thelastpsychiatrist.com - As The Population Ages, Will Suicides Increase? Adnotated.

Don't bet your life on it.

An editorial in AJP opens,

In most countries of the world, older adults kill themselves at higher rates than any other age group. Given that the leading edge of the large post-World War II "baby boom" cohort will reach the age of 65 in 2011, demographers predict a rapid rise in the number of seniors taking their own lives in subsequent decades. The need for effective approaches to late-life suicide prevention is pressing.

No.

First, I'd like to debunk the prevailing belief that almost all suicides are due to a psychiatric illness, a belief he supports using an article he himself wrote that references studies that don't actually show this.

Construction Of Pathology.

Simply assuming anyone who commits suicide is therefore "somehow not normal"; or "only someone mentally ill would kill himself" is wrong.ⁱ

If a serial killer says, "kill yourself or I kill your kids" and you kill yourself, are you mentally ill? Was Ajax mentally ill? Consequently, the fact that you committed suicide is not proof of illness, in the exact same way that death cannot be proof of pancreatic cancer.

Attributing causality to a complex behavior is masturbation with words.ⁱⁱ How is killing yourself from MDD different than killing yourself because of terminal pancreatic cancer?ⁱⁱⁱ Note that the syntactic construction forces me to say "from MDD" but "because of pancreatic cancer." But is that a real, existent distinction?

Is it the same biological mechanism? Different? Note: "He was depressed, he killed himself, for no reason, his life was great." The presence of pathology is assumed because of the absence of causes; psychiatry abhors a vacuum.

While it is clear that suicide is a risk in depression, the issue here is whether one can assume depression if they committed suicide?^iv

Three Problems Of "Psychological Autopsy"
Hearsay:

The evidentiary support for the presence of mental illness in those who commits suicide is mostly determined not by a past history of diagnosed psychopathology, but by a post-mortem psychological evaluation ("tell me what he was like?") in which the deceased has drastically biased everyone around him by killing himself.^v A psychological evaluation is basically interviewing "informants" (e.g. family), over three hours, asking psychiatric screening questions to determine diagnoses. Think about this, seriously think about this. The guy is dead, and you're asking the family if this guy ever exhibited signs of mental illness.

The closest analogy is doing a post-mortem of a marriage by only asking the ex-wife. "The evidence strongly suggests 75% of divorced men are manipulative jerks." Oh.

Validity of Symptoms Descriptions:

Example, from one of the sources of the above article:

Where subjects suffered both physical illness and depressive symptoms before death it was often difficult to judge whether a depressive episode was present. To ensure a consistent approach to diagnosis, we took possible depressive symptoms at face value; thus, if a subject was reported to suffer tiredness, this was included as a depressive symptom regardless as to whether it may have been due to physical illness.

Go figure: 77% of these people "had" a psychiatric diagnosis.^vi

Generalizability:
So it's legitimate to ask, what percent of suicides have ever been diagnosed before they died? What percent have been to a psychiatrist or primary care doc for psychopathology? The answer varies from 30-60%, which is another way of saying 40-70% have never been. A full 75% had never attempted suicide in their lives -- this was their first and last attempt. It's important to keep this in mind because the point of the editorial is to offer the elderly "access through a care manager to algorithm-driven treatment" -- yes, that's what he wrote -- then you're going to help a maximum of 45% (the so far best response rate in psychiatry) of the 50% you actually ever meet.^vii

1. But it is wrong in a very specific way. There's wrongs delicious to socialism, wrongs that old women find tasty ; and then there's wrongs bitter to socialism, wrongs that old women find insufferable. Saying "only someone mentally ill would kill" is not merely wrong -- it is ideologically evil. [↩]
2. Really ? Are rape, or for that matter... banking, any less complex than suicide ? [↩]
3. Because "MDD" is not a real disease ?

   I know you don't want to admit this, like you magically can't remember what chromosomes are when "discussing" "transsexualism" ; nevertheless : pancreatic cancer will kill the patient whether he's asleep or not, in a coma or not. MDD will not. [↩]

4. The only real issue is the obnoxious tendency of the living to try and impose their meaningless psychogenic noise on the dead. This doesn't stop or start with suicide, take for instance all the infuriating nonsense about "battle with terminal disease", as fucking if that's what goes on...

   The common man is fucking insufferable ; and he's insufferable when trying to come up with something to say to pick up a slavegirl waiting in a queue, when trying to speak at his best friend's wedding, when trying to give testimony, or standing above a grave, or going into unknown territory, or at all other times. That's the long and the short of it. [↩]

5. Think about it -- you know for a fact he's not about to come back and demand satisfaction out of you, yes ? [↩]
6. Inflationism is a consistent behaviour of socialism. There's a very important reason "tiredness" has to be on the list of depression symptoms, notwithstanding it experimentally has very little to do with depression and semiologically is of extremely little value in discerning anything from anything else : if it's not there, then so many cases of suicide no longer get the third "symptom" that's "required" to classify them as "depression", thus either the "requirement" will have to be dropped to just two "symptoms", or else the world narrative old women favour will suffer some humiliation. This last else only provided for theoretical completeness, in practice it ain't gonna start happening until you start caging old women. [↩]
7. Rather : he'll get to spend more imaginary "money" from the USG pile of scrip while delivering exactly nothing and, importantly, avoiding any responsibility for any of the foregoing. Which is the only point of the entire exercise. [↩]