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Addressing Suicide Risk for Older Adults: The Importance of Belonging

September 24, 2020

A paper by Dr. Laura Shannonhouse, Associate Professor, Georgia State University; Matthew Fullen, Assistant Professor, Virginia Tech; and Mary Chase Mize, Doctoral Student, Georgia State University


Overview of Suicide Among Older Adults

As the population of older adults continues to grow, the rates of suicide among older adults are projected to increase. Currently, an older adult dies by suicide every 65 minutes, and suicide attempts are more lethal in later life.1,2 Further, many suicides go unreported and/or are miscategorized, and in older adults this may include voluntary stopping of eating and drinking, withholding of medical treatment, overdose, etc. However, suicide is preventable when quality intervention is used.3 Although there are hundreds of correlates to suicide, two key predictors have been found to be part of a causal pathway, and together encapsulate suicide desire: (a) thwarted belongingness (sense of isolation), and (b) perceived burdensomeness (the feeling of being a burden to loved ones)3,4, which are likely exacerbated by the COVID-19 pandemic.5 Therefore, one important facet of suicide prevention is promoting a strong sense of belongingness and connection among at-risk older adults, and being able to intervene when needed.


Grant Project

With funding from the Administration for Community Living, a team led by researchers at Georgia State University partnered with nutrition service providers in six metro-Atlanta counties (both rural and urban) to equip nutrition services volunteers to respond to homebound, isolated older adults at risk of suicide. We trained over 160 home-delivered meal (HDM) volunteers in the 14 hour standardized and manualized Applied Suicide Intervention Skills Training (ASIST). ASIST has been recognized by the SAMHSA evidenced based registry, the National Registry of Evidence Based Programs (NREPP), and has been adopted by multiple states, the U.S. Armed Forces, the Centers for Disease Control, and crisis centers throughout the country.



In one of our grant studies with 493 homebound, isolated older adults in six counties, 15.6% scored above the suicide risk cutoff, 23.7% of homebound older adults reported a history of suicidal ideation or behavior, and 65 adults in this sample (13.2%) indicated the possibility of attempting suicide in the future. These findings tell us that suicide is a problem in the Aging Services Network (ASN), and that it is higher than typically reported. In another study, we compared psychological outcomes from 221 HDM recipients across four counties with 150 participants in congregate meals programs who had a variety of socialization programming at senior centers. The congregate participates were statistically significantly less depressed, less anxious, and found at reduced risk of suicide than those that were homebound. These findings tell us the important role the ASN provides in fostering socialization!


We found that HDM volunteers trained in ASIST manifested statistically significant increases in suicide intervention skills as measured before and after the 14 hour standardized and manualized ASIST training.  Over a period of just a few short months, those HDM volunteers performed over 60 suicide interventions with older adults!  Not only do volunteers trained get the skills, they use them!!


In our analysis of HDM volunteers’ experiences with the ASIST training, participants described ASIST as a useful, thought-provoking program that should be made available to all HDM volunteers. These volunteers were eager to share insights into how HDM programs could be adjusted to increase opportunities for volunteers to connect with older adults, foster belongingness, and even assess risk.


Because of the interruption in HDM services due to the pandemic, we modified our IRB and added a common disaster measure to assess the impact of COVID-19 related resource loss on psychological outcomes of homebound older adults.  We found that those who lost resources due to the pandemic (e.g., access to transportation, in-home care, or even their sense of humor) had greater levels of depression, anxiety, and psychological distress.  Social support, however, was related to lower levels of these mental health concerns, again emphasizing the importance of the ASN.  


In sum, belonging is especially important today as the ASN navigates unique challenges associated with COVID-19. Social support is one of the strongest predictors of positive psychological outcomes during disaster. Efforts to promote belongingness in the midst of the pandemic are vital. Please find links to several resources below that are outputs of our grant work, and also underscore ways to foster belongingness with older adults when needed the most.


*This work was supported by the Department of Health and Human Services (HHS), via the Association for Community Living (ACL) Grant #: 90INNU0010-01-00. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of HHS.



  1. Mental Heath Distress in homebound older adults:  Importance of the aging network

  1. COVID-19 and Older Adults: When social distancing meets social isolation:
  2. COVID-19 and Older Adults:  Time to Connect:


Tip Sheets: 

  1. Caring for older adults during Covid-19:   
  2. More than a meal: Facts, Stress, & Coping for Home Delivered Meal Volunteers during COVID-19:
  3. Caregiver tips during Covid-19:
  4. Quick tips for social distancing (older adults):


National Nutrition Resource Center Resource:

Enhancing Socialization through Making Meaningful Volunteer Connections during COVID-19:

Selected References

1. Barry, L. C., & Byers, A. L. (2016). Risk Factors and Prevention Strategies for Late-Life Mood and Anxiety Disorders. Handbook of the Psychology of Aging, 409-427. doi:10.1016/b978-0-12-411469-2.00021-2

2. Drapeau, C. W. & McIntosh, J. L. (2020). U.S.A. suicide: 2018 official final data. American Association of Suicidology.

3. Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

4. Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric 

properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24(1),  197-215.

5. Reger MA, Stanley IH, Joiner TE. Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm? JAMA Psychiatry. Published online April 10, 2020. doi:10.1001/jamapsychiatry 2020.1060

Last modified on 12/04/2020

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