Factors determining the balance between the wish to die and the wish to live in older adults

Abstract

Background: The “Internal Struggle Hypothesis” (Kovacs and Beck,) suggests that suicidal persons may have both a wish to live (WTL) and a wish to die (WTD). The current study investigates whether the three-group typology – “WTL”, “ambivalent (AMB)”, and “WTD” – is determined by common correlates of suicidality and whether these groups can be ordinally ranked. Methods: The sample comprised 113 older inpatients. Discriminant analysis was used to create two functions (combining social, psychiatric, psychological, and somatic variables) to predict the assignment of older inpatients into the groups WTL, AMB, and WTD. Results: The functions “Subjective Well-being” and “Social Support” allowed us to assign patients into these three distinct groups with good accuracy (66.1%). “Subjective Well-being” contrasted the groups WTD and WTL and “Social Support” discriminated between the groups WTD and AMB. “Social Support” was highest in the AMB group. Conclusions: Our results suggest a simultaneous presence of a WTL and a WTD in older inpatients, and also that the balance between them is determined by “Subjective Well-being” and “Social Support”. Unexpectedly, the AMB group showed the highest scores on “Social Support”. We hypothesize that higher social support might function as an important determinant of a remaining WTL when a WTD is present because of a lower sense of well-being. The study suggests that the groups WTL–AMB–WTD can not situated on a one-dimensional continuum.