Silent Struggles: Age-Specific Patterns of Suicidal Ideation and Protective Factors in Kermanshah

Abstract

Background: Suicide remains a pressing public health concern across the lifespan. While younger adults frequently become the focus of prevention efforts, older adults — particularly in culturally conservative contexts like Kermanshah, Iran — face underexplored risks and protective dynamics related to suicidal ideation. Objectives: This study aimed to compare the prevalence and nature of suicidal ideation, as well as the strength of protective beliefs [reasons for living (RFL)] between young (18 - 25 years) and elderly (≥ 60 years) individuals in Kermanshah. The goal was to explore how age and cultural factors shape psychological vulnerability and resilience. Materials and Methods: The study population consisted of elderly individuals (aged 60 and above) and young adults (aged 18 to 25) residing in Kermanshah province, Iran. A total of 124 participants completed the Persian versions of the Beck Scale for Suicide Ideation (BSSI) and the RFL Inventory. Independent t-tests and Mann-Whitney U tests were used to assess differences in suicidal ideation and RFL subscale scores between age groups. Effect sizes were also calculated. Results: Mild levels of suicidal ideation were reported by 65% of youth, and 59% of elderly participants showed mild suicidal ideation (BSSI ≥ 1), though only 6% had severe scores (BSSI ≥ 15). However, older adults scored significantly higher on RFL subscales related to moral objections, family responsibility, and concern for children (P < 0.01), suggesting culturally embedded protective factors. Effect sizes ranged from small to moderate (Cohen’s d = 0.28 - 0.46). Conclusions: Although suicidal ideation levels were comparable across age groups, older adults demonstrated stronger culturally-informed protective beliefs. These findings underscore the need for suicide prevention strategies that are culturally sensitive and age-specific, incorporating family and moral frameworks, especially in non-Western settings.