Suicide is a major public health problem, with 817,000 cases worldwide in 2016. The incidence is highest in those aged 70 years or older, among both men and women, in almost all regions of the world¹.

Effective interventions that mitigate iden­tified risk factors and sustain protective fac­tors are relevant across all age groups, but re­search specifically focused on suicide pre­vention in older adults is still in its early stag­es. The evidence on the effectiveness of suicide prevention interventions for older adults remains limited. The International Association for Suicide Prevention Interest Group on Suicide in Old Age² recommended multi-component approaches, based on the available scientific evidence, with an organized system of distribution of resources and the monitoring of the effectiveness of each intervention.

Loneliness occurs when a person feels disconnected from his/her closest social circle: partners, family members, peers, friends and significant others. It often affects older adults, particularly men when single, widowed or divorced³. It may result from the loss of an important intimate relationship or a social role that previously used to give a person his/her sense of self-esteem and dignity. In case of negative life events or other psychological stressful situations, when the person has nobody to share his/her feelings with, loneliness can have particularly negative consequenc­es. This, in combination with other risk factors, can lead to an increase of the risk for suicidal behaviour. A particular expression of loneliness among older adults is the fact that suicides more often occur when the person is alone at home⁴.

The consequences of the COVID-19 pan­demic have resulted in new challenges for older adults, and we are just beginning to see the effects on morbidity, mortality and suicide rates worldwide⁵. Many government policies to tackle the pandemic that include social isolation, lockdown and social distancing have resulted in increased distress in older adults. We therefore need to develop strong primary care and commu­nity assets to support older adults. A rise in suicide deaths in older adults as a result of the pandemic is not inevitable⁶. The traditional approaches to suicide prevention need to be re-considered⁷, so that we can develop innovative ways to address this issue in older adults in the new context. The voices of people with lived experience should be heard to inform developments in strategies.

Previous traumatic experiences (e.g., history of abuse during childhood, loss of a parent) can have consequences in later life and be associated with increased likelihood of suicidal behaviour. But present traumatic experiences may also increase the risk for suicide. According to the World Health Organization, around 1 in 6 older people experienced some form of abuse in the past year⁸. However, the prevalence rates reported in existing population-based elder abuse studies likely underestimate the true population prevalence. Not only this field of research suffers from methodological and comparability challenges, but elder abuse prevalence surveys also carry substantial participation bias, in that they exclude individuals with cognitive impairment, who could potentially be most vulnerable to abuse, especially in institutions.

Older adults with mental health problems are at high risk for abuse. There are many forms of elder abuse, including psychological, physical, sexual, financial and social abuse, as well as neglect and abandonment. Abuse should never be condoned, whatever the mitigating circumstances. What may not be considered abusive towards a healthy, competent person may be so in a vulnerable older adult. This is mainly explained by the high risk of older adults to be dependent (financially, emotionally, physically) from the persons who perpetrate acts of violence, abuse or neglect against them.

Each form of elder abuse represents a risk factor for suicide. Several psychosocial risk factors found in severely abused older adults are also frequently present in older adults who attempted or completed suicide. Abused older adults have been paid inadequate attention in suicide prevention efforts. This omission must be remedied, as the aged global population will dramatically increase in coming decades, which, in the absence of meaningful preventive efforts, may drive a sharp rise in the incidence of older adults’ abuse and suicide⁹.

Help to establish strong social relationships and an effective legal frame to protect the individual against any form of violence are common protective factors against suicide. However, in the case of older adults, we should recognize that efforts to sustain these protective factors have been weaker than for the younger population.

Considering the high potential of loneliness as a risk factor for suicide, the WPA Section on Old Age Psychiatry has supported the establishment of an End Loneliness Day. The Section is also going to become partner of the Campaign to End Loneliness. Having the friendship and support we need is a fundamental part of our well-being. When loneliness becomes entrenched in later life, it can be hardest to overcome. The campaign aims to involve academics, front-line practitioners, decision-makers and businesses (see https://www.campaigntoendloneliness.org).

Considering that all forms of elder a­buse are a violation of basic human rights, the WPA Section on Old Age Psychiatry is contributing to the effort to develop a new United Nations Convention on the Rights of Older Persons. A first action was a webinar organized in collaboration with the International Psychogeriatric Association on December 10, 2020, on the occasion of the Human Rights Day. The Section also organized an intersectional symposium on Threats to the Dignity of Older Adults with Mental Disorders during COVID-19 Pandemic within the 2020 WPA Thematic Meeting on Intersectional Collaboration. A Position Statement on Human Rights and Mental Health of Older Adults is now in preparation.

自杀是一个主要的公共卫生问题，2016 年全世界有 817,000 例自杀。在世界几乎所有地区，70 岁或以上的男性和女性的发病率最高¹。

减轻已识别风险因素和维持保护因素的有效干预措施适用于所有年龄组，但专门针对老年人自杀预防的研究仍处于早期阶段。关于老年人自杀预防干预措施有效性的证据仍然有限。国际预防自杀协会老年自杀问题²建议采用多组分方法，基于现有科学证据，采用有组织的资源分配系统和监测每项干预措施的有效性。

当一个人感到与他/她最亲密的社交圈脱节时，就会产生孤独感：伴侣、家人、同龄人、朋友和重要的其他人。它通常影响老年人，尤其是单身、丧偶或离婚的男性³. 它可能是由于失去了以前用来赋予一个人自尊和尊严感的重要亲密关系或社会角色。如果遇到负面的生活事件或其他心理压力情况，当这个人没有人可以分享他/她的感受时，孤独会产生特别负面的后果。这与其他风险因素相结合，可能会增加自杀行为的风险。老年人孤独感的一个特殊表现是，当一个人独自在家时，更容易发生自杀⁴。

COVID-19 大流行的后果给老年人带来了新的挑战，我们才刚刚开始看到其对全球发病率、死亡率和自杀率的影响⁵。许多政府应对大流行的政策，包括社会隔离、封锁和社会疏远，导致老年人的痛苦增加。因此，我们需要发展强大的初级保健和社区资产来支持老年人。大流行导致老年人自杀死亡人数上升并非不可避免⁶。需要重新考虑预防自杀的传统方法⁷，以便我们可以开发创新方法来解决新环境中老年人的这个问题。应该听取有实际经验的人的声音，为战略的发展提供信息。

以前的创伤经历（例如，童年时期的虐待史，失去父母）可能会对以后的生活产生影响，并与自杀行为的可能性增加有关。但目前的创伤经历也可能增加自杀的风险。根据世界卫生组织的数据，大约六分之一的老年人在过去一年中经历过某种形式的虐待⁸. 然而，现有的基于人群的虐待老人研究报告的患病率可能低估了真实的人口患病率。不仅这一研究领域在方法和可比性方面面临挑战，而且老年人虐待流行率调查也存在严重的参与偏见，因为它们排除了有认知障碍的个体，这些人可能最容易受到虐待，尤其是在机构中。

有心理健康问题的老年人很容易受到虐待。虐待老人的形式多种多样，包括心理、身体、性、经济和社会虐待，以及忽视和遗弃。无论情况如何，都不应宽恕虐待行为。对于一个健康、有能力的人来说，可能不被认为是虐待，但对一个脆弱的老年人来说可能是这样。这主要是因为老年人有很高的风险依赖（经济上、情感上、身体上）对他们实施暴力、虐待或忽视行为的人。

每种形式的虐待老人都是自杀的危险因素。在遭受严重虐待的老年人身上发现的几种心理社会风险因素也经常出现在企图或完成自杀的老年人身上。在自杀预防工作中，受虐待的老年人没有得到足够的重视。必须纠正这一疏漏，因为未来几十年全球老龄人口将急剧增加，如果缺乏有意义的预防措施，这可能会导致老年人虐待和自杀的发生率急剧上升⁹。

帮助建立牢固的社会关系和有效的法律框架来保护个人免受任何形式的暴力是防止自杀的常见保护因素。然而，就老年人而言，我们应该认识到，维持这些保护因素的努力比年轻人要弱。

考虑到孤独作为自杀危险因素的可能性很大，WPA 老年精神病学组支持设立结束孤独日。该科还将成为终结孤独运动的合作伙伴。拥有我们需要的友谊和支持是我们幸福的基本组成部分。当孤独在以后的生活中根深蒂固时，它可能最难克服。该运动旨在让学者、一线从业者、决策者和企业参与其中（参见 https://www.campaigntoendloneiness.org）。

考虑到所有形式的虐待老年人都是对基本人权的侵犯，WPA 老年精神病学科正在为制定新的联合国老年人权利公约做出贡献。第一项行动是与国际老年精神病学协会合作于 2020 年 12 月 10 日人权日之​​际组织的网络研讨会。该科还在 2020 年 WPA 跨部门合作专题会议期间组织了一次关于在 COVID-19 大流行期间对患有精神障碍的老年人的尊严构成威胁的跨部门研讨会。目前正在准备一份关于老年人人权和心理健康的立场声明。