Psychosocial Factors Associated With Attempted Suicide Among Elderly and Non-Elderly Patients At A Rural Tertiary Care Hospital in India

Abstract

Introduction: Attempted suicide is a major public health problem shaped by psychological vulnerability, psychiatric illness, and social adversity. In India, attempts are closely linked to poverty, family conflict, alcohol use, and limited access to mental health care, particularly in rural areas. Age strongly influences suicidal behaviour: older adults typically show higher intent and use more lethal methods, while younger individuals more often act impulsively after acute crises. Indian studies directly comparing the psychosocial profiles of elderly and non-elderly suicide attempters remain scarce, especially from rural settings. This study compared the sociodemographic, clinical, and psychosocial factors associated with attempted suicide among elderly and non-elderly patients and assessed the severity and predictors of suicide intent.

Methods: This cross-sectional comparative study enrolled 300 consecutive adults admitted following a suicide attempt to Adichunchanagiri Hospital and Research Centre, a rural tertiary care facility, over 18 months (May 2024 to October 2025). Participants were categorized as non-elderly (18-59 years) or elderly (60 years and above). Data were collected using a semi-structured proforma and standardized instruments, including the Beck Suicide Intent Scale, the Risk-Rescue Rating Scale, the modified Kuppuswamy Socioeconomic Status Scale, the Presumptive Stressful Life Events Scale, the Alcohol Use Disorders Identification Test (AUDIT), International Classification of Diseases, 11th Revision (ICD-11) diagnostic guidelines, and the Mini-Mental State Examination (MMSE) in patients aged 65 years and above. Categorical variables were compared using the chi-square or Fisher's exact test, continuous variables using Student's t-test, and independent predictors were identified using multivariable logistic regression (p < 0.05 considered significant).

Results: Of 300 participants, 213 (71.0%) were non-elderly and 87 (29.0%) were elderly (mean age 48.8 ± 18.5 years); 52.3% were male, 76.7% resided in rural areas, and 75.0% belonged to lower or upper-lower socioeconomic strata. Current or past psychiatric illness was present in 34.7% and alcohol use in 39.7% of participants; 23.0% had a prior suicide attempt, and poisoning was the predominant method (65.3%). Elderly attempters had significantly higher rates of chronic physical illness (69.0% vs 25.8%), functional impairment (66.7% vs 13.1%), and social isolation (48.3% vs 17.8%), whereas non-elderly attempters more often reported unemployment (38.5% vs 13.8%), financial strain (54.0% vs 25.3%), and marital discord (37.6% vs 11.5%) (all p < 0.001). On multivariable analysis, chronic physical illness (adjusted odds ratio (AOR) 6.50), functional impairment (AOR 5.10), and social isolation (AOR 4.10) independently predicted membership in the elderly group, while unemployment (AOR 0.32) and marital conflict (AOR 0.30) independently predicted the non-elderly group. Clinically significant suicide intent was present in 28.0% of participants; lower socioeconomic status and the presence of a suicide note were the only independent predictors of higher intent, while age, gender, psychiatric diagnosis, alcohol use, prior attempts, and method of attempt were not.

Conclusions: Attempted suicide in this rural population was driven predominantly by socioeconomic deprivation and cumulative psychosocial stress, with distinct age-specific patterns: health deterioration and social disconnection predominated among elderly patients, while acute financial and interpersonal crises predominated among non-elderly patients. Suicide intent was better predicted by behavioural markers and socioeconomic adversity than by demographic variables. These findings support the need for age-tailored, psychosocially integrated suicide prevention strategies in rural clinical settings.

Categories: Psychiatry, Public Health, Geriatrics