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Is Suicide Ideation a Surrogate Endpoint for Geriatric Suicide?

Authors

  • Dr. Paul S. Links MD,

    Corresponding author
    1. Arthur Sommer Rotenberg Chair in Suicide Studies and Professor in the Department of Psychiatry, University of Toronto, St. Michael's Hospital.
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  • Dr. Marnin J. Heisel PhD,

    1. faculty member in the Department of Psychiatry, University of Rochester School of Medicine and Dentistry, affiliated with the Center for the Study and Prevention of Suicide.
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  • Dr. Assistant Professor Adam Quastel MD

    1. Department of Psychiatry, University of Toronto, St. Michael's Hospital.
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  • This research was conducted while the second author was the Stephen Godfrey Fellow in Suicide Studies and the third author was the Zyprexa Research Fellow, both with the Suicide Studies Unit, Department of Psychiatry, University of Toronto, St. Michael's Hospital. The authors wish to thank Ms. Rebecca Zakoor for her kind assistance with this project.

Address correspondence to Dr. Links, Arthur Sommer Rotenberg Chair in Suicide Studies, Department of Psychiatry, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B-1W8, Canada; E-mail: paul_links@utoronto.ca.

Abstract

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention, and ideation. Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide (n = 6); those not supporting this hypothesis (n = 1); and those providing insufficient information to test the hypothesis (n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed.

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