Understanding and differentiating late adulthood suicide within a life-span developmental perspective: Protocol sentence analysis of suicide notes

Independent doctoral-level clinician judges (two psychologists in clinical practice) reliably (average rater concordance of.782, p $<$.0001) noted the incidence of contents corresponding to 48 protocol sentences derived to reflect important aspects of suicide in late adulthood using a procedure developed by Leenaars in two studies of suicide notes. Study 1--N = 40, 20 notes in each of two age groups--Over Age 65 and Under Age 55; and Study 2--N = 60, 20 notes in each of three age groups--Young, Middle, and Late Adulthood. The current studies were designed to address two major concerns: (1) validation of consistent empirical findings and previously-unintegrated theoretical statements from the existing literature on late adulthood suicide and (2) replication and extension of Leenaars' findings about age and suicide (focusing on differentiating later from earlier life-era suicides). Although it was unknown, a priori, which protocol sentence items would be highly predictive (descriptive) and which items would be highly discriminative (differentiating by age group) of late adulthood suicide, all 48 items constituted hypotheses about late life suicide. Thus, it was expected that the sentences, as a set, would discriminate significantly in favor of the notes of late life suicide completers. Also, with the exception of items known to most probably reflect commonalities in suicidal dynamics across the life-span (Items 3, 6, 7, 8, 9, 11, 15, 17, 20, 25, 31, 33, 35, 40, and 44), all of the sentences were expected to differentiate notes of older adults individually when paired against notes of other age groups. Frequency counts indicated that many of the protocol sentences were predictive of note content, irrespective of age. As a set, the 48 sentences did not discriminate late adulthood suicides in either study, although specific items did in both. The current results suggest that in adult suicide overall, more commonalities exist than differences. Significant individual differences between age groups, however appear to reflect developmental crises precipitating suicidal behavior in a given period of life. It was concluded that a life-span developmental approach was vital in understanding the seriously suicidal person's immediate motives from the personal document of a suicide note and in situating the suicidal event in an accurate psychosocial, temporal/cultural, and individual psychodynamic context.