Middle adulthood can often bring its own unique challenges, many associated with specific transitions experienced during this life stage. Although there is no agreed upon definition of middle age and middle-adulthood, it can refer to a range of ages from 30 to 65.
Some significant life transitions that may be experienced by mid-age adults include the transition to parenthood, the transition to caregiving, and the transition into menopause.
This blog discusses the significance of those three transitions, how they may relate to suicide risk, and how to support adults as they experience the transitions. While these transitions are well-recognized as impacting a person’s general wellbeing and stress, they have not been well studied in the context of suicide and suicide prevention. As such, there can be limited information about specific suicide risk factors, warning signs, and protective factors for adults experiencing these transitions.
Transition to Parenthood
The transition to parenthood can be a joyful and fulfilling experience, but it also introduces new roles and responsibilities that can bring significant stress and, for some, increase the risk of suicide. Some risk factors for parental suicide include:
- High levels of parenting stress, including feelings of inadequacy.
- Child-rearing challenges.
- Marital and familial relationship problems.
- Child custody issues.
(Sources: Cerel et al., 2016; Naess et al., 2021).
Additionally, experiences of post-partum depression can lead to feelings of shame, humiliation, and suicidal ideation, with mothers fearing they may harm their baby (Paris et al. 2009). These same feelings of shame may prevent mothers from reaching out for help and support.
However, parenthood may also serve as a protective factor and contribute to a lower suicide risk. In a study of Swedish adults, it was found that having children was associated with significantly lower suicide rates (Dhara et al., 2021). It may be the sense of responsibility of caring for someone, combined with the sense of meaning and purpose that parenthood can give, that acts as a protective factor.
Supporting Parental Mental Health and Wellbeing
Although the research exploring parental mental health and suicide risk is limited, there are evidence-based recommendations for supporting parents. Support and help for parents can include:
- Community-based and accessible parenting classes and programs.
- Development and implementation of screening standards for post-partum depression, anxiety, and psychosis.
- Supportive parental leave policies.
- Early intervention programs for children and youth with mental health, physical health and/or behavioral challenges.
In many communities, public health authorities and non-profit organizations facilitate parenting classes and programs, where parents can engage with health authorities for advice, learn new skills, and build community with other parents. Many of these organizations will also provide early intervention programs for children and youth with various health challenges, including mental, physical or behavioral challenges.
It is also important for health professionals to implement screening standards for post-partum depression, anxiety, and psychosis. The warning signs of post-partum mental health challenges should also be distributed to new parents and their circle of support. Individuals experiencing post-partum mental health challenges and their families may not be able to recognize or understand signs distress. As such, it is important for their friends and family to understand the warning signs and invitations for help.
Lastly, governments and workplaces should implement supportive parental leave policies which encourage new parents to take the time they may need to rest, recover, and care for a newborn. To be supportive and accessible, parental leave policies should provide some financial support to cover lost income and should not discriminate against family status.
Transition to Caregiving
Many middle-aged adults may find themselves in the challenging position of caring for aging parents while still supporting their own children; they are often referred to as the “sandwich generation”. The stress and exhaustion of juggling these dual responsibilities can lead to burnout and emotional distress. In fact, research suggests that adult caregivers of aging parents work up to 100 hours per month in caregiving (Conway, 2019). As such, the stress and exhaustion of dual responsibilities (caring for parents, as well as their own children) can lead to burnout and emotional distress of caregivers.
Research indicates that this burden is particularly heavy for those caring for individuals with dementia. These family carers have been found to have higher rates of suicidal ideation, with one study finding that 16% of dementia carers had contemplated suicide within the past year (O’Dwyer et al., 2015).
A 2024 research article by Teasdale-Dube et al. attempted to explore risk factors for suicide ideation among caregivers. They identified the following as potential risk factors:
- Past experiences of suicidal thoughts.
- Presence of mental health challenges or mental illness, such as depression or anxiety.
- Having a low level of perceived health.
- Perceiving or experiencing a high level of caregiving burden.
Similarly to the other middle-adulthood transitions discussed, social support is identified as a protective factor against suicide risk and helps to mitigate the emotional burden experienced by caregivers (Ike et al., 2024). Caregiving can be an incredibly isolating experience, and because middle-aged caregivers can find themselves caught between competing priorities, it is important that their social support is patient, compassionate, and understanding.
Supporting Caregivers of Aging Parents
Support for caregivers of aging parents includes:
- Compassionate social support.
- Community-based respite programs.
- Incorporation of suicide screening tools into the services that are accessed by caregivers.
As indicated above, social support is a protective factor against suicide risk and can help to mitigate the emotional burden experienced by caregivers. Social isolation can contribute to experiencing caregiving burden, highlighting the importance of relationships and connection. Social support can be informal, such as a group of friends taking turns to drop meals off or help with chores, or it can be formal support in terms of professional therapeutic programs.
Providing access to appropriate respite care programs, which give caregivers an opportunity to take a break and rest, is another important way to provide support to caregivers. Respite programs are typically provided by local health authorities, or non-profit hospice and palliative care providers. If overnight respite care is not appropriate, it may be possible to have nurses or personal support workers (PSWs) visit the home to help the caregiver and care recipient.
Lastly, Teasedale-Dube et al. discuss the help-seeking behaviour of caregivers, and write that “in other words, services are not specific, and service seeking is not either. Caution is necessary as access to services does not mean that suicidal thoughts are evaluated, discussed, treated, or the object of professional attention” (2024). This points to the importance of incorporating suicide screening tools in services that caregivers are accessing, whether or not they are mental health specific services.
Transition through Menopause
The menopausal transition, which typically begins in the mid-forties and lasts on average up to five years, culminates with menopause. During this time, many women experience significant changes in their physical and psychological well-being. According to a 2023 paper, one in ten women report experiencing suicidal thoughts due to perimenopause, and those in the perimenopausal stage are more likely to have suicidal ideation compared those who have not yet experienced menopause (Nakanishi et al.). A qualitative study of Australian women revealed that many participants identified negative impacts on their psychological well-being during menopause, including increased anxiety and depression, negative emotional states, and reduced self-worth. (O’Reilly, 2024).
Several risk factors have been associated with increased suicidality during menopause. These factors include:
- History of depression or prior suicidal ideation.
- Sleep disturbances.
- Experiencing a prolonged menopausal transition.
- Fluctuations in reproductive hormone levels.
The menopause transition can have significant physical impacts which can result in poor overall wellbeing. Greater fatigue, combined with poorer sleep, may lead some people experiencing menopause to have difficulty focusing or problem solving, which can contribute to higher risks of suicide. Also, a prolonged menopausal transition may impact a person’s sense of self, and sense of hope for the future, which may also contribute to suicide risk.
While greater research is needed to understand the experiences of suicide ideation and behaviours in women experiencing menopause, it is clear that menopause has a significant impact on wellbeing.
Supporting Mental Health and Wellbeing through the Menopausal Transition
There are things that can be done to help keep women safe from suicide during the menopausal transition. These include:
- Social support, including peer support programs
- Increased education and literacy regarding the menopausal transition
- Access to understanding and compassionate health care
Greater social support is strongly associated with decreased suicidal ideation (Nakanishi et al. 2023). Unfortunately, Panay et al. (2021) states that “at least one-third of European women did not feel supported by family, friends, and HCPs [healthcare practitioners]”. Implementing psychosocial interventions to enhance social support can be beneficial in supporting women through this challenging life stage. One example of a psychosocial intervention could be helping women to connect to peer support programs.
Panay et al. (2021) also discuss that individual experiences of menopause can be impacted by the knowledge, perceptions, and attitudes about menopause that they’ve been exposed to. There is an opportunity for healthcare practitioners and community organizations to engage to promote public education around menopause. This public education should include an awareness around menopause symptoms and impacts, as well as treatment opportunities. Hopefully, increased public education around the menopausal transition will also reduce the stigma around menopause and help-seeking.
Lastly, those experiencing menopause should have access to understanding and compassionate health care. Many women experience difficulty accessing care, with physical symptoms often attributed to psychological causes and dismissed. When individuals are met with understanding, compassion, and patience, they are likely to feel more hopeful about the future. Women should have access to evidence-based information and treatments to support their transition through menopause.
Resources for Support in Waterloo Region
Camino Wellbeing + Mental Health
Camino offers prenatal and early childhood programs, including group programs for pregnant and parenting youth (those up to 29 years of age) and adults. Learn more about their programs at: www.caminowellbeing.ca
Region of Waterloo Public Health and Emergency Services
The Region of Waterloo’s Public Health and Emergency Services department also offers a variety of information and services to parents. This includes the opportunity to speak to a public health nurse for parenting advice. To learn more about the Region’ support for parents, visit: Parenting Support – Region of Waterloo.
Community Support Connections
Community Support Connections provides individual and group support to caregivers in Waterloo Region, although they do not provide respite services. To learn more about Community Support Connections and how to access their services, visit: Caregiver Support – Community Support Connections
Hospice Waterloo Region
Hospice Waterloo provides a variety of services for free of charge to their clients and families. This can include respite services, professional counselling, complementary therapies, and groups for caregivers. To learn more about Hospice Waterloo, visit: Are You a Caregiver? (hospicewaterloo.ca)
Resources for Support in Ontario
EarlyON Centres
EarlyON Child and Family centres offer free, high-quality programs for families and children from birth to 6 years old. EarlyOn centres are available across Ontario; to learn more or find your EarlyOn centre, visit: Find an EarlyON child and family centre | ontario.ca
The Ontario Caregiver Organization
The Ontario Caregiver Organizations hosts the Ontario Caregiver Helpline, which is a one-stop resource for information about the programs and services that can support a caregiver. Visit Need Assistance? Helpline is Here. – Ontario Caregiver to learn more.
Ontario Health at Home
Ontario Health at Home as a webpage which provides further education resources, financial resources, and additional provincial and national organizations that caregivers can connect with. These resources can be viewed at: Resources for Caregivers | Ontario Health atHome
Resources for Further Learning
Menopause Foundation of Canada
The Menopause Foundation of Canada aims to raise awareness of the impact of menopause. They provide significant information and resources on their website, and have developed a tool so that Canadians can find physicians knowledgeable about menopause. To check out their resources and the physician finder tool, visit: The Menopause Foundation of Canada (menopausefoundationcanada.ca)
Menopause and U
A project of the Society of Obstetricians and Gynecologists Canada, Menopause and U provides facts on menopause from Canadian experts, including information about evidence-based therapies, and how menopause may impact other aspects of women’s health. Learn more by visiting: Menopause and U
Citations
Cerel, J., Frey, L.M., Maple, M. & Kinner, D.G. (2016). Parents with Suicidal Behavior: Parenting is Not Always Protective. Journal of Child and Family Studies, (25), 2327–2336. https://doi.org/10.1007/s10826-016-0377-x
Conway, K. (2019) The Experience of Adult Children Caregiving for Aging Parents. Home Health Care Management & Practice, 31(2):92-98. doi:10.1177/1084822318803559
Næss, E.O., Mehlum, L. & Ping, Q. (2021). Marital status and suicide risk: Temporal effect of marital breakdown and contextual difference by socioeconomic status. SSM – Population Health, 15, 100853. doi:10.1016/j.ssmph.2021.100853
Nakanishi, M., Endo, K., Yamasaki, S., Stanyon, D., Sullivan, S., Yamaguchi, S., Ando, S., Hiraiwa-Hasegawa, M., Kasai, K., Nishida, A., & Miyashita, M. (2023). Association between menopause and suicidal ideation in mothers of adolescents: A longitudinal study using data from a population-based cohort. Journal of affective disorders, 340, 529–534. https://doi.org/10.1016/j.jad.2023.08.055
O’Dwyer, S. T., Moyle, W., Zimmer-Gembeck, M., & De Leo, D. (2015). Suicidal ideation in family carers of people with dementia. Aging & Mental Health, 20(2), 222–230. https://doi.org/10.1080/13607863.2015.1063109
O’Reilly, K., McDermid, F., McInnes, S. & Peters, K. (2024) “I was just a shell”: Mental health concerns for women in perimenopause and menopause. International Journal of Mental Health Nursing, 33, 693–702. Available from: https://doi.org/10.1111/inm.13271
Paris, R., Bolton, R.E. & Weinberg, M.K. (2009). Postpartum depression, suicidality, and mother-infant interactions. Arch Womens Ment Health 12, 309–321. https://doi.org/10.1007/s00737-009-0105-2
Teasdale-Dubé, A., Viau-Quesnel, C., & Lapierre, S. (2024). Suicidal Ideation in Canadian Family Caregivers for a Person with Dementia: A Portrait of the Situation. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 1–8. doi:10.1017/S0714980824000011