Beyond Depression: Estimating 12-Months Prevalence of Passive Suicidal Ideation in Mid- and Late-Life in the Health and Retirement Study

Am J Geriatr Psychiatry. 2019 Dec;27(12):1399-1410. doi: 10.1016/j.jagp.2019.06.015. Epub 2019 Jul 2.


Objectives: To provide valid estimates of the 12-month prevalence of passive suicidal ideation among older adults, without conditioning on depression status, using the Health and Retirement Study (HRS).

Methods: Data come from the 2012 HRS (n = 17,434) and 2004/5 Baltimore Epidemiologic Catchment Area (ECA) Study (n = 755). In the HRS, passive suicidal ideation (i.e., thought a lot about death-your own, someone else's, or death in general) is only assessed on respondents who reported dysphoria/anhedonia; in the ECA, ideation is assessed on all respondents, regardless of depression. We compare two approaches to estimating the 12-month prevalence of passive suicidal ideation in the HRS without conditioning on depression symptoms: 1) a probit selection model within the HRS, and 2) a prediction model developed using appended ECA data applied to the HRS.

Results: Using observed data alone on those who screened positive for depression, 6% of older adults reported passive suicidal ideation in the past year. Depending on the approach used, between 5.4% and 9.2% of HRS respondents who screened negative for depression would have reported passive suicidal ideation had they been assessed. Correcting for this selection bias, between 10.9% and 13.4% of U.S. adults over age 50 experienced passive suicidal ideation in 2012.

Conclusions: Population surveillance of suicidal ideation among older adults is biased by survey approaches that only assess ideation in the context of depression.

Keywords: Aging; depression; population-based; suicide; surveillance.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Activities of Daily Living*
  • Affect
  • Aged
  • Depression / epidemiology*
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Selection Bias
  • Stroke / epidemiology*
  • Suicidal Ideation*
  • Suicide / prevention & control
  • United States / epidemiology