Future orientation and suicide ideation and attempts in depressed adults ages 50 and over

Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness

OBJECTIVE

Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. We tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress.

METHODS

A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems.

RESULTS

Chronic medical problems are associated with suicide ideation and, as hypothesized, happiness attenuates the relationship between self-reported diseases and suicidal distress.

CONCLUSIONS

Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. Our results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk.

What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community dwelling Israelis

PURPOSE

To identify the specific cognitive domains associated with passive suicidal ideation (e.g. thoughts of being better off dead).

METHODS

A cross sectional, national based study of 1,712 individuals over the age of 50. Outcome measure, passive suicidal ideation, was evaluated by the question, 'in the past month, have you felt that you would rather be dead?', taken from the Euro-D. Cognitive domains assessed were time orientation, verbal learning, verbal recall, word fluency, and arithmetic.

RESULTS

After adjusting for demographic and clinical information, those reporting passive suicidal ideation were significantly more likely to have impaired performance on the time orientation task. None of the other cognitive domains were associated with passive suicidal ideation.

CONCLUSIONS

Clinicians working with older adults need to be aware not only of demographic and clinical information, but also of cognitive functioning and more specifically, time orientation, as a potential determinant of passive suicidal ideation. Possibly, cognitive domains that are less affected by education and prior learning (e.g. time orientation) have a unique association with passive suicidal ideation.

Postmodernity and mental health

Contemporary Western societies are characterized by rapid social transformations, the scope and pace of which are unprecedented in comparison to previous eras. This new era is often referred to as "postmodern." Social theory suggests that such transformations influence multifarious processes related to psychiatry, including risk factors, help-seeking behavior, the clinical encounter, and clinical outcomes. I introduce and critically discuss five key themes that arise out of sociological analysis of postmodernity and that may have special relevance to psychiatry: (1) individualization; (2) social roles and self-identity; (3) the culture of expertise; (4) the transformation of intimacy; and (5) future orientation. Although extant work implicitly corroborates the importance of the identified themes as influences relevant to psychiatry, little work in psychiatry has explicitly applied these themes or investigated their impact. Further integration of these themes into research may give a fresh perspective on important issues pertinent to contemporary psychiatry.

Optimistic Explanatory Style as a Moderator of the Association Between Negative Life Events and Suicide Ideation

Background: Individuals experiencing negative and potentially traumatic life events are at increased risk for suicidal thoughts and behaviors; however, suicidal outcomes are not inevitable. Individuals who attribute negative life events to external, transient, and specific factors, rather than internal, stable, and global self-characteristics, may experience fewer deleterious outcomes, including suicidal behavior. Aims: This study examines the moderating effect of explanatory style on the relationship between negative life experiences and suicide ideation in a college student sample. Methods: A total of 138 participants (73% female) were recruited from a rural, Eastern college and completed a self-report psychosocial assessment. Results: Optimistic explanatory style mitigates the influence of negative and potentially traumatic life events on thoughts of suicide, above and beyond the effects of hopelessness and depression. Conclusions: Beliefs about the origin, pervasiveness, and potential recurrence of a negative life event may affect psychological outcomes. Optimistic explanatory style was associated with reduced suicide ideation, whereas pessimistic explanatory style was associated with increased thoughts of suicide. Optimistic reframing of negative life events for clients may have treatment implications for the prevention of suicidal activity.

Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older

OBJECTIVE

Adults with mood disorders are at elevated risk for suicide. Psychological features such as hopelessness increase their risk for suicide ideation. Few studies have examined psychological constructs posited to lower risk for suicide ideation. The authors tested the hypothesis that reasons for living (RFL) are inversely related to suicide ideation.

DESIGN

This report is a secondary analysis of cross-sectional data.

SETTING

Participants were recruited from the clinical services of three teaching hospitals in Rochester, NY.

PARTICIPANTS

The sample consisted of 125 adults 50 years or older receiving treatment for a mood disorder.

MEASUREMENTS

A diagnostic interview and measures of suicide ideation, depression, hopelessness, and RFL were included in the assessment battery. Dependent variables were presence and severity of suicide ideation. Data were analyzed using multivariate logistic and linear regressions.

RESULTS

Patients who reported higher levels of fear of suicide were less likely to report suicide ideation. The relationships between hopelessness and both the presence and severity of suicide ideation were stronger among those who reported greater levels of responsibility to family.

CONCLUSIONS

Clinicians working with at-risk older adults are encouraged to explore their patients' RFL. These cross-sectional findings point to the need for prospective research examining the associations among different RFL, hopelessness, and suicide ideation in depressed older adults.

The five-item Brief-Symptom Rating Scale as a suicide ideation screening instrument for psychiatric inpatients and community residents

BACKGROUND

An efficient screening instrument which can be used in diverse settings to predict suicide in different populations is vital. The aim of this study was to use the five-item Brief Symptom Rating Scale (BSRS-5) as a screening instrument for the prediction of suicide ideation in psychiatric, community and general medical settings.

METHODS

Five hundred and one psychiatric, 1,040 community and 969 general medical participants were recruited. The community participants completed a structured telephone interview, and the other two groups completed the self-report BSRS-5 questionnaire.

RESULTS

The logistic regression analysis showed that the predictors of suicide ideation for the psychiatric group were depression, hostility and inferiority (p < 0.001, p = 0.016, p = 0.011), for the community group, inferiority, hostility and insomnia (p < 0.001, p < 0.001, p = 0.003), and for the general medical group, inferiority, hostility, depression and insomnia (p < 0.001, p = 0.001, p = 0.020, p = 0.008). The structural equation model showed the same symptom domains that predicted suicide ideation for all three groups. The receiver operating characteristic curve using the significant symptom domains from logistic regression showed that for the psychiatric group, the optimal cut-off point was 4/5 for the total of the significant dimensions (positive predictive value [PPV] = 78.01%, negative predictive value [NPV] = 79.05%), for the community group, 7/8 (PPV = 68.75%, NPV = 96.09%), and for the general medical group, 12/13 (PPV = 92.86%, NPV = 88.48%).

CONCLUSION

The BSRS-5 is an efficient tool for the screening of suicide ideation-prone psychiatric inpatients, general medical patients, and community residents. Understanding the discriminative symptom domains for different groups and the relationship between them can help health care professionals in their preventative programs and clinical treatment.

Stemming the Tide of Suicide in Older White Men: A Call to Action

Preventing suicide has been identified as a national priority by recent commissions in the United States. Despite increased awareness of suicide as a public health problem, suicide in older adults remains a neglected topic in prevention strategies and research. This is especially true regarding elderly White men, who in terms of suicide rates have represented the most at-risk age group for the past half century. In light of the unprecedented aging of the United States as the baby boom generation enters late adulthood, suicide prevention initiatives that focus on aging males are needed to prevent a national crisis in geriatric mental health. This article provides a brief review of the perennially under-recognized reality of suicide in older men and prevention strategies that, if implemented, might help stem this rising tide of suicide in this vulnerable population.

Recent understandings in geriatric affective disorder

PURPOSE OF REVIEW

This article focuses on recent research into depression, bipolar disorder and anxiety in older people.

RECENT FINDINGS

Many physical illnesses are associated with a high prevalence of depression but overall medical burden may largely account for this. The relationship between depression and vascular disease is two way. Frontal brain dysfunction may underlie depression both in cerebrovascular disease and neurodegenerative disorders. Besides antidepressants, psychological treatments, psychosocial interventions and enhanced primary care services are effective. Longer-term outcomes are poor but preventive strategies show promise. Medical and psychiatric comorbidity are also important themes in later-life anxiety and bipolar disorders.

SUMMARY

Improving prognosis is a key concern and more research into novel pharmacological approaches (including vasoprotection), psychological interventions and prevention is needed.

Positive affect and suicide ideation in older adult primary care patients

Suicide is a significant public health problem for older adults. Identification of protective factors associated with reduced risk is important. The authors examined the association of positive affect and suicide ideation in 462 primary care patients ages 65 and older. Positive affect distinguished suicide ideators from nonideators, after controlling for age, gender, depression, negative affect, illness burden, activity, sociability, cognitive functioning, and physical functioning. There was a trend toward age moderation of this relationship. Clinical and theoretical formulations of late-life suicide should consider the role of positive affect, including the possibility that its protective effects grow more pronounced with age.

A review of the literature on rural suicide: risk and protective factors, incidence, and prevention

BACKGROUND

Suicide is a major cause of mortality worldwide. Differences in rates of suicide exist between urban and rural areas; however, little rigorous research has examined the phenomena of rural suicide.

OBJECTIVE

This review examines the current body of literature on rural suicide and investigates differences between rural and urban suicide, including socioeconomic, psychological, and cultural variables. Prevention and intervention strategies specific to rural communities are discussed. DESCRIPTION OF STUDIES: All empirical and epidemiological studies of rural suicide were included in the review regardless of study design or methodology.

RESULTS

Although findings are mixed, research and epidemiological data indicate that suicide is a public health concern in rural areas, with suicide rates often greater than in urban areas.

DISCUSSION

Rural locale may create geographic, psychological, and sociocultural barriers to treatment of suicide. A better understanding of the role of rurality in the development and maintenance of suicidal thoughts and behaviors is needed and may inform prevention and intervention efforts.

Optimism and suicide ideation among young adult college students

Given that college students may be at increased risk for suicide, it is important to conduct research that could guide suicide prevention efforts on college campuses. Although much research has been conducted on the role of hopelessness and depression in suicide ideation, the role of dispositional optimism is unclear. Subjects were 284 college students (185 female, 65%), ages 18 and over. Optimism was assessed with the Life Orientation Test-Revised. The outcome measure was the Beck Scale for Suicide Ideation. A hierarchical, multivariate regression was used to test the hypothesis that optimism is inversely associated with suicide ideation, even after controlling for age, gender, depressive symptoms, and hopelessness. The hypothesis was supported. Optimism holds promise as a cognitive characteristic associated with decreased thoughts of suicide in college students; a better understanding of its putative protective role in this group, and cross-culturally, is needed. Prevention programs designed to enhance optimism in the college setting might decrease suicide risk.