Depressive disorder untreated can last 7 to 14 months and longer than 2 years. In the elderly, a pathological grieving process that has progressed to an episode of depressive illness may last 5 years or longer. Studies of the outcome of depressive episodes among psychiatric patients have shown rates of relapse that ranged from 5% to 52%. Some 15% to 67% of patients with depressive disorder with >2 years of follow-up were found across 12 studies to have continued symptoms and a chronic course.
Suicide
It is important to emphasize that in the US population, suicide rates are high among adolescents and higher among the elderly. Rates of completed suicide increase for white men throughout the life cycle and peak between ages 80 to 90. Rates of completed suicide by white women peak at ages 50 to 59. The divorced, white man who views his life accomplishments negatively and uses alcohol to medicate his dysphoric symptoms is the elder who completes a suicide—more usually with a firearm.
Among ethnic elders, the rates of completed suicide among Chinese-American men and Japanese-American men age 85 and older exceed the rates of white men by 20% and 60%, respectively (Table 3). The single, poor Asian male who was unable to establish a family or to bring his family to the United States because of the Asian Exclusion laws and who has isolated himself from mainstream American culture is at high risk to complete a suicide.
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Table 3. 1980 Us Average Annual Age-Specific Crude And Age-Adjusted Suicide Rates Per 100,000 Population For Chinese, Japanese, And White Men Ages 55 To 85 Years* |
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|
Age Group |
Chinese Men |
Japanese Men |
White Men |
| All ages, crude |
8.26 |
12.57 |
20.57 |
| Age-adjusted |
7.93 |
11.08 |
19.41 |
| 55 to 64 years |
9.37 |
12.38 |
26.52 |
| 65 to 74 years |
25.85 |
11.17 |
32.41 |
| 75 to 84 years |
21.82 |
39.56 |
46.18 |
| 85+years |
64.10 |
139.76 |
53.28 |
| *Source: Liu W, Yu E. Ethnicity, mental health, and the urban delivery system. In: Maldonado J, Moore J, eds. Urban Ethnicity in the United States. Beverly Hills, Calif: Sage; 1985:211-247. | |||
The ratio of suicide attempts to completed suicide in younger age US cohorts is estimated at 20:1. The ratio of suicide attempts to completed suicides in the US elderly is estimated at 4:1. Clues to suicidal ideation among the elderly include statements such as “You’d be better off without me,” behaviors of giving away prized possessions, and indefinite plans for the future. Specific questions should be asked to elicit the presence of suicidal ideation and the presence of a plan for a suicidal act. Such a direct approach will enable the older person to reveal the extent of his or her despair. Because thoughts of suicide usually are associated with fantasies of rescue, the elder may view the therapist positively and anticipate help in avoiding acting on his or her suicidal thoughts. We must remember that the elderly, while representing only 13% of the US population, complete 39% of the deaths by suicide that occur in the United States each year.