A Shortened Version of the Reasons for Living—Older Adults Scale for Clinical and Research Utility

A Shortened Version of the Reasons for Living—Older Adults Scale for Clinical and Research Utility Abstract Background and Objectives Older adults have elevated suicide rates, and identification of protective factors, such as reasons for living, is important in preventing suicide. The Reasons for Living—Older Adults scale (RFL-OA) is a 69-item measure of these protective factors in late life, which yields good psychometric properties. However, its length limits its utility in some clinical and research contexts where a shorter measure is ideal. The objective of this study was to create a shortened version of the RFL-OA. Research Design and Methods First, data collected previously during validation of the original RFL-OA (n = 199, age 65 and older, 65% female) were used to select 30 items, spanning all content areas, that were highly endorsed. Second, new data were collected (n = 219, age 60 and older, 52% female) with the 30-item RFL-OA and measures of depression, hopelessness, suicidal ideation, religiosity, health, and social desirability to examine the measure’s internal consistency and convergent and discriminant validity. Results Scores on the 30-item RFL-OA exhibited strong internal consistency. The short RFL-OA demonstrated good convergent validity via significant, moderate correlations with suicidal ideation, hopelessness, depression, and religiosity. It demonstrated adequate discriminant validity via only small correlations with disability, subjective health, and social desirability. Discussion and Implications The shorter RFL-OA has good psychometric properties among community-dwelling older adults. It may have greater utility, compared to the original 69-item measure, for clinicians and researchers with limited time but who want to assess protective factors against suicidal behavior in late life. Suicide, Measurement, Psychometrics Over 800,000 people worldwide took their own lives in 2012, which represents a suicide rate of 11.4 per 100,000 individuals (World Health Organization, 2014). The latest estimate of the suicide rate for the United States was 13.8 per 100,000 in 2015 (Centers for Disease Control, 2015). The highest rates of suicide in most of the world occur among individuals aged 70 and older (World Health Organization, 2014), with the rate for individuals 85 years of age and older being 18.6 per 100,000. Unfortunately, though the all-cause mortality rate has decreased in the United States, suicide rates continue to increase, with the age-adjusted rate increasing by 24% between 1999 and 2014 (Curtin, Warner, & Hedegaard, 2016). Though a variety of risk factors have been identified and targeted for the prevention of suicide, the current approaches to suicide prevention remain inadequate (Bakhiyi, Calati, Guillaume, & Courtet, 2016). More recent preventive approaches have begun to heavily focus on resilience and the buffering effects of several factors (e.g., Bakhiyi et al., 2016; Heisel, Neufeld, & Flett, 2016). Among these various protective factors is an individual’s reasons for living. Linehan and colleagues (1983) noted that individuals with prior suicidal behavior reported fewer reasons for living than individuals without such histories and placed less value on their reasons for living. These findings revealed the potentially protective value of reasons for living and spurred the further exploration of reasons for living in the literature. In subsequent years, age-appropriate reasons for living scales were developed for adolescents (Osman et al., 1996), young adults (Gutierrez et al., 2002), and older adults (Edelstein et al., 2009). In their systematic review of research conducted with the original reasons for living scale (RFL; Linehan et al., 1983), Bakhiyi and colleagues (2016) concluded that reasons for living can protect against suicidal ideation and death by suicide, even after adjusting for depression and hopelessness. Virtually all of the reviewed research was conducted with individuals under the age of 65. Several of these studies (e.g., Segal, Gottschling, Marty, Meyer, & Coolidge, 2015; Segal, Marty, Meyer, & Coolidge, 2012) provided evidence of the utility of the RFL scale (Linehan et al., 1983) with older adults. The Reasons for Living—Older Adults inventory (RFL-OA; Edelstein et al., 2009) was originally developed for use with older adults who are at risk for suicide to provide a more age-appropriate measure of reasons for living than the original RFL scale. It is a 69-item measure, 28 of which are similar to those of the original Reasons for Living inventory (Linehan et al., 1983). Psychometric evaluation of the instrument with clinical and nonclinical samples yielded strong reliability, and convergent and criterion-related validity evidence. Although the RFL-OA is quite suitable as a clinical assessment instrument, its length is a significant limiting factor for researchers seeking such an instrument and for clinicians with limited time. In light of that, the substantial suicide risk for older adults, and the paucity of research on protective factors for older adults at risk for suicide, the present study was conducted to develop a brief version of the RFL-OA and examine its psychometric properties with a sample of community-dwelling older adults from across the United States. The selection of items and examination of the shortened measure’s psychometric properties were completed in two steps. Study 1: Item Selection Research Design and Methods Participants Data from four samples previously collected for studies examining the psychometric properties of the original RFL-OA were used to examine item performance and select items to retain for the shorter version. A total of 199 adults aged 65 and older comprised the sample for the present study, and data were collected via mail-in surveys completed in West Virginia. Measures The original 69-item RFL-OA was used in all samples noted above. Basic demographic information (age, gender, race/ethnicity) also was gathered. The RFL-OA has previously been validated in samples of older adults (Edelstein et al., 2009) and used in both research and clinical settings. Each item (a reason for living) is rated on a 1–6 Likert-type scale for its importance for not committing suicide (1 = “Extremely unimportant,” 2 = “Quite unimportant,” 3 = “Somewhat unimportant,” 4 = “Somewhat important,” 5 = Quite important,” 6 = “Extremely important”). As an additional note, relatively recently, researchers and clinicians in the field of suicidology generally discourage the use of the term “committing suicide,” in favor of other terminology such as “die by suicide” (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). The wording of this measure was not changed for the purpose of this study, as a change in wording may affect how the shorter version relates to the original and the general public is likely still most familiar with the original terminology (i.e., “committing suicide”). Analyses Exploratory factor analysis (EFA) was used to examine correlations between items and factor loadings and structure of the original RFL-OA. Based on the resulting factor structure, areas of content were identified to preserve in the shorter RFL-OA for the purpose of maintaining content validity (i.e., some items within each factor/content area were retained for the shorter scale). Then, items were selected to retain based on frequency of endorsement (i.e., percentage of participants who rated the item as “Quite important” or “Extremely important”). Given the purpose of the shorter scale as a possible clinical tool in addition to research purposes, the goal of item selection was to retain items among which participants or patients would be likely to identify relevant reasons for living. Results The combined sample consisted of 199 participants age 65 and older. The majority of the sample was female (65%) and Caucasian/White (98%). EFA yielded five factors from the original 69 items of the RFL-OA. These factors consisted of religious, family related, coping ability related, and positive outlook toward life-related reasons for not taking your life, and a factor that encompassed other reasons for not taking your life. Within each of five factors, items to retain were selected based on frequency of endorsement of reasons as “Quite important” or greater. In general, retained items were endorsed by 70% or more of participants, though this varied slightly by factor. Thirty items were retained for the shorter scale. This number of items was selected based on the researchers’ judgment that all identified content areas appeared to be well covered in the shortened version of the measure, with an adequate number of highly endorsed items to make it likely that a client could identify one or more relevant reasons for living. This was consistent with the goal of enhancing clinical utility with the shorter version of the measure. Study 2: Psychometric Examination Research Design and Methods Participants Participants were adults age 60 and older who were enrolled in and participated in surveys through Amazon Mechanical Turk (MTurk) and located in the United States. Procedure Participants were recruited via MTurk with a brief study description. Participants who were interested in the study were directed via a link to the set of questionnaires on SurveyMonkey. Participants were first shown a cover page with informed consent information and indicated their consent by continuing to the next page for the survey. Participants completed the questionnaires online in the following order: demographic information, then the shortened RFL-OA, then the Centers for Epidemiological Studies—Depression scale (CESD), Beck Hopelessness Scale (BHS), Social Desirability Scale (SDS), Duke University Religion Index (DUREL), and Activities of Daily Living (ADLs; see below). The Geriatric Suicide Ideation Scale (GSIS) (see below) was administered last to allow for a mental health services referral notice immediately following completion of that scale. When participants finished the survey, they were given a code with which to confirm participation in MTurk and receive payment. This study was approved by the West Virginia University Institutional Review Board. Measures Demographic information including age, gender, racial/ethnic background, marital status, education level, occupational status, and self-rated health were collected. Centers for Epidemiological Studies—Depression scale The CESD is a 20-item self-report measure of depressive symptoms that has been widely used and validated in a variety of populations (Radloff, 1977). Depressive symptoms are rated by frequency of occurrence from 0 to 3, with total scores ranging from 0 to 60. Higher scores are indicative of greater depressive symptoms. The CESD exhibits good internal reliability (e.g., α = .78–.83) and validity (e.g., supported factor model in older adults; area under the curve predicting depression diagnosis = .84–.86) among older adults (Hertzog et al., 1990; Lewinsohn, Seeley, Roberts, & Allen, 1997). Beck Hopelessness Scale The BHS is a 20-item self-report measure of hopelessness (Beck, Weissman, Lester, & Trexler, 1974). Respondents rate each statement as true or false, and total scores range from 0 to 20 such that higher scores are indicative of greater hopelessness. The BHS has been used for all ages and demonstrates good internal reliability (e.g., α = .85–.93) and validity, via positive associations with suicidality (e.g., r = .43) and depression (e.g., r = .51), among older adults (Cukrowicz, Jahn, Graham, Poindexter, & Williams, 2013; Lutz & Fiske, 2017). Geriatric Suicide Ideation Scale The GSIS is a 31-item measure of suicidal ideation among older adults (Heisel & Flett, 2006). Respondents rate agreement with symptoms from 1 (“strongly disagree”) to 5 (“strongly agree”). Total scores range from 31 to 155, with higher scores representing greater levels of suicidal ideation. The GSIS exhibits good internal consistency (e.g., α = .90–.93) and test–retest reliability (e.g., intraclass correlation = .53–.81, r = .86), as well as convergent validity (e.g., correlated with Beck Scale for Suicide Ideation r = .62; correlated with depression r = .43–.77), among older adults (Heisel & Flett, 2006, 2016). Duke University Religion Index The DUREL is a brief, five-item self-report measure of religiosity (Koenig & Büssing, 2010). It yields three scores. The first item measures frequency of attendance at public religious activities (i.e., “church or other religious meetings”) and is rated on a 6-point scale ranging from 1 (“Never”) to 6 (“More than once a week”). The second item measures frequency of participation in private religious activities (“such as prayer, meditation, or Bible study”) and is rated on a 6-point scale ranging from 1 (“Rarely or never”) to 6 (“More than once a day”). The final three items measure intrinsic religiosity (e.g., experiencing the presence of a divine being, incorporation of religious beliefs into daily life) and are rated on a 5-point scale ranging from 1 (“Definitely not true”) to 5 (“Definitely true of me”). These three item scores are totaled. Higher scores represent greater religiosity for all three parts. The scale has exhibited adequate internal reliability (α = .78–.91) and convergent validity (correlations with other religiosity measures r = .71–.86; Koenig & Büssing, 2010). Activities of Daily Living To measure functional ability, activities of daily living were assessed using the Functional Activities Questionnaire (Pfeffer, Kurosaki, Harrah, Chance, & Filos, 1982). Participants rated their ability to complete 10 activities, from 0 (“normal”) to 3 (“dependent”). Total scores range from 0 to 30, with higher scores indicating greater functional impairment. This questionnaire (originally validated as an alternate informant measure) has demonstrated convergent validity with other ADL measures (r = .72) and several indices of cognitive functioning (e.g., neurologists’ estimates of function r = −.83; Pfeffer et al., 1982). Self-Rated Health As a measure of general self-rated health, participants were asked “In general, would you say your health is: excellent, very good, good, fair, or poor?” Responses were scored from 1 (“poor”) to 5 (“excellent”). Single self-rated health items such as this one serve as valid measures of general subjective health and are predictive of mortality in older adults (e.g., “poor” self-rated health is associated with mortality rate two times as high as “excellent” self-rated health; DeSalvo, Bloser, Reynolds, He, & Muntner, 2006; Miller & Wolinsky, 2007). Social Desirability Scale The 13-item short form C of the Marlowe-Crowne Social Desirability Scale was used to measure the extent to which participants were responding along socially desirable lines (Reynolds, 1982). Items require true or false responses and are then coded such that the socially desirable response is 1 and the other response is 0. Total scores range from 0 to 13, with higher scores indicating greater socially desirable responding. This short form exhibits good internal reliability (Kuder-Richardson Formula 20 = 0.76) and correlates highly with the original standard Marlowe–Crowne measure (r = .93) in an undergraduate sample (Reynolds, 1982). Analyses Data collection included items designed to check validity of responses and participants’ recorded age. Validity of responses was assessed by (a) matching responses on multiple items assessing age in years and year of birth at different times in the survey (i.e., whether age and year of birth matched within 1 year and whether year of birth reported at the beginning of the survey matched year of birth reported at the end of the survey) and (b) randomly distributed items requesting participants to select a particular response if they were reading that item (e.g., “To check that you are reading this item, please select ‘True’”). Data only from participants who responded correctly on five or more of six validity items, and whose responses regarding age and birth year were consistent, were used. In addition, only data from participants who completed the RFL-OA were used in these analyses. On all other measures, pairwise deletion was used if participants did not complete the measures. First, EFA with promax rotation was used to examine the factor structure of the shortened RFL-OA and to examine individual item performance in terms of correlation with other items and loading onto the scale factors. Second, internal consistency was measured using Cronbach’s alpha. Third, convergent validity evidence for the shortened RFL-OA was examined via correlations with measures of depression symptoms (CESD), hopelessness (BHS), suicide ideation (GSIS), and religiosity (due to a number of items related to religious/spiritual reasons for living; DUREL). Finally, discriminant validity evidence was examined via correlations with measures of social desirability (SDS) and functional impairment/activities of daily living (ADL). Results Two hundred ninety-one older adults participated in an MTurk survey. Forty-three were excluded from data analysis due to failure to meet validity standards outlined above. Of those who met validity standards, 29 failed to complete the RFL-OA. The final sample consisted of 219 participants. Ages ranged from 60 to 80 years, with the majority (71.2%) between the ages of 60 and 65 years. Slightly more than half of the sample was female (52.1%). The sample was majority non-Hispanic White/Caucasian (80.8%), with 8.7% Black/African American, 3.2% Asian American, 3.7% Hispanic, 1.4% Native American, and 1.8% other race/ethnicity. The majority of the sample had completed at least some college (82.1%). EFA of the 30-item scale with the new data yielded three factors. These factors, broadly speaking, consisted of items measuring religious (e.g., “I put my life in God’s hands”), family-related (e.g., “I want to see my grandchildren grow up”), and positive/hopeful (e.g., “Life is too beautiful and precious to end it”) reasons for not taking your life. See Table 1 for loadings of items onto factors. The factors were correlated (r = .28 between positive and religious reasons; r = .63 between positive and family-related reasons; and r = .35 between religious and family-related reasons). Cronbach’s alpha of scores on the 30-item RFL-OA is .94, suggesting very good internal reliability in this sample. Table 1. Rotated Factor Loadings of 30 Items From Shortened Reasons for Living—Older Adults Scale Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Note: Loadings are from the pattern matrix using promax rotation. Bolded values indicate the factors onto which items loaded most strongly. Loved ones = reasons for living associated with loved ones/family; Positive = positive attitudes about life; Religious = religious reasons for living. aItems are abbreviated—see full measure for wording of items. View Large Table 1. Rotated Factor Loadings of 30 Items From Shortened Reasons for Living—Older Adults Scale Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Note: Loadings are from the pattern matrix using promax rotation. Bolded values indicate the factors onto which items loaded most strongly. Loved ones = reasons for living associated with loved ones/family; Positive = positive attitudes about life; Religious = religious reasons for living. aItems are abbreviated—see full measure for wording of items. View Large The 30-item RFL-OA also exhibited good convergent and discriminant validity. See Table 2 for correlations between all relevant measures. The shortened RFL-OA is moderately and significantly negatively correlated with suicide ideation, hopelessness, and depression. The total RFL-OA score is also correlated with religiosity, though it is more strongly correlated with items measuring intrinsic religiosity than those measuring attendance or participation in public and private religious activities. Though the RFL-OA is significantly correlated with activities of daily living and social desirability, these correlations are small. The RFL-OA is not significantly correlated with self-rated health. Table 2. Correlations Between 30-Item Reasons for Living—Older Adults Scale and Other Measures   RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19    RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19  Note: RFL-OA = 30-item Reasons for Living—Older adults scale; CESD = Centers for Epidemiological Studies—Depression scale; BHS = Beck Hopelessness Scale; GSIS = Geriatric Suicide Ideation Scale; DUREL = Duke University Religion Index; DUREL1 = frequency of attendance at religious services; DUREL2 = frequency of private religious activities; DUREL3–5 = intrinsic religiosity; ADL = Activities of daily living; Health = self-rated health; SDS = Social Desirability Scale. N = sample size with completed measure (of 219 with complete RFL-OA). *p < .05. **p < .01. ***p < .001. View Large Table 2. Correlations Between 30-Item Reasons for Living—Older Adults Scale and Other Measures   RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19    RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19  Note: RFL-OA = 30-item Reasons for Living—Older adults scale; CESD = Centers for Epidemiological Studies—Depression scale; BHS = Beck Hopelessness Scale; GSIS = Geriatric Suicide Ideation Scale; DUREL = Duke University Religion Index; DUREL1 = frequency of attendance at religious services; DUREL2 = frequency of private religious activities; DUREL3–5 = intrinsic religiosity; ADL = Activities of daily living; Health = self-rated health; SDS = Social Desirability Scale. N = sample size with completed measure (of 219 with complete RFL-OA). *p < .05. **p < .01. ***p < .001. View Large Discussion and Implications Given the considerable suicide risk for older adults and the limited data on protective factors for older adults at risk for suicide, this present study was conducted to develop and evaluate a shortened measure of reasons for living in older adults. Identifying reasons for living can assist as a preventative strategy and coping skill for individuals with suicide ideation; however, the length of the initial Reasons for Living Scale—Older Adult scale (RFL-OA) potentially limited its research use and clinical application. The purpose of the present two studies was to develop a shortened version of the RFL-OA and examine its psychometric properties. The original RFL-OA (Edelstein et al., 2009) includes 69 items, whereas the shortened version includes 30 items. Study 1 involved item selection to assist in the development of the shortened RFL-OA scale from a combined sample of previous data on the original version. A five-factor structure was identified from the original RFL-OA. The five factors identified were as follows: religious reasons for living, family-related reasons for living, coping self-efficacy beliefs, positive outlook toward life, and a factor that encompassed other reasons for living. Thirty items were retained in this shorter version. Study 2 examined the psychometric properties of the shortened RFL-OA scale with a new sample of 219 older adults recruited from Amazon’s Mechanical Turk. Reliability analysis yielded a Cronbach’s alpha of .94, supporting the measure’s internal reliability. The shortened RFL-OA is significantly correlated at a moderate level with suicide ideation, hopelessness, depression, and religiosity, providing convergent validity evidence. Only small or nonsignificant correlations were found between the RFL-OA and activities of daily living, self-rated health, and social desirability, providing evidence of discriminant validity. Of note, an EFA for the 30-item RFL yielded three factors instead of the five factors in the 69-item version: religious reasons for living, family-related reasons for living, and positive/hopeful attitudes about life. However, items from coping self-efficacy and positive outlook factors appeared to be combined into one factor in the shorter version and were otherwise consistent with the factor structure of the longer version. The factor structure identified by the current studies is consistent with previous research examining factors that influence reasons for living in older adult samples. Higher religiosity has been found to be associated with greater number of reasons for living (June, Segal, Coolidge, & Klebe, 2009). Also, religious-based moral objections and child-related concerns are stronger reasons for not dying by suicide for older than younger adults (Miller, Segal, & Coolidge, 2001), providing further support for the factors identified in this study. The shortened version of the RFL-OA scale, in conjunction with Cognitive Behavior Therapy (CBT), could assist with the identification of reasons for living in older adults who are experiencing suicidality and be incorporated into clinical treatment. CBT has been successfully utilized to help target risk factors for suicide in older adults (Bhar & Brown, 2011). The use of CBT strategies, such as identifying reasons for living, can facilitate assessment of suicide risk and may help decrease depression, hopelessness, and suicide ideation. Additionally, the three factors that the shortened scale identified can help guide conversations about reasons for living during treatment. For example, religious reasons for living, one of the three factors, can provide additional information about a client’s risk for suicide. Religious affiliation is associated with individuals being less likely to have a history of suicide attempts, which is one of the main predictors of future suicide attempts (Dervic et al., 2004; Leon et al., 1990). Identification of religious reasons for living during clinical treatment can help individuals recognize meaning in their lives and increase hopefulness and optimism in therapy. There are a few limitations of this study. One potential limitation was that the sample from Study 2 consisted primarily of non-Hispanic White/Caucasian participants who had at least some college education, and were between the ages of 60 and 65 years. This fact could limit the generalizability of the findings and should be considered when interpreting the findings presented. Additional research should consider further examination of the RFL-OA with a more demographically diverse sample of participants in terms of age, ethnicity, race, and education. Another potential limitation is the decision-making process during item selection in Study 1 was based on retaining items that have been endorsed by the majority of research participants. This specific process was chosen in anticipation of using the RFL-OA scale as a tool in clinical settings for assisting people who were suicidal in identifying reasons for living. Depending on other researchers’ or clinicians’ different goals for use of a shortened measure, additional item selection methods may be considered. The shortened RFL-OA scale exhibits strong reliability and validity evidence with a sample of community-dwelling older adults from across the United States. The scale can help researchers and clinicians determine beliefs and expectancies that are thought to reduce suicide risk through administration of a brief clinical assessment instrument. Identifying an older adult’s reasons for living may aid in prevention of suicide ideation and help mitigate risk of suicide. Future research on the clinical application of the shortened RFL-OA scale may help explore whether this instrument could be used as a tool for assessing suicide ideation. Funding None reported. Conflict of Interest None reported. References Bakhiyi, C. L., Calati, R., Guillaume, S., & Courtet, P. ( 2016). Do reasons for living protect against suicidal thoughts and behaviors? A systematic review of the literature. Journal of Psychiatric Research , 77, 92– 108. doi: 10.1016/j.jpsychires.2016.02.019 Google Scholar CrossRef Search ADS PubMed  Beck, A. T., Weissman, A., Lester, D., & Trexler, L. ( 1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology , 42, 861– 865. doi: 10.1037/h0037562 Google Scholar CrossRef Search ADS PubMed  Bhar, S. S., & Brown, G. K. ( 2011). Treatment of depression and suicide in older adults. Cognitive and Behavioral Practice , 19, 116– 125. doi: 10.10/j.cbpa.2010.12.005. Google Scholar CrossRef Search ADS   Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. ( 2015). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from www.cdc.gov/ncipc/wisqars Cukrowicz, K. C., Jahn, D. R., Graham, R. D., Poindexter, E. K., & Williams, R. B. ( 2013). Suicide risk in older adults: Evaluating models of risk and predicting excess zeros in a primary care sample. Journal of Abnormal Psychology , 122, 1021– 1030. doi: 10.1037/a0034953 Google Scholar CrossRef Search ADS PubMed  Curtin, S. C., Warner, M., & Hedegaard, H. ( 2016). Increase in suicide in the United States, 1999–2014  (NCHS Data Brief No. 241). Hyattsville, MD: National Center for Health Statistics. Dervic, K., Oquendo, M. A., Grunebaum, M. F., Ellis, S., Burke, A. K., & Mann, J. J. ( 2004). Religious affiliation and suicide attempt. The American Journal of Psychiatry , 161, 2303– 2308. doi: 10.1176/appi.ajp.161.12.2303 Google Scholar CrossRef Search ADS PubMed  DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. ( 2006). Mortality prediction with a single general self-rated health question: A meta-analysis. Journal of General Internal Medicine , 21, 267– 275. doi: 10.1111/j.1525-1497.2005.00291.x Google Scholar CrossRef Search ADS PubMed  Edelstein, B. A., Heisel, M. J., McKee, D. R., Martin, R. R., Koven, L. P., Duberstein, P. R., & Britton, P. C. ( 2009). Development and psychometric evaluation of the reasons for living–older adults scale: A suicide risk assessment inventory. The Gerontologist , 49, 736– 745. doi: 10.1093/geront/gnp052 Google Scholar CrossRef Search ADS PubMed  Gutierrez, P. M., Osman, A., Barrios, F. X., Kopper, B. A., Baker, M. T., & Haraburda, C. M. ( 2002). Development of the reasons for living inventory for young adults. Journal of Clinical Psychology , 58, 339– 357. doi: 10.1002/jclp.1147 Google Scholar CrossRef Search ADS PubMed  Heisel, M. J., & Flett, G. L. ( 2006). The development and initial validation of the geriatric suicide ideation scale. The American Journal of Geriatric Psychiatry , 14, 742– 751. doi: 10.1097/01.JGP.0000218699.27899.f9 Google Scholar CrossRef Search ADS PubMed  Heisel, M. J., & Flett, G. L. ( 2016). Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults. Aging & Mental Health , 20, 208– 221. doi: 10.1080/13607863.2015.1072798 Google Scholar CrossRef Search ADS PubMed  Heisel, M. J., Neufeld, E., & Flett, G. L. ( 2016). Reasons for living, meaning in life, and suicide ideation: Investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults. Aging & Mental Health , 20, 195– 207. doi: 10.1080/13607863.2015.1078279 Google Scholar CrossRef Search ADS PubMed  Hertzog, C., Van Alstine, J., Usala, P. D., Hultsch, D. F., & Dixon, R. ( 1990). Measurement properties of the Center for Epidemiological Studies Depression Scale (CES-D) in older populations. Psychological Assessment , 2, 64– 72. doi: 10.1037/1040-3590.2.1.64 Google Scholar CrossRef Search ADS   June, A., Segal, D. L., Coolidge, F. L., & Klebe, K. ( 2009). Religiousness, social support and reasons for living in African American and European American older adults: An exploratory study. Aging and Mental Health , 13, 753– 760. doi: 10.1080/13607860902918215 Google Scholar CrossRef Search ADS PubMed  Koenig, H. G., & Büssing, A. ( 2010). The Duke University Religion Index (DUREL): A five-item measure for use in epidemiological studies. Religions , 1, 78– 85. doi: 10.3390/rel1010078 Google Scholar CrossRef Search ADS   Leon, A. C., Friedman, R. A., Sweeney, J. A., Brown, R. P., & Mann, J. J. ( 1990). Statistical issues in the identification of risk factors for suicidal behavior: The application of survival analysis. Psychiatry Research , 31, 99– 108. doi: 10.1016/0165-1781(90)90112-I Google Scholar CrossRef Search ADS PubMed  Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. ( 1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging , 12, 277– 287.doi: 10.1037/0882-7974.12.2.277 Google Scholar CrossRef Search ADS PubMed  Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. ( 1983). Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. Journal of Consulting and Clinical Psychology , 51, 276– 286. doi: 10.1037/0022-006X.51.2.276 Google Scholar CrossRef Search ADS PubMed  Lutz, J., & Fiske, A. ( 2017). Perceived burdensomeness in older and younger adults: Evaluation of the psychometric properties of the interpersonal needs questionnaire. Journal of Clinical Psychology , 73, 1179– 1195. doi: 10.1002/jclp.22415 Google Scholar CrossRef Search ADS PubMed  Miller, J. S., Segal, D. L., & Coolidge, F. L. ( 2001). A comparison of suicidal thinking and reasons for living among younger and older adults. Death Studies , 25, 357– 365. doi: 10.1080/07481180126250 Google Scholar CrossRef Search ADS PubMed  Miller, T. R., & Wolinsky, F. D. ( 2007). Self-rated health trajectories and mortality among older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences , 62, S22– S27. doi: 10.1093/geronb/62.1.S22 Google Scholar CrossRef Search ADS   Osman, A., Kopper, B. A., Barrios, F. X., Osman, J. R., Besett, T., & Linehan, M. M. ( 1996). The Brief Reasons for Living Inventory for Adolescents (BRFL-A). Journal of Abnormal Child Psychology , 24, 433– 443. doi: 10.1007/BF01441566 Google Scholar CrossRef Search ADS PubMed  Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H., Jr, Chance, J. M., & Filos, S. ( 1982). Measurement of functional activities in older adults in the community. Journal of Gerontology , 37, 323– 329. doi: 10.1093/geronj/37.3.323 Google Scholar CrossRef Search ADS PubMed  Radloff, L. S. ( 1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement , 1, 385– 401. doi: 10.1177/014 662167700100306 Google Scholar CrossRef Search ADS   Reynolds, W. M. ( 1982). Development of reliable and valid short forms of the Marlowe-Crowne social desirability scale. Journal of Clinical Psychology , 38, 119– 125. Google Scholar CrossRef Search ADS   Segal, D. L., Gottschling, J., Marty, M., Meyer, W. J., & Coolidge, F. L. ( 2015). Relationships among depressive, passive-aggressive, sadistic and self-defeating personality disorder features with suicidal ideation and reasons for living among older adults. Aging & Mental Health , 19, 1071– 1077. doi: 10.1080/13607863.2014.1003280 Google Scholar CrossRef Search ADS PubMed  Segal, D. L., Marty, M. A., Meyer, W. J., & Coolidge, F. L. ( 2012). Personality, suicidal ideation, and reasons for living among older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences , 67, 159– 166. doi: 10.1093/geronb/gbr080 Google Scholar CrossRef Search ADS   Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. ( 2007). Rebuilding the tower of babel: A revised nomenclature for the study of suicide and suicidal behaviors, part 1: Background, rationale, and methodology. Suicide and Life Threatening Behavior , 37, 248– 263. doi: 10.1521/suli.2007.37.3.248 Google Scholar CrossRef Search ADS PubMed  World Health Organization.( 2014). Preventing suicide: A global perspective. Retrieved from http://apps.who.int/iris/bitstream/10665/131056/8/9789241564878_eng.pdf?ua=1&ua=1 © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Gerontologist Oxford University Press

A Shortened Version of the Reasons for Living—Older Adults Scale for Clinical and Research Utility

Loading next page...
 
/lp/ou_press/a-shortened-version-of-the-reasons-for-living-older-adults-scale-for-eh80WJD595
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
0016-9013
eISSN
1758-5341
D.O.I.
10.1093/geront/gny009
Publisher site
See Article on Publisher Site

Abstract

Abstract Background and Objectives Older adults have elevated suicide rates, and identification of protective factors, such as reasons for living, is important in preventing suicide. The Reasons for Living—Older Adults scale (RFL-OA) is a 69-item measure of these protective factors in late life, which yields good psychometric properties. However, its length limits its utility in some clinical and research contexts where a shorter measure is ideal. The objective of this study was to create a shortened version of the RFL-OA. Research Design and Methods First, data collected previously during validation of the original RFL-OA (n = 199, age 65 and older, 65% female) were used to select 30 items, spanning all content areas, that were highly endorsed. Second, new data were collected (n = 219, age 60 and older, 52% female) with the 30-item RFL-OA and measures of depression, hopelessness, suicidal ideation, religiosity, health, and social desirability to examine the measure’s internal consistency and convergent and discriminant validity. Results Scores on the 30-item RFL-OA exhibited strong internal consistency. The short RFL-OA demonstrated good convergent validity via significant, moderate correlations with suicidal ideation, hopelessness, depression, and religiosity. It demonstrated adequate discriminant validity via only small correlations with disability, subjective health, and social desirability. Discussion and Implications The shorter RFL-OA has good psychometric properties among community-dwelling older adults. It may have greater utility, compared to the original 69-item measure, for clinicians and researchers with limited time but who want to assess protective factors against suicidal behavior in late life. Suicide, Measurement, Psychometrics Over 800,000 people worldwide took their own lives in 2012, which represents a suicide rate of 11.4 per 100,000 individuals (World Health Organization, 2014). The latest estimate of the suicide rate for the United States was 13.8 per 100,000 in 2015 (Centers for Disease Control, 2015). The highest rates of suicide in most of the world occur among individuals aged 70 and older (World Health Organization, 2014), with the rate for individuals 85 years of age and older being 18.6 per 100,000. Unfortunately, though the all-cause mortality rate has decreased in the United States, suicide rates continue to increase, with the age-adjusted rate increasing by 24% between 1999 and 2014 (Curtin, Warner, & Hedegaard, 2016). Though a variety of risk factors have been identified and targeted for the prevention of suicide, the current approaches to suicide prevention remain inadequate (Bakhiyi, Calati, Guillaume, & Courtet, 2016). More recent preventive approaches have begun to heavily focus on resilience and the buffering effects of several factors (e.g., Bakhiyi et al., 2016; Heisel, Neufeld, & Flett, 2016). Among these various protective factors is an individual’s reasons for living. Linehan and colleagues (1983) noted that individuals with prior suicidal behavior reported fewer reasons for living than individuals without such histories and placed less value on their reasons for living. These findings revealed the potentially protective value of reasons for living and spurred the further exploration of reasons for living in the literature. In subsequent years, age-appropriate reasons for living scales were developed for adolescents (Osman et al., 1996), young adults (Gutierrez et al., 2002), and older adults (Edelstein et al., 2009). In their systematic review of research conducted with the original reasons for living scale (RFL; Linehan et al., 1983), Bakhiyi and colleagues (2016) concluded that reasons for living can protect against suicidal ideation and death by suicide, even after adjusting for depression and hopelessness. Virtually all of the reviewed research was conducted with individuals under the age of 65. Several of these studies (e.g., Segal, Gottschling, Marty, Meyer, & Coolidge, 2015; Segal, Marty, Meyer, & Coolidge, 2012) provided evidence of the utility of the RFL scale (Linehan et al., 1983) with older adults. The Reasons for Living—Older Adults inventory (RFL-OA; Edelstein et al., 2009) was originally developed for use with older adults who are at risk for suicide to provide a more age-appropriate measure of reasons for living than the original RFL scale. It is a 69-item measure, 28 of which are similar to those of the original Reasons for Living inventory (Linehan et al., 1983). Psychometric evaluation of the instrument with clinical and nonclinical samples yielded strong reliability, and convergent and criterion-related validity evidence. Although the RFL-OA is quite suitable as a clinical assessment instrument, its length is a significant limiting factor for researchers seeking such an instrument and for clinicians with limited time. In light of that, the substantial suicide risk for older adults, and the paucity of research on protective factors for older adults at risk for suicide, the present study was conducted to develop a brief version of the RFL-OA and examine its psychometric properties with a sample of community-dwelling older adults from across the United States. The selection of items and examination of the shortened measure’s psychometric properties were completed in two steps. Study 1: Item Selection Research Design and Methods Participants Data from four samples previously collected for studies examining the psychometric properties of the original RFL-OA were used to examine item performance and select items to retain for the shorter version. A total of 199 adults aged 65 and older comprised the sample for the present study, and data were collected via mail-in surveys completed in West Virginia. Measures The original 69-item RFL-OA was used in all samples noted above. Basic demographic information (age, gender, race/ethnicity) also was gathered. The RFL-OA has previously been validated in samples of older adults (Edelstein et al., 2009) and used in both research and clinical settings. Each item (a reason for living) is rated on a 1–6 Likert-type scale for its importance for not committing suicide (1 = “Extremely unimportant,” 2 = “Quite unimportant,” 3 = “Somewhat unimportant,” 4 = “Somewhat important,” 5 = Quite important,” 6 = “Extremely important”). As an additional note, relatively recently, researchers and clinicians in the field of suicidology generally discourage the use of the term “committing suicide,” in favor of other terminology such as “die by suicide” (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). The wording of this measure was not changed for the purpose of this study, as a change in wording may affect how the shorter version relates to the original and the general public is likely still most familiar with the original terminology (i.e., “committing suicide”). Analyses Exploratory factor analysis (EFA) was used to examine correlations between items and factor loadings and structure of the original RFL-OA. Based on the resulting factor structure, areas of content were identified to preserve in the shorter RFL-OA for the purpose of maintaining content validity (i.e., some items within each factor/content area were retained for the shorter scale). Then, items were selected to retain based on frequency of endorsement (i.e., percentage of participants who rated the item as “Quite important” or “Extremely important”). Given the purpose of the shorter scale as a possible clinical tool in addition to research purposes, the goal of item selection was to retain items among which participants or patients would be likely to identify relevant reasons for living. Results The combined sample consisted of 199 participants age 65 and older. The majority of the sample was female (65%) and Caucasian/White (98%). EFA yielded five factors from the original 69 items of the RFL-OA. These factors consisted of religious, family related, coping ability related, and positive outlook toward life-related reasons for not taking your life, and a factor that encompassed other reasons for not taking your life. Within each of five factors, items to retain were selected based on frequency of endorsement of reasons as “Quite important” or greater. In general, retained items were endorsed by 70% or more of participants, though this varied slightly by factor. Thirty items were retained for the shorter scale. This number of items was selected based on the researchers’ judgment that all identified content areas appeared to be well covered in the shortened version of the measure, with an adequate number of highly endorsed items to make it likely that a client could identify one or more relevant reasons for living. This was consistent with the goal of enhancing clinical utility with the shorter version of the measure. Study 2: Psychometric Examination Research Design and Methods Participants Participants were adults age 60 and older who were enrolled in and participated in surveys through Amazon Mechanical Turk (MTurk) and located in the United States. Procedure Participants were recruited via MTurk with a brief study description. Participants who were interested in the study were directed via a link to the set of questionnaires on SurveyMonkey. Participants were first shown a cover page with informed consent information and indicated their consent by continuing to the next page for the survey. Participants completed the questionnaires online in the following order: demographic information, then the shortened RFL-OA, then the Centers for Epidemiological Studies—Depression scale (CESD), Beck Hopelessness Scale (BHS), Social Desirability Scale (SDS), Duke University Religion Index (DUREL), and Activities of Daily Living (ADLs; see below). The Geriatric Suicide Ideation Scale (GSIS) (see below) was administered last to allow for a mental health services referral notice immediately following completion of that scale. When participants finished the survey, they were given a code with which to confirm participation in MTurk and receive payment. This study was approved by the West Virginia University Institutional Review Board. Measures Demographic information including age, gender, racial/ethnic background, marital status, education level, occupational status, and self-rated health were collected. Centers for Epidemiological Studies—Depression scale The CESD is a 20-item self-report measure of depressive symptoms that has been widely used and validated in a variety of populations (Radloff, 1977). Depressive symptoms are rated by frequency of occurrence from 0 to 3, with total scores ranging from 0 to 60. Higher scores are indicative of greater depressive symptoms. The CESD exhibits good internal reliability (e.g., α = .78–.83) and validity (e.g., supported factor model in older adults; area under the curve predicting depression diagnosis = .84–.86) among older adults (Hertzog et al., 1990; Lewinsohn, Seeley, Roberts, & Allen, 1997). Beck Hopelessness Scale The BHS is a 20-item self-report measure of hopelessness (Beck, Weissman, Lester, & Trexler, 1974). Respondents rate each statement as true or false, and total scores range from 0 to 20 such that higher scores are indicative of greater hopelessness. The BHS has been used for all ages and demonstrates good internal reliability (e.g., α = .85–.93) and validity, via positive associations with suicidality (e.g., r = .43) and depression (e.g., r = .51), among older adults (Cukrowicz, Jahn, Graham, Poindexter, & Williams, 2013; Lutz & Fiske, 2017). Geriatric Suicide Ideation Scale The GSIS is a 31-item measure of suicidal ideation among older adults (Heisel & Flett, 2006). Respondents rate agreement with symptoms from 1 (“strongly disagree”) to 5 (“strongly agree”). Total scores range from 31 to 155, with higher scores representing greater levels of suicidal ideation. The GSIS exhibits good internal consistency (e.g., α = .90–.93) and test–retest reliability (e.g., intraclass correlation = .53–.81, r = .86), as well as convergent validity (e.g., correlated with Beck Scale for Suicide Ideation r = .62; correlated with depression r = .43–.77), among older adults (Heisel & Flett, 2006, 2016). Duke University Religion Index The DUREL is a brief, five-item self-report measure of religiosity (Koenig & Büssing, 2010). It yields three scores. The first item measures frequency of attendance at public religious activities (i.e., “church or other religious meetings”) and is rated on a 6-point scale ranging from 1 (“Never”) to 6 (“More than once a week”). The second item measures frequency of participation in private religious activities (“such as prayer, meditation, or Bible study”) and is rated on a 6-point scale ranging from 1 (“Rarely or never”) to 6 (“More than once a day”). The final three items measure intrinsic religiosity (e.g., experiencing the presence of a divine being, incorporation of religious beliefs into daily life) and are rated on a 5-point scale ranging from 1 (“Definitely not true”) to 5 (“Definitely true of me”). These three item scores are totaled. Higher scores represent greater religiosity for all three parts. The scale has exhibited adequate internal reliability (α = .78–.91) and convergent validity (correlations with other religiosity measures r = .71–.86; Koenig & Büssing, 2010). Activities of Daily Living To measure functional ability, activities of daily living were assessed using the Functional Activities Questionnaire (Pfeffer, Kurosaki, Harrah, Chance, & Filos, 1982). Participants rated their ability to complete 10 activities, from 0 (“normal”) to 3 (“dependent”). Total scores range from 0 to 30, with higher scores indicating greater functional impairment. This questionnaire (originally validated as an alternate informant measure) has demonstrated convergent validity with other ADL measures (r = .72) and several indices of cognitive functioning (e.g., neurologists’ estimates of function r = −.83; Pfeffer et al., 1982). Self-Rated Health As a measure of general self-rated health, participants were asked “In general, would you say your health is: excellent, very good, good, fair, or poor?” Responses were scored from 1 (“poor”) to 5 (“excellent”). Single self-rated health items such as this one serve as valid measures of general subjective health and are predictive of mortality in older adults (e.g., “poor” self-rated health is associated with mortality rate two times as high as “excellent” self-rated health; DeSalvo, Bloser, Reynolds, He, & Muntner, 2006; Miller & Wolinsky, 2007). Social Desirability Scale The 13-item short form C of the Marlowe-Crowne Social Desirability Scale was used to measure the extent to which participants were responding along socially desirable lines (Reynolds, 1982). Items require true or false responses and are then coded such that the socially desirable response is 1 and the other response is 0. Total scores range from 0 to 13, with higher scores indicating greater socially desirable responding. This short form exhibits good internal reliability (Kuder-Richardson Formula 20 = 0.76) and correlates highly with the original standard Marlowe–Crowne measure (r = .93) in an undergraduate sample (Reynolds, 1982). Analyses Data collection included items designed to check validity of responses and participants’ recorded age. Validity of responses was assessed by (a) matching responses on multiple items assessing age in years and year of birth at different times in the survey (i.e., whether age and year of birth matched within 1 year and whether year of birth reported at the beginning of the survey matched year of birth reported at the end of the survey) and (b) randomly distributed items requesting participants to select a particular response if they were reading that item (e.g., “To check that you are reading this item, please select ‘True’”). Data only from participants who responded correctly on five or more of six validity items, and whose responses regarding age and birth year were consistent, were used. In addition, only data from participants who completed the RFL-OA were used in these analyses. On all other measures, pairwise deletion was used if participants did not complete the measures. First, EFA with promax rotation was used to examine the factor structure of the shortened RFL-OA and to examine individual item performance in terms of correlation with other items and loading onto the scale factors. Second, internal consistency was measured using Cronbach’s alpha. Third, convergent validity evidence for the shortened RFL-OA was examined via correlations with measures of depression symptoms (CESD), hopelessness (BHS), suicide ideation (GSIS), and religiosity (due to a number of items related to religious/spiritual reasons for living; DUREL). Finally, discriminant validity evidence was examined via correlations with measures of social desirability (SDS) and functional impairment/activities of daily living (ADL). Results Two hundred ninety-one older adults participated in an MTurk survey. Forty-three were excluded from data analysis due to failure to meet validity standards outlined above. Of those who met validity standards, 29 failed to complete the RFL-OA. The final sample consisted of 219 participants. Ages ranged from 60 to 80 years, with the majority (71.2%) between the ages of 60 and 65 years. Slightly more than half of the sample was female (52.1%). The sample was majority non-Hispanic White/Caucasian (80.8%), with 8.7% Black/African American, 3.2% Asian American, 3.7% Hispanic, 1.4% Native American, and 1.8% other race/ethnicity. The majority of the sample had completed at least some college (82.1%). EFA of the 30-item scale with the new data yielded three factors. These factors, broadly speaking, consisted of items measuring religious (e.g., “I put my life in God’s hands”), family-related (e.g., “I want to see my grandchildren grow up”), and positive/hopeful (e.g., “Life is too beautiful and precious to end it”) reasons for not taking your life. See Table 1 for loadings of items onto factors. The factors were correlated (r = .28 between positive and religious reasons; r = .63 between positive and family-related reasons; and r = .35 between religious and family-related reasons). Cronbach’s alpha of scores on the 30-item RFL-OA is .94, suggesting very good internal reliability in this sample. Table 1. Rotated Factor Loadings of 30 Items From Shortened Reasons for Living—Older Adults Scale Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Note: Loadings are from the pattern matrix using promax rotation. Bolded values indicate the factors onto which items loaded most strongly. Loved ones = reasons for living associated with loved ones/family; Positive = positive attitudes about life; Religious = religious reasons for living. aItems are abbreviated—see full measure for wording of items. View Large Table 1. Rotated Factor Loadings of 30 Items From Shortened Reasons for Living—Older Adults Scale Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Itema  Positive  Religious  Family  2. Can find other solutions to problems  .725  −.008  .060  3. Have love of life  .735  .019  .001  6. Can learn to adjust or cope with problems  .707  −.082  .116  7. Would be stupid or foolish  .537  .027  .117  8. Don’t believe things get miserable or hopeless enough  .627  −.036  .106  11. Want to experience life  .738  .030  .006  14. Have coped before and will again  .741  .060  −.026  15. Have hope that things will improve  .879  .010  −.202  16. Have learned to laugh at troubles, not take life too seriously  .480  −.023  .144  17. No reason to hurry death  .696  −.029  −.028  19. Still capable of doing many things  .858  −.028  −.121  20. Care enough about myself to live  .743  −.049  .027  22. Life too beautiful and precious to end  .802  .039  .005  23. Life is a gift  .684  .218  −.022  24. Can think of someone else worse off than me  .325  .112  .161  25. Happy and content with life  .445  −.023  .337  26. Have desire to live  .838  −.065  −.092  4. Only God has right to end life  −.141  .874  .078  9. God will give me will to live  −.001  .912  .011  13. God will not overburden me  .088  .853  .064  18. Have faith in God  .101  .902  −.077  28. Religion gives me strength and peace  −.044  .922  .019  29. Put life in God’s hands  .025  .954  −.033  1. Would hurt family  .183  −.011  .460  5. Want to see grandchildren grow up  −.163  .083  .855  10. Love and enjoy family, could not leave them  .246  −.055  .612  12. Have loving family who supports me  .205  −.120  .708  21. Enjoy grandchildren/great grandchildren  −.145  .085  .831  27. Don’t want to abandon spouse  −.038  .011  .491  30. Want to spend time with friends and loved ones  .302  −.007  .514  Note: Loadings are from the pattern matrix using promax rotation. Bolded values indicate the factors onto which items loaded most strongly. Loved ones = reasons for living associated with loved ones/family; Positive = positive attitudes about life; Religious = religious reasons for living. aItems are abbreviated—see full measure for wording of items. View Large The 30-item RFL-OA also exhibited good convergent and discriminant validity. See Table 2 for correlations between all relevant measures. The shortened RFL-OA is moderately and significantly negatively correlated with suicide ideation, hopelessness, and depression. The total RFL-OA score is also correlated with religiosity, though it is more strongly correlated with items measuring intrinsic religiosity than those measuring attendance or participation in public and private religious activities. Though the RFL-OA is significantly correlated with activities of daily living and social desirability, these correlations are small. The RFL-OA is not significantly correlated with self-rated health. Table 2. Correlations Between 30-Item Reasons for Living—Older Adults Scale and Other Measures   RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19    RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19  Note: RFL-OA = 30-item Reasons for Living—Older adults scale; CESD = Centers for Epidemiological Studies—Depression scale; BHS = Beck Hopelessness Scale; GSIS = Geriatric Suicide Ideation Scale; DUREL = Duke University Religion Index; DUREL1 = frequency of attendance at religious services; DUREL2 = frequency of private religious activities; DUREL3–5 = intrinsic religiosity; ADL = Activities of daily living; Health = self-rated health; SDS = Social Desirability Scale. N = sample size with completed measure (of 219 with complete RFL-OA). *p < .05. **p < .01. ***p < .001. View Large Table 2. Correlations Between 30-Item Reasons for Living—Older Adults Scale and Other Measures   RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19    RFL-OA  CESD  BHS  GSIS  DUREL1  DUREL2  DUREL3–5  ADL  Health  SDS  RFL-OA    −.490***  −.569***  −.533***  .184**  .338***  .499***  −.250***  .106  .197**  CESD      .800***  .785***  .143*  −.005  −.064  .592***  −.202**  −.297***  BHS        .760***  .087  −.074  −.163*  .375***  −.258***  −.235**  GSIS          .302***  .032  −.019  .606***  −.142*  −.163*  DUREL1            .507***  .592***  .322***  .002  .124  DUREL2              .727***  .070  −.006  .095  DUREL3–5                .082  −.035  .174*  ADL                  −.088  −.190**  Health                    .146*  N  219  197  206  202  219  219  219  212  219  211  Mean  136.76  14.17  5.04  59.64  2.93  3.15  9.29  3.76  2.56  6.68  SD  27.49  12.39  4.85  24.47  1.69  1.82  4.07  6.18  0.92  3.19  Note: RFL-OA = 30-item Reasons for Living—Older adults scale; CESD = Centers for Epidemiological Studies—Depression scale; BHS = Beck Hopelessness Scale; GSIS = Geriatric Suicide Ideation Scale; DUREL = Duke University Religion Index; DUREL1 = frequency of attendance at religious services; DUREL2 = frequency of private religious activities; DUREL3–5 = intrinsic religiosity; ADL = Activities of daily living; Health = self-rated health; SDS = Social Desirability Scale. N = sample size with completed measure (of 219 with complete RFL-OA). *p < .05. **p < .01. ***p < .001. View Large Discussion and Implications Given the considerable suicide risk for older adults and the limited data on protective factors for older adults at risk for suicide, this present study was conducted to develop and evaluate a shortened measure of reasons for living in older adults. Identifying reasons for living can assist as a preventative strategy and coping skill for individuals with suicide ideation; however, the length of the initial Reasons for Living Scale—Older Adult scale (RFL-OA) potentially limited its research use and clinical application. The purpose of the present two studies was to develop a shortened version of the RFL-OA and examine its psychometric properties. The original RFL-OA (Edelstein et al., 2009) includes 69 items, whereas the shortened version includes 30 items. Study 1 involved item selection to assist in the development of the shortened RFL-OA scale from a combined sample of previous data on the original version. A five-factor structure was identified from the original RFL-OA. The five factors identified were as follows: religious reasons for living, family-related reasons for living, coping self-efficacy beliefs, positive outlook toward life, and a factor that encompassed other reasons for living. Thirty items were retained in this shorter version. Study 2 examined the psychometric properties of the shortened RFL-OA scale with a new sample of 219 older adults recruited from Amazon’s Mechanical Turk. Reliability analysis yielded a Cronbach’s alpha of .94, supporting the measure’s internal reliability. The shortened RFL-OA is significantly correlated at a moderate level with suicide ideation, hopelessness, depression, and religiosity, providing convergent validity evidence. Only small or nonsignificant correlations were found between the RFL-OA and activities of daily living, self-rated health, and social desirability, providing evidence of discriminant validity. Of note, an EFA for the 30-item RFL yielded three factors instead of the five factors in the 69-item version: religious reasons for living, family-related reasons for living, and positive/hopeful attitudes about life. However, items from coping self-efficacy and positive outlook factors appeared to be combined into one factor in the shorter version and were otherwise consistent with the factor structure of the longer version. The factor structure identified by the current studies is consistent with previous research examining factors that influence reasons for living in older adult samples. Higher religiosity has been found to be associated with greater number of reasons for living (June, Segal, Coolidge, & Klebe, 2009). Also, religious-based moral objections and child-related concerns are stronger reasons for not dying by suicide for older than younger adults (Miller, Segal, & Coolidge, 2001), providing further support for the factors identified in this study. The shortened version of the RFL-OA scale, in conjunction with Cognitive Behavior Therapy (CBT), could assist with the identification of reasons for living in older adults who are experiencing suicidality and be incorporated into clinical treatment. CBT has been successfully utilized to help target risk factors for suicide in older adults (Bhar & Brown, 2011). The use of CBT strategies, such as identifying reasons for living, can facilitate assessment of suicide risk and may help decrease depression, hopelessness, and suicide ideation. Additionally, the three factors that the shortened scale identified can help guide conversations about reasons for living during treatment. For example, religious reasons for living, one of the three factors, can provide additional information about a client’s risk for suicide. Religious affiliation is associated with individuals being less likely to have a history of suicide attempts, which is one of the main predictors of future suicide attempts (Dervic et al., 2004; Leon et al., 1990). Identification of religious reasons for living during clinical treatment can help individuals recognize meaning in their lives and increase hopefulness and optimism in therapy. There are a few limitations of this study. One potential limitation was that the sample from Study 2 consisted primarily of non-Hispanic White/Caucasian participants who had at least some college education, and were between the ages of 60 and 65 years. This fact could limit the generalizability of the findings and should be considered when interpreting the findings presented. Additional research should consider further examination of the RFL-OA with a more demographically diverse sample of participants in terms of age, ethnicity, race, and education. Another potential limitation is the decision-making process during item selection in Study 1 was based on retaining items that have been endorsed by the majority of research participants. This specific process was chosen in anticipation of using the RFL-OA scale as a tool in clinical settings for assisting people who were suicidal in identifying reasons for living. Depending on other researchers’ or clinicians’ different goals for use of a shortened measure, additional item selection methods may be considered. The shortened RFL-OA scale exhibits strong reliability and validity evidence with a sample of community-dwelling older adults from across the United States. The scale can help researchers and clinicians determine beliefs and expectancies that are thought to reduce suicide risk through administration of a brief clinical assessment instrument. Identifying an older adult’s reasons for living may aid in prevention of suicide ideation and help mitigate risk of suicide. Future research on the clinical application of the shortened RFL-OA scale may help explore whether this instrument could be used as a tool for assessing suicide ideation. Funding None reported. Conflict of Interest None reported. References Bakhiyi, C. L., Calati, R., Guillaume, S., & Courtet, P. ( 2016). Do reasons for living protect against suicidal thoughts and behaviors? A systematic review of the literature. Journal of Psychiatric Research , 77, 92– 108. doi: 10.1016/j.jpsychires.2016.02.019 Google Scholar CrossRef Search ADS PubMed  Beck, A. T., Weissman, A., Lester, D., & Trexler, L. ( 1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology , 42, 861– 865. doi: 10.1037/h0037562 Google Scholar CrossRef Search ADS PubMed  Bhar, S. S., & Brown, G. K. ( 2011). Treatment of depression and suicide in older adults. Cognitive and Behavioral Practice , 19, 116– 125. doi: 10.10/j.cbpa.2010.12.005. Google Scholar CrossRef Search ADS   Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. ( 2015). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from www.cdc.gov/ncipc/wisqars Cukrowicz, K. C., Jahn, D. R., Graham, R. D., Poindexter, E. K., & Williams, R. B. ( 2013). Suicide risk in older adults: Evaluating models of risk and predicting excess zeros in a primary care sample. Journal of Abnormal Psychology , 122, 1021– 1030. doi: 10.1037/a0034953 Google Scholar CrossRef Search ADS PubMed  Curtin, S. C., Warner, M., & Hedegaard, H. ( 2016). Increase in suicide in the United States, 1999–2014  (NCHS Data Brief No. 241). Hyattsville, MD: National Center for Health Statistics. Dervic, K., Oquendo, M. A., Grunebaum, M. F., Ellis, S., Burke, A. K., & Mann, J. J. ( 2004). Religious affiliation and suicide attempt. The American Journal of Psychiatry , 161, 2303– 2308. doi: 10.1176/appi.ajp.161.12.2303 Google Scholar CrossRef Search ADS PubMed  DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. ( 2006). Mortality prediction with a single general self-rated health question: A meta-analysis. Journal of General Internal Medicine , 21, 267– 275. doi: 10.1111/j.1525-1497.2005.00291.x Google Scholar CrossRef Search ADS PubMed  Edelstein, B. A., Heisel, M. J., McKee, D. R., Martin, R. R., Koven, L. P., Duberstein, P. R., & Britton, P. C. ( 2009). Development and psychometric evaluation of the reasons for living–older adults scale: A suicide risk assessment inventory. The Gerontologist , 49, 736– 745. doi: 10.1093/geront/gnp052 Google Scholar CrossRef Search ADS PubMed  Gutierrez, P. M., Osman, A., Barrios, F. X., Kopper, B. A., Baker, M. T., & Haraburda, C. M. ( 2002). Development of the reasons for living inventory for young adults. Journal of Clinical Psychology , 58, 339– 357. doi: 10.1002/jclp.1147 Google Scholar CrossRef Search ADS PubMed  Heisel, M. J., & Flett, G. L. ( 2006). The development and initial validation of the geriatric suicide ideation scale. The American Journal of Geriatric Psychiatry , 14, 742– 751. doi: 10.1097/01.JGP.0000218699.27899.f9 Google Scholar CrossRef Search ADS PubMed  Heisel, M. J., & Flett, G. L. ( 2016). Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults. Aging & Mental Health , 20, 208– 221. doi: 10.1080/13607863.2015.1072798 Google Scholar CrossRef Search ADS PubMed  Heisel, M. J., Neufeld, E., & Flett, G. L. ( 2016). Reasons for living, meaning in life, and suicide ideation: Investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults. Aging & Mental Health , 20, 195– 207. doi: 10.1080/13607863.2015.1078279 Google Scholar CrossRef Search ADS PubMed  Hertzog, C., Van Alstine, J., Usala, P. D., Hultsch, D. F., & Dixon, R. ( 1990). Measurement properties of the Center for Epidemiological Studies Depression Scale (CES-D) in older populations. Psychological Assessment , 2, 64– 72. doi: 10.1037/1040-3590.2.1.64 Google Scholar CrossRef Search ADS   June, A., Segal, D. L., Coolidge, F. L., & Klebe, K. ( 2009). Religiousness, social support and reasons for living in African American and European American older adults: An exploratory study. Aging and Mental Health , 13, 753– 760. doi: 10.1080/13607860902918215 Google Scholar CrossRef Search ADS PubMed  Koenig, H. G., & Büssing, A. ( 2010). The Duke University Religion Index (DUREL): A five-item measure for use in epidemiological studies. Religions , 1, 78– 85. doi: 10.3390/rel1010078 Google Scholar CrossRef Search ADS   Leon, A. C., Friedman, R. A., Sweeney, J. A., Brown, R. P., & Mann, J. J. ( 1990). Statistical issues in the identification of risk factors for suicidal behavior: The application of survival analysis. Psychiatry Research , 31, 99– 108. doi: 10.1016/0165-1781(90)90112-I Google Scholar CrossRef Search ADS PubMed  Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. ( 1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging , 12, 277– 287.doi: 10.1037/0882-7974.12.2.277 Google Scholar CrossRef Search ADS PubMed  Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. ( 1983). Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. Journal of Consulting and Clinical Psychology , 51, 276– 286. doi: 10.1037/0022-006X.51.2.276 Google Scholar CrossRef Search ADS PubMed  Lutz, J., & Fiske, A. ( 2017). Perceived burdensomeness in older and younger adults: Evaluation of the psychometric properties of the interpersonal needs questionnaire. Journal of Clinical Psychology , 73, 1179– 1195. doi: 10.1002/jclp.22415 Google Scholar CrossRef Search ADS PubMed  Miller, J. S., Segal, D. L., & Coolidge, F. L. ( 2001). A comparison of suicidal thinking and reasons for living among younger and older adults. Death Studies , 25, 357– 365. doi: 10.1080/07481180126250 Google Scholar CrossRef Search ADS PubMed  Miller, T. R., & Wolinsky, F. D. ( 2007). Self-rated health trajectories and mortality among older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences , 62, S22– S27. doi: 10.1093/geronb/62.1.S22 Google Scholar CrossRef Search ADS   Osman, A., Kopper, B. A., Barrios, F. X., Osman, J. R., Besett, T., & Linehan, M. M. ( 1996). The Brief Reasons for Living Inventory for Adolescents (BRFL-A). Journal of Abnormal Child Psychology , 24, 433– 443. doi: 10.1007/BF01441566 Google Scholar CrossRef Search ADS PubMed  Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H., Jr, Chance, J. M., & Filos, S. ( 1982). Measurement of functional activities in older adults in the community. Journal of Gerontology , 37, 323– 329. doi: 10.1093/geronj/37.3.323 Google Scholar CrossRef Search ADS PubMed  Radloff, L. S. ( 1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement , 1, 385– 401. doi: 10.1177/014 662167700100306 Google Scholar CrossRef Search ADS   Reynolds, W. M. ( 1982). Development of reliable and valid short forms of the Marlowe-Crowne social desirability scale. Journal of Clinical Psychology , 38, 119– 125. Google Scholar CrossRef Search ADS   Segal, D. L., Gottschling, J., Marty, M., Meyer, W. J., & Coolidge, F. L. ( 2015). Relationships among depressive, passive-aggressive, sadistic and self-defeating personality disorder features with suicidal ideation and reasons for living among older adults. Aging & Mental Health , 19, 1071– 1077. doi: 10.1080/13607863.2014.1003280 Google Scholar CrossRef Search ADS PubMed  Segal, D. L., Marty, M. A., Meyer, W. J., & Coolidge, F. L. ( 2012). Personality, suicidal ideation, and reasons for living among older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences , 67, 159– 166. doi: 10.1093/geronb/gbr080 Google Scholar CrossRef Search ADS   Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. ( 2007). Rebuilding the tower of babel: A revised nomenclature for the study of suicide and suicidal behaviors, part 1: Background, rationale, and methodology. Suicide and Life Threatening Behavior , 37, 248– 263. doi: 10.1521/suli.2007.37.3.248 Google Scholar CrossRef Search ADS PubMed  World Health Organization.( 2014). Preventing suicide: A global perspective. Retrieved from http://apps.who.int/iris/bitstream/10665/131056/8/9789241564878_eng.pdf?ua=1&ua=1 © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Journal

The GerontologistOxford University Press

Published: Feb 26, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off