Effect of social support on the relationship between perceived burdensomeness and suicide in the elderly

Introduction: Aging is characterized by major life events such as loss of loved ones and physical disability, which are known risk factors for suicidal behavior. The Interpersonal Theory of Suicide relates the desire to die to perception of burdensomeness, whereas perceived social support is an important buffer against suicidal behavior.  We examined the relationship between perceived burden, suicidal behavior and ideation, and whether social network diversity moderates this relationship.

Methods: Perceived Burden Scale scores measuring perception of imposed caregiving burden were compared in adults (Age > 40, M=65, SD=9) with medically-serious (n₁=32) and less-serious suicide attempts (n₂=32), contemplated suicide (n₃=34), depressed non-suicidal adults (n₄=37), and healthy controls (n₅=30). The Social Network Index (SNI) measured participants’ social network diversity, and Interpersonal Support Evaluation List (ISEL) measured perceived social support. NEO Five Factor Inventory assessed personality dimensions.

 Results: Low-lethality attempters reported higher levels of burdensomeness, than high lethality attempters, depressed, and healthy subjects. Additionally, ideators and high-lethality attempters reported higher perceived burdensomeness than depressed non-suicidal and healthy subjects (ps< .05; F_(4,164)=18.7, ƞ²_p=.32). Group membership, SNI, and neuroticism subscale reliably predicted perceived burdensomeness (ps< .05). 

Conclusion: Contrary to clinical lore, our data indicates higher reported perception of burden in low-lethality (more ambivalent) than high-lethality (more determined) attempters. Elevated neuroticism leading to maladaptive stress responses could contribute to this perception. Diverse social networks may moderate this effect of perceived burden on suicidal behavior, a finding that can inform in-home assistance program policies for elderly.