Development and Psychometric Evaluation of the Reasons for Living—Older Adults Scale: A Suicide Risk Assessment Inventory
Barry A. Edelstein, PhD; Marnin J. Heisel, PhD; Deborah R. McKee, PhD; Ronald R. Martin, PhD; Lesley P. Koven, PhD; Paul R. Duberstein, PhD; Peter C. Britton, PhD
Authors and Disclosures
Posted: 01/20/2010; Gerontologist. 2009;49(6):736-745. © 2009Abstract and Introduction
Purpose: The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale—Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide.
Design and methods: Two studies are reported. Study 1 involved instrumentdevelopment with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worstpoint in one's life, and current mental status and physical functioning.
Results: Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach's alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicideideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior.
Implications: These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential valueof attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.
Older adults, 65 years of age and older, are at greater risk for suicide than any other age group in the United States, with White men, aged 85 years and older, having the highest rate of suicide (National Center for Injury Prevention and Control [NCIPC], 2007).Older adults less frequently engage in self-harm behavior than do younger individuals but are considerably more likely to die as a result of self-harm (Draper, 1996). Older adults account for 20% of deaths by suicide but represent only 13% of the U.S. population (NCIPC).
Although these suicide rates are astonishingly high, little research has addressed suicidal ideation and behavior among olderadults (Pearson & Brown, 2000). Equally astonishing is the fact that 70% of older adults who died by suicide had seen their primary care provider within 30 days of their deaths (Conwell, Olsen, Caine, & Falnnery, 1991; Diekstra & van Egmond, 1989; Luoma, Martin, & Pearson, 2002). These data suggest that many individuals who are at risk for suicide are, in principle, identifiable, and their suicidesare potentially preventable. Although some predictors of older adult suicide are known (e.g., psychiatric illness, physical illness, functional impairment; Heisel & Duberstein, 2005), the lack of research focus on older adults to date has hindered the advancement of our knowledge regarding the assessment of suicide risk and prevention of suicide in this population. Age-related changes in thephenomenology and presentation of mental disorders (e.g., Edelstein, Kalish, Drozdick, & McKee, 1999; Kogan, & Edelstein, 2004; Edelstein et al., 2008) suggest the need for assessment instruments tailored to older adults. Unfortunately, to date there is only one published self-report suicide risk assessment instrument created explicitly for older adults (Heisel & Flett, 2006). Much of the research on...