Attitudes and beliefs about older adult suicide and about older adults who died by suicide, and the role of ageism
Date
2023
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Abstract
Background: In most countries, individuals age 65 years or older have the highest suicide rates (World Health Organization, 2018). However, suicide is not uniformly common among all older adults (Canetto, 1992, 2017). For example, in the United States (U.S.), European-descent men age 65 years or older have high suicide rates while African-descent women age 65 years or older have low suicide rates (Canetto, 2021). These patterns suggest cultural influences on older adults' suicide. Studies indicate that cultural factors like suicide attitudes and beliefs predict suicide. For example, a U.S. longitudinal study found that suicide acceptability predicted subsequent suicide in the general population–in some cases, by a twofold increase (Phillips & Luth, 2020). Most studies of attitudes and beliefs about older adults' suicide have been conducted in Anglophone-countries. This study explored attitudes and beliefs about older adults' decision to suicide and about older adults who died by suicide in a non-Anglophone country, Israel. Specifically, this study examined Israeli attitudes and beliefs about older adult suicide/female and male suicide, attitudes and beliefs about older adults who died by suicide/females and males who died by suicide, and the role of ageism in these attitudes and beliefs. Methods: Attitudes and beliefs about older adult suicide (as compared to younger adult suicide) as well as female and male suicide, and attitudes and beliefs about older adults who died by suicide (as compared to younger adults who died by suicide) as well as females and males who died by suicide, depending on one of five precipitants (1. A Chronic Nonfatal Debilitating Physical Illness; 2. A Terminal Debilitating Physical Illness; 3. An Achievement Failure; 4. Widowhood; 5. Economic Hardship) were measured. A modified version of the Suicide Attitude Vignette Experience (Stillion et al., 1984) form A was used as the stimulus material. Participants were asked to evaluate the suicide using Deluty's (1988-1989a, 1988-1989b) 7-point scales of suicide acceptability, permissibility, and agreement, as well as Stillion et al.'s (1989) 5-point scale of sympathy for the suicide, expanded to seven points to match Deluty's scales. To assess attitudes and beliefs about the person who died by suicide, participants responded to a 7-point scale about how emotionally adjusted they thought the person who died by suicide was (Lewis & Shepeard, 1992, as modified by Dahlen & Canetto, 1996). In addition, respondents expressed their view about the seriousness of the suicidal intent of the person who died by suicide via a 7-point scale (Dahlen & Canetto, 1996). Lower scores on these 7-point scales indicated less acceptability, permissibility, agreement, emotional adjustment, and seriousness. Ageism was measured using the 6-point scale, Fraboni Scale of Ageism (FSA) (Fraboni et al., 1990), as revised by Bodner & Lazar (2008). Ageism was the average of the 21 FSA items scores, as done in a study by Gamliel and Levi-Belz (2016). Low scores on this 21-item measure indicated less ageism. The sample was 1,107 individuals: 551 older adults ages 61 to 91 (Mage = 72.06, SD = 6.77) (276 females and 275 males) and 556 younger adults ages 21 to 37 (Mage = 25.82, SD = 3.94) (285 females and 271 males). The older adult participants were recruited from community day centers and the younger adults from university campuses and workplaces. Results: The decision to suicide, across sex and age of the person who died by suicide and across suicide precipitants, was rated as follows: acceptability (M = 5.656, SD = 1.779), permissibility (M = 5.466, SD = 1.912), agreement (M = 5.826, SD = 1.661), sympathy (M = 5.337, SD = 2.104). The person who died by suicide, across sex and age of the person who died by suicide and across suicide precipitants, was rated as follows: emotionally adjusted (M = 5.535, SD = 1.712), seriousness of suicide intent (M = 2.681, SD = 2.035). Older adult suicide was rated as relatively less acceptable, less permissible, less agreeable, and as eliciting less sympathy than younger adult suicide. Younger adult suicide following achievement failure was considered most permissible and acceptable and received the most agreement and sympathy across precipitant conditions. Younger adults whose suicide followed an achievement failure were rated as more serious in suicide intent than older adults whose suicide followed a terminal debilitating physical illness. However, older adults whose suicide followed a terminal debilitating physical illness were rated as more serious in suicide intent than younger adults whose suicide followed a terminal debilitating physical illness. Male suicide was considered more permissible than female suicide. Female and male suicide was evaluated similarly in terms of acceptability and sympathy. No difference was found between the perceived emotional adjustment of females and males who died by suicide, although males who died by suicide were believed to be less serious in their suicide intent than females who died by suicide. No differences were found in suicide acceptability and permissibility, agreement with, or sympathy for older adult suicide across respondents' characteristics such as their sex or age. The average ageism score, independent of respondent characteristics (i.e., their sex and age) was M = 2.966, (SD = 0.683). Younger adults (M = 2.891, SD = 0.716) held less ageist beliefs than older adults (M = 3.044, SD = 0.629). Ageism did not predict acceptability, permissibility, agreement, or sympathy with the older adults' decision to suicide, nor the perceived emotional adjustment or the perceived seriousness of suicide intent of the older adult who died by suicide. Discussion: This study's findings on attitudes and beliefs about older adult suicide, and about older adult suicide precipitated by a terminal debilitating physical illness, did not align with the findings of similar U.S. studies. A main finding of this study was that older adult suicide was rated as less acceptable, less permissible, and less agreeable than younger adult suicide. Older adult suicide following a terminal illness received the lowest amount of sympathy when compared to other conditions involving both older and younger adults, except for younger adult suicide following a terminal debilitating illness. Further, older adults whose suicide occurred after a terminal debilitating physical illness were rated as more serious in their suicide intent when compared to younger adults whose suicide followed a terminal debilitating physical illness, but not to younger adults whose suicide followed an achievement failure. In fact, younger adults whose suicide followed an achievement failure were rated as most serious in their intent relative to all other precipitant conditions. This study's findings on attitudes and beliefs about persons who died by suicide were both similar to, and different from U.S. findings about attitudes and beliefs about persons who died by suicide. This study found no difference in attitudes and beliefs about older adult suicide depending on respondent characteristics (i.e., their sex and age), in contrast to some U.S. studies. Furthermore, in this study ageism was not a predictor of, or a moderator for attitudes and beliefs about suicide, in contrast to a prior Israeli study's findings that ageism moderates suicide attitudes and beliefs. Possible explanations for the divergent findings across studies include differences in national context and culture, and method issues, Recommendations for future research include using a broader range of attitude and belief questions, examining ageism via qualitative methods, and studying suicide attitudes and beliefs across a diversity of national and cultural contexts.
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Subject
attitude
Israel
suicide
belief
ageism
older adult