and attempts.

Methods: 106 individuals aged 60 years and older participated in this cross-sectional, case-control study. They were placed in three groups: suicidal depressed, non-suicidal depressed and non-depressed. Following a detailed clinical characterization, we assessed perceived social support (Interpersonal Support Evaluation List), and chronic interpersonal difficulties (Inventory of Interpersonal Problems). Using general linear models, we explored the relationship between suicidal thoughts/attempts, social support, and chronic interpersonal difficulties. We also examined whether lower perceived social support explained the relationship between chronic interpersonal difficulties and suicidal thoughts/attempts.

Results: Suicidal depressed elders reported the lowest levels of perceived social support (belonging, tangible support, and self-esteem) and higher levels of chronic interpersonal difficulties (struggle against others and interpersonal hostility), compared to both non-suicidal depressed and non-depressed elders. The relationship between chronic interpersonal difficulties and suicidal behavior was partially explained by low perceived social support.

Conclusions: The experience of strong affects, interpersonal struggle, and hostility in relationships may undermine the sense of social support in depressed elders, possibly leading them to contemplate or attempt suicide. Depressed elders with a history of interpersonal difficulties need to be carefully monitored for suicidal behavior.

Figure 1. Perceived Social Support, Depression, and Suicidal Behavior: Interpersonal Support Evaluation List subscores

Figure illustrates self-reported levels of perceived social support by group, as measured by Interpersonal Support Evaluation List subscores. Lower scores indicate lower levels of perceived social support. Tukey post-hoc comparisons were used. Total ISEL score: F(2, 99)=15.93, p=0.0001. Appraisal: F(2, 99)=6.66, p=0.002. Belonging: F(2, 99)=9.94, p=0.0001. Tangible: F(2, 99)=9.28, p=0.0002. Self-esteem: F(2, 99)=12.96, p=0.0001.

Figure 2. Chronic Interpersonal Difficulties, Depression, and Suicidal Behavior: Inventory of Interpersonal Problems scores and subscores

Figure illustrates self-reported levels of chronic interpersonal difficulties by group, as measured by Inventory of Interpersonal Problems subscores. Lower scores indicate lower levels of chronic interpersonal difficulties. Tukey post-hoc comparisons were used. For IIP total score: F(2, 93)=4.26, p=0.017; Aggression: F(2, 93)=3.4, p=0.038; Ambivalence: F(2, 93)=3.59, p=0.032; Sensitivity: F(2, 93)=2.76, p=0.068.

Figure 3. Lack of Social Support Explains the Effect of Interpersonal Discord on Suicidal Behavior

Figure illustrates how a lack of social support explains the effect of interpersonal discord on group status. Groups include suicidal depressed elderly, non-suicidal depressed elderly, or non-depressed elderly. IIP: Inventory of Interpersonal Problems; ISEL: Interpersonal Support Evaluation List.