Social inequalities in the occurrence of suicidal ideation among older primary care patients

Objectives: To examine whether there is an association between area socioeconomic status and the experience of suicidal ideation among older adults. Design: Secondary analyses of data from a prospective study of naturalistic outcomes of depressive symptoms. Setting: Monroe County, NY. Participants: A cohort of older adults (≥65 years, N = 515) attending primary care settings. Measurements: Area socioeconomic status was based on the median household incomes of the census tracts (CTs) in which participants lived. At 6- and 12-month follow-up, the longitudinal interval follow-up evaluation was used to assess weekly depressive symptom status over the previous 6 months, which was used to construct a measure of any suicidal ideation during the study. Results: Residents of CTs with median household incomes of less than $30,000/yr were more likely to experience suicidal ideation than residents of higher income CTs (unadjusted odds ratio [OR], 4.60; 95% confidence interval [CI], 1.64-12.86). Adjustment for demographic and baseline clinical factors did not eliminate the association (OR, 5.44; 95% CI, 1.71-17.24). Subsequent models that adjusted for medical, functional, and psychosocial variables did not explain this association either. Conclusions: There is a robust association between lower CT income and the occurrence of suicidal ideation in a primary care cohort of older adults over 1 year. These findings indicate the need for more research into how social worlds come to influence the emotional well being of older adults and whether social factors such as CT income can be used to identify individuals at increased risk for suicidal behavior.