“I Just Can't Take It Anymore”: Using Suicide Notes to Understand Suicidality in Older Adults

Introduction

Suicide is a complex multifactorial process that can result from a variety of biological, psychosocial and social stressors. The relative contributions of these stressors vary across the lifespan, as has been shown through epidemiological studies. Older adults face a unique set of challenges which may predispose them to suicidal ideation and suicide completion. Our study explored the subjective experience of mental illness and suicidality through the analysis of suicide notes, specifically in the older adult population.

Methods

Suicide note samples were obtained from the Office of the Chief Coroner for Ontario for suicide deaths in Toronto, Canada between 2003 and 2009. We employed a constructivist grounded theory informed analysis of written samples, whereby thematic analysis was conducted through line-by-line open coding, axial coding and theorizing of data. Demographic data and method of suicide were also collected.

Results

A total of 29 suicide notes (average 221 words per letter; range 6-1095) written by individuals 65 years and older (average age 76.2±8.3) at time of death were included in the analysis. Expressed reasons for suicide centred on themes of burdensomeness, experiences of mental illness, loneliness/isolation and physical health/disability. Suicide notes also elucidated the writers' conceptions of suicide as well as their emotional responses to stressors.

Conclusions

Suicide notes offer a unique window into the lived experience of those at highest risk of suicide. Our study can help bridge the gap between the known risk factors for suicide in older adults, with the subjective thoughts and emotions of those in distress.