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Lau SCL, Zhang G, Rueschman M, Li X, Irwin MR, Krafty RT, McCall WV, Skidmore E, Patel SR, Redline S, Smagula SF. Sleep-wake behavioral characteristics associated with depression symptoms: findings from the Multi-Ethnic Study of Atherosclerosis. Sleep 2024; 47:zsae045. [PMID: 38394355 PMCID: PMC11009024 DOI: 10.1093/sleep/zsae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
STUDY OBJECTIVES To help prioritize target/groups for experimental intervention studies, we characterized cross-sectional associations between 24-hour sleep-wake measures and depression symptoms, and evaluated if similar sleep-wake-depression relationships existed in people with and without higher insomnia severity. METHODS Participants had ≥3 days of actigraphy data (n = 1884; mean age = 68.6/SD = 9.1; 54.1% female). We extracted 18 sleep, activity, timing, rhythmicity, and fragmentation measures from actigraphy. We used individual and multivariable regressions with the outcome of clinically significant depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16). We conducted sensitivity analyses in people with higher insomnia severity (top quartile of the Women's Health Initiative Insomnia Rating Scale total score). RESULTS From separate models in the overall sample, the odds of having depression symptoms were higher with: later timing (e.g. activity onset time odds ratio [OR]/1 SD = 1.32; 95% confidence interval [CI]: 1.16 to 1.50), lower rhythmicity (e.g. pseudo-F OR/1 SD = 0.75; 95% CI: 0.66 to 0.85), less activity (e.g. amplitude OR/1 SD = 0.83; 95% CI: 0.72 to 0.95), and worse insomnia (OR/1 SD = 1.48, 95% CI: 1.31 to 1.68). In multivariable models conducted among people with lower insomnia severity, later timing, lower rhythmicity, and higher insomnia severity were independent correlates of depression. In people with higher insomnia symptom severity, measures of later timing were most strongly associated with depression symptoms. CONCLUSIONS These correlative observations suggest that experimental studies are warranted to test if: broadly promoting 24-hour sleep-wake functioning reduces depression even in people without severe insomnia, and if advancing timing leads to depression symptom reductions in people with insomnia.
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Affiliation(s)
- Stephen C L Lau
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Gehui Zhang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Xiaoyu Li
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael R Irwin
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Elizabeth Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Westcott JB, Fullen MC, Tomlin CC, Eikenberg K, Delaughter PM, Breedlove Mize MC, Shannonhouse LR. 'We all have a stake in this': a phenomenological inquiry into integrating suicide intervention in home-delivered meal service contexts. Aging Ment Health 2023:1-9. [PMID: 37970795 DOI: 10.1080/13607863.2023.2282681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Late-life suicide is a public health concern, yet many older adults do not have access to traditional mental health services. The present study sought to explore how suicide intervention is integrated into home-delivered meal (HDM) contexts following volunteer training in an evidence-based suicide first responder program. METHODS Using phenomenological inquiry, we examined the experiences of 20 HDM volunteers trained in ASIST. RESULTS Three primary themes emerged: (a) Logistics influencing integration of Suicide Intervention into HDM Systems, describing HDM program logistics; (b) Intrapersonal Context, describing HDM volunteer characteristics influencing intervention utilization and HDM client concerns; and (c) Interpersonal Context, describing HDM relationship characteristics that influenced intervention utilization. CONCLUSION HDM and other nutrition services have potential for addressing late life suicide, particularly when volunteers best equipped to address risk receive training and HDM policies reflect the needs of their clients. Implications for HDM services, as well as the Aging Services Network, are discussed.
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Affiliation(s)
- Jordan B Westcott
- Educational Psychology and Counseling Department, University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Matthew C Fullen
- Counselor Education Department, Virginia Tech, Blacksburg, VA, USA
| | - Connie C Tomlin
- Counselor Education Department, Virginia Tech, Blacksburg, VA, USA
| | - Kelly Eikenberg
- Counselor Education Department, Virginia Tech, Blacksburg, VA, USA
| | | | | | - Laura R Shannonhouse
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, USA
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3
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Shannonhouse L, Hong J, Fullen M, Westcott J, Mingo CA, Mize MC, Love SF. Racial Differences in the Relationship Between Pain and Suicide Desire in Older Adults. J Appl Gerontol 2022; 42:972-980. [PMID: 36540033 DOI: 10.1177/07334648221145854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Older adults are reported to die by suicide at higher rates than the general population. Suicide desire among older adults is associated with pain, and pain experiences have been found to differ based on race. To investigate the relationship between pain and suicidal desire, 437 racially diverse older adults who receive home-based services (home-delivered meals) in the Southeastern region of the United States completed standardized measures of psychological pain, chronic physical pain, and suicidal desire. Results identified race moderated the relationship between pain and suicidal desire, indicating a stronger relationship between pain and suicidal desire among Black older adults than White older adults. Chronic physical pain (i.e., emotional burden) interacted with race to predict Perceived Burdensomeness ( p = .011) and Thwarted Belongingness ( p = .032). Greater attention to pain experiences among Black older adults is warranted, considering the impact of COVID-19 on racial/ethnic minorities’ mental health.
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Affiliation(s)
| | - Jihee Hong
- University of Maryland, College Park, MD, USA
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Papadaki A, Ali B, Cameron A, Armstrong MEG, Isaacs P, Thomas KS, Gadbois EA, Willis P. 'It's not just about the dinner; it's about everything else that we do': A qualitative study exploring how Meals on Wheels meet the needs of self-isolating adults during COVID-19. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2012-e2021. [PMID: 34766667 PMCID: PMC8652984 DOI: 10.1111/hsc.13634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
Meals on Wheels (MoWs), a service offered by local authorities in England, deliver meals to older, housebound and/or vulnerable adults, who might otherwise not be able to acquire and prepare their own meals. Research suggests that MoWs provide benefits beyond nutrition. Little is known about the actual interactions between service providers and clients, particularly during the COVID-19 pandemic. The aim of this small-scale, formative study was to explore MoWs service providers' experiences and their perceptions around the benefits and challenges faced by the service, and understand how these experiences changed during the first UK national lockdown. Semi-structured interviews were conducted in September 2020 with 18 service providers of MoWs (drivers who deliver the meals, service coordinators and managers) in two local authorities in England, and analysed thematically. Participants indicated that benefits of the service encompassed those to clients (e.g. welfare checks, encouraging independence and identifying and addressing isolation and loneliness), employees (e.g. sense of pride, rewarding relationships with clients) and the wider community (e.g. reducing pressures on families), and described MoWs as the 'fourth emergency service' (e.g. being the first responders to emergency situations). Participants identified several challenges faced by the MoWs service, including organisational challenges (e.g. funding cuts and closures, lack of appropriate publicity to raise awareness of the service) and restrictions on time spent with clients. The pandemic and lockdown resulted in increased demand on resources, concerns about client and staff wellbeing and uncertainty about how the service will cope if lockdowns continue. These findings provide important insights regarding the wide benefits of MoWs and the challenges the service faces, which can be used as the formative research base to guide future interventions and policies to protect vulnerable adults, not only during the COVID-19 pandemic, but beyond.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Becky Ali
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
| | - Ailsa Cameron
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Paul Isaacs
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Kali S. Thomas
- U.S. Department of Veterans Affairs Medical CenterProvidenceRhode IslandUSA
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Emily A. Gadbois
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Paul Willis
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
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5
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Chattun MR, Amdanee N, Zhang X, Yao Z. Suicidality in the geriatric population. Asian J Psychiatr 2022; 75:103213. [PMID: 35917739 DOI: 10.1016/j.ajp.2022.103213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.
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Affiliation(s)
- Mohammad Ridwan Chattun
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Medical School of Nanjing University, Nanjing Brain Hospital, 22 Hankou Road, Nanjing 210093, China.
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6
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Smith L, Shin JI, Carmichael C, Jacob L, Kostev K, Grabovac I, Barnett Y, Butler L, Lindsay RK, Pizzol D, Veronese N, Soysal P, Koyanagi A. Association of food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from low- and middle-income countries. J Affect Disord 2022; 309:446-452. [PMID: 35461821 DOI: 10.1016/j.jad.2022.04.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from six low- and middle-income countries (LMICs). METHODS Cross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts. RESULTS The final analytical sample included 34,129 individuals aged ≥50 years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI = 1.73-4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI = 1.35-4.97) and 5.15 (95%CI = 2.52-10.53) times higher odds for suicide attempts, respectively. LIMITATIONS The cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study. CONCLUSIONS Food insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.
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Affiliation(s)
- Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux 78180, France
| | - Karel Kostev
- IQVIA, Epidemiology, Frankfurt am Main, Main Airport Center, Unterschweinstiege 2-14, 60549 Frankfurt am Main, Germany
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Yvonne Barnett
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Laurie Butler
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Rosie K Lindsay
- Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.
| | - Damiano Pizzol
- Italian Agency for Development Cooperation-Khartoum, Khartoum 11111, Sudan
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90133 Palermo, Italy
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), 34093 Fatih, İstanbul, Turkey
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
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7
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‘Listen closer’: home-delivered meal volunteers’ understanding of their role in suicide intervention. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Suicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed.
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8
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Heisel MJ, Flett GL. Screening for suicide risk among older adults: assessing preliminary psychometric properties of the Brief Geriatric Suicide Ideation Scale (BGSIS) and the GSIS-Screen. Aging Ment Health 2022; 26:392-406. [PMID: 33327729 DOI: 10.1080/13607863.2020.1857690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen). METHODS A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173). RESULTS Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings. CONCLUSION Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.
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Affiliation(s)
- Marnin J Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, USA
| | - Gordon L Flett
- Department of Psychology, York University, Toronto, Ontario, Canada
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Na KS, Geem ZW, Cho SE. The Development of a Suicidal Ideation Predictive Model for Community-Dwelling Elderly Aged >55 Years. Neuropsychiatr Dis Treat 2022; 18:163-172. [PMID: 35140466 PMCID: PMC8819701 DOI: 10.2147/ndt.s336947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Suicide is an important health and social concern worldwide. Both suicidal ideation and suicide rates are higher in the elderly population than in other age groups; thus, more careful attention and targeted interventions are required. Therefore, we have developed a model to predict suicidal ideation in the community-dwelling elderly aged of >55 years. PATIENTS AND METHODS A random forest algorithm was applied to those who participated in the Korea Welfare Panel. We used a total of 26 variables as potential predictors. To resolve the imbalance in the dataset resulting from the low frequency of suicidal ideation, training was performed by applying the synthetic minority oversampling technique. The performance index was calculated by applying the predictive model to the test set, which was not included in the training process. RESULTS A total of 6410 elderly Korean aged of >55 (mean, 71.48; standard deviation, 9.56) years were included in the analysis, of which 2.7% had suicidal ideation. The results for predicting suicidal ideation using the 26 chosen variables showed an AUC of 0.879, accuracy of 0.871, sensitivity of 0.750, and specificity of 0.874. The most significant variable in the predictive model was the severity of depression, followed by life satisfaction and self-esteem factors. Basic demographic variables such as age and gender demonstrated a relatively small effect. CONCLUSION Machine learning can be used to create algorithms for predicting suicidal ideation in community-dwelling elderly. However, there are limitations to predicting future suicidal ideation. A predictive model that includes both biological and cognitive indicators should be created in the future.
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Affiliation(s)
- Kyoung-Sae Na
- Department of Psychiatry, Gachon University College of Medicine, Incheon, 21565, Republic of Korea
| | - Zong Woo Geem
- College of IT Convergence, Gachon University, Seongnam, 13120, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Incheon, 21565, Republic of Korea
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10
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Angelelli J, McCartney D, Roehmer C, Swart ECS, Quinby E, Darwin J, Dicianno BE. Effect of Social Determinants of Health Interventions on Adults Living with Disabilities: A Scoping Review. Arch Phys Med Rehabil 2021; 103:1023-1033.e11. [PMID: 34756446 DOI: 10.1016/j.apmr.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18 living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional settings. DATA SOURCES A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of Science Core Collection published between January 1997 and July 2020. STUDY SELECTION Search terms were based on the primary SDoH domains identified by the Centers for Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts were screened based on identification criteria of persons age 18 and above living in non-institutional, community-based settings receiving LTSS. DATA EXTRACTION During Level 2 review, articles were reviewed based on population focus, type of LTSS (personal assistance services, home care, adult day care, home modification, durable medical equipment, community transition services, caregiver supports and/or prevention services related to home- and community-based care), SDoH intervention and association with health outcomes, population health and/or cost. A total of 1037 abstracts underwent Level 2 review, yielding 131 publications or 1.3% for full review. DATA SYNTHESIS Studies (n=33) designed a priori to test outcomes of interventions were rated according to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria. Qualifying articles that did not include interventions (n=98) were included in our summary of the literature but were not assessed by GRADE. CONCLUSIONS The preponderance of research surrounding SDoH and health outcomes has focused on older adults living with disabilities, and most interventions scored low or very low using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured against outcomes for persons of all ages living with disabilities. Robust evaluation of models that feature SDoH interventions in partnership with community-based organizations is recommended as home and community-based care infrastructure expands in response to the American Rescue Plan Act of 2021.
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Affiliation(s)
- Joe Angelelli
- UPMC Center for High-Value Health Care, UPMC Health Plan, Pittsburgh, PA.
| | - David McCartney
- UPMC Center for High-Value Health Care, UPMC Health Plan, Pittsburgh, PA
| | - Christian Roehmer
- Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Eleanor Quinby
- Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jessa Darwin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
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11
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Niculescu I, Arora T, Iaboni A. Screening for depression in older adults with cognitive impairment in the homecare setting: a systematic review. Aging Ment Health 2021; 25:1585-1594. [PMID: 32677506 DOI: 10.1080/13607863.2020.1793899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Previous systematic reviews have examined depression screening in older adults with cognitive impairment (CI) in outpatient and inpatient clinics, nursing homes, and residential care. Despite an increasing number of older adults with CI receiving care in their homes, less is known about best depression screening practices in homecare. The objective of this review is to identify evidence-based practices for depression screening for individuals with CI receiving homecare by assessing tool performance and establishing the current evidence for screening practices in this setting. METHODS This review is registered under PROSPERO (ID: CRD42018110243). A systematic search was conducted using MEDLINE, EMBASE, Health and Psychosocial Abstracts, PsycINFO and CINAHL. The following criteria were used: assessment of depression at home in older adults (>55 years) with CI, where performance outcomes of the depression screening tool were reported. RESULTS Of 5,453 studies, only three met eligibility criteria. These studies evaluated the Patient Health Questionnaire (n = 236), the Geriatric Depression Scale (n = 79) and the Mental Health Index (n = 1,444) in older adults at home with and without CI. Psychometric evaluation demonstrated moderate performance in the subsamples of people with CI. CONCLUSION At present, there is insufficient evidence to support best practices in screening for depression in people with CI in homecare.
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Affiliation(s)
- Iulia Niculescu
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada
| | - Twinkle Arora
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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12
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Smith L, Shin JI, Barnett Y, Allen PM, Lindsay R, Pizzol D, Jacob L, Oh H, Yang L, Tully MA, Veronese N, Koyanagi A. Association of objective visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years in low/middle-income countries. Br J Ophthalmol 2021; 106:1610-1616. [PMID: 33931392 DOI: 10.1136/bjophthalmol-2021-318864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/13/2021] [Accepted: 04/24/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is currently limited literature on the association between visual impairment and suicidal thoughts and behaviours, especially among older adults from low/middle-income countries (LMICs). Thus, we aimed to investigate the associations of objectively measured distance visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years from six LMICs and to identify potential mediators. METHODS Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analysed. Objective distance visual acuity was measured using the tumbling E logMAR chart, and vision impairment was categorised as none, mild, moderate and severe. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analysis were conducted. RESULTS Data on 34 129 individuals aged ≥50 years (mean (SD) age, 62.4 (16.0) years; 47.9% men) were analysed. After adjustment for potential confounders, compared with no visual impairment, severe visual impairment was significantly associated with suicidal ideation (OR=9.50; 95% CI=2.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95% CI=1.14 to 4.35) and 11.50 (95% CI=1.44 to 91.88) times higher odds of suicide attempts, respectively. Disability, poor self-rated health, mobility and loneliness explained 14.0%, 9.3%, 7.2% and 6.3% of the association between moderate/severe visual impairment and suicide attempts, respectively. CONCLUSION Interventions to reduce suicidal ideation and suicide attempts among older adults with visual impairment in LMICs are required, targeting identified mediators, while using tested strategies for suicide prevention per se in LMICs may yield beneficial outcomes.
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Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Yvonne Barnett
- Faculty of Science and Engineering, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rosie Lindsay
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum, Sudan
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Hans Oh
- School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Lin Yang
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Calgary, Alberta, Canada
| | - Mark A Tully
- Institute of Mental Health Sciences, Ulster University, Coleraine, Londonderry, UK
| | - Nicola Veronese
- Department of Medicine, University of Palermo, Palermo, Italy
| | - Ai Koyanagi
- Research and development unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
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Kim J, Park MJ. Multilevel Effect of Neighborhood Social Cohesion and Characteristics on Suicidal Ideation Among Korean Older Adults. Community Ment Health J 2021; 57:522-528. [PMID: 32676878 DOI: 10.1007/s10597-020-00678-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
This study examined the effect of neighborhood factors on suicidal ideation of community-dwelling older adults in Korea. To understand the effect of neighborhood factors (neighborhood social cohesion, satisfaction with neighborhood safety, living environment, suicide rate, proportion of social welfare agencies, proportion of social welfare expenses) and individual factors (health, social relationships) on suicidal ideation of older adults, we conducted a multilevel logistic regression analysis. The 2017 Community Health Survey of Korea included data on 67,820 people aged 65 years or older and in 255 neighborhoods. At the individual level, the presence of suicidal ideation was associated with less education attainment, lower family income, not living with a spouse, fewer social networks, fewer social activities, more depressive symptoms, and lower health-related quality of life. At the neighborhood level, lack of social cohesion, a higher suicide rate, and a smaller social welfare budget were significantly effect related to the probability of suicidal ideation.
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Affiliation(s)
- Jin Kim
- Department of Aging and Social Work, Catholic University of Pusan, #57 Oryundae-ro, Geumjeong-gu, Busan, 609-757, South Korea
| | - Mi Jin Park
- Department of Aging and Social Work, Catholic University of Pusan, #57 Oryundae-ro, Geumjeong-gu, Busan, 609-757, South Korea.
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Xiang X, An R, Oh H. The Bidirectional Relationship Between Depressive Symptoms and Homebound Status Among Older Adults. J Gerontol B Psychol Sci Soc Sci 2020; 75:357-366. [PMID: 29378023 DOI: 10.1093/geronb/gbx180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/31/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to examine the bidirectional relationship between depressive symptoms and homebound status among older adults. METHOD The study sample included 7,603 community-dwelling older adults from the National Health and Aging Trends Study. A bivariate latent state-trait model of depressive symptoms and homebound status was estimated via structural equation modeling. RESULTS The model fit the data well (Root Mean Square Error of Approximation = .02, Comparative Fit Index = .97, Standardized Root Mean Square Residual = .06). The relationship between homebound status and depressive symptoms can be decomposed into three parts: a moderate correlation between the stable trait components (r = .56, p <.001); a contemporary association of the state components (b = .17, p <.001); and bidirectional lagged effects between the state components. Change in homebound status was as a stronger predictor of depressive symptoms (b = .19, p < .001) than change in depressive symptoms was of homebound status (b = .06, p < .001; test of difference: Δ scaled χ2(1) = 24.2, p < .001). DISCUSSION Homebound status and depressive symptoms form a feedback loop to influence each other. Improving the outdoor mobility of older adults may have immediate benefits for reducing depressive symptoms.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor
| | - Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
| | - Hyunsung Oh
- School of Social Work, Arizona State University, Phoenix
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15
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Limitation on activities of daily living, depressive symptoms and suicidal ideation among nursing home residents: The moderating role of resilience. Geriatr Nurs 2020; 41:622-628. [DOI: 10.1016/j.gerinurse.2020.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/18/2022]
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16
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The Cost of Being Apart: The Contribution of Perceived Burdensomeness and Thwarted Belongingness to Suicide Ideation Among Israeli Older Adults. J Nerv Ment Dis 2020; 208:663-670. [PMID: 32520851 DOI: 10.1097/nmd.0000000000001198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Older adults have the highest suicide rates of all age groups in most industrialized countries. However, research concerning psychological risk factors for suicide among older adults is sparse. Thus, our study aimed to examine the contribution of perceived burdensomeness (PB) and thwarted belongingness (TB) to suicide ideation (SI) among older adults. Participants included 160 Israeli older adults (aged 65-91 years), who completed measures of suicide risk, PB, and TB as well as hopelessness and depression. Using hierarchical regression, we found that PB and TB accounted for 9.8% of the variance in SI and that the interaction of PB and TB had a significant unique contribution to SI among the participants, beyond the effect of hopelessness and depression. The study's findings highlight the contribution of interpersonal variables to SI among older adults and suggest that mental health professionals should be aware of PB and TB levels when assessing suicide risk among older adults.
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Cheng X, Bu H, Duan W, He A, Zhang Y. Measuring character strengths as possible protective factors against suicidal ideation in older Chinese adults: a cross-sectional study. BMC Public Health 2020; 20:439. [PMID: 32245407 PMCID: PMC7118809 DOI: 10.1186/s12889-020-8457-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Suicide is a global issue among the elderly. The number of older people committing suicide is proliferating, and the elderly suicide rate is the highest among all age groups in China. A better understanding of the possible protective factors against suicidal ideation is necessary to facilitate prevention and intervention efforts. The objectives of the present study are threefold. First, this study aims to examine the psychometric properties of the three-dimensional inventory of character strengths (TICS) with a sample of older adults. Second, this study intends to investigate correlations among suicide ideation, wellbeing, and character strengths. Third, the study seeks to explore the possible protective roles of the three character strengths and wellbeing in explaining suicidal ideation among older adults. METHODS A cross-sectional study comprising 308 older adults aged at least 50 years old from nursing homes was conducted. Four questionnaires, namely, the TICS, the Geriatric Suicide Ideation Scale-10 items, the Brief Inventory of Thriving, and the Satisfaction with Life Scale, were used. Exploratory structural equation modeling, intraclass correlation coefficients, partial correlations, and sets of hierarchical regressions were adopted to estimate and report the results. RESULTS TICS could be used to assess the character strengths (i.e., caring, inquisitiveness, and self-control) among older adults with an acceptable goodness-of-fit (chi square = 157.30, df = 63, p < 0.001, CFI = 0.94, TLI = 0.90, RMSEA = 0.07, 90% CI = [0.06, 0.08]). Wellbeing and character strengths exhibited a negative association with suicidal ideation among older adults. Moreover, character strengths showed an independently cross-sectional relationship with suicidal ideation, explaining 65.1% of the variance of suicidal ideation after controlling for the wellbeing and demographics. CONCLUSION This study indicated that character strengths were associated with low levels of suicidal ideation. Therefore, the protective factors against suicidal ideation among older adults should be given additional attention.
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Affiliation(s)
- Xinfeng Cheng
- Economics and Management Department, Xi'an Technological University, Xi'an, China.,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - He Bu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Wenjie Duan
- Social and Public Administration School, East China University of Science and Technology, Shanghai, China.
| | - Along He
- Department of Sociology, Wuhan University, Wuhan, China
| | - Yaping Zhang
- Goizueta Business School, Emory University, Atlanta, Georgia
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Santos J, Martins S, Azevedo LF, Fernandes L. Pain as a risk factor for suicidal behavior in older adults: A systematic review. Arch Gerontol Geriatr 2020; 87:104000. [DOI: 10.1016/j.archger.2019.104000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 11/30/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
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Albert SM, King J, Anderson S, Dew MA, Zhang J, Stahl ST, Karp JF, Gildengers AG, Butters MA, Reynolds CF. Depression Agency-Based Collaborative: Effect of Problem-Solving Therapy on Risk of Common Mental Disorders in Older Adults With Home Care Needs. Am J Geriatr Psychiatry 2019; 27:619-624. [PMID: 30795944 PMCID: PMC6511292 DOI: 10.1016/j.jagp.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Interventions to prevent depression in older adults have mainly focused on young-old ambulatory adults, not on the old-old with disabilities who receive supportive services in their homes. OBJECTIVE The Depression Agency-Based Collaborative (Dep-ABC) is a single-blind pilot randomized controlled trial assessing the effect of an intervention-development strategy using problem-solving therapy (PST) on the risk of common mental health disorders in this vulnerable population. METHODS The intervention involved six to eight sessions of PST over 12 weeks. Participants were followed up to 12 months postintervention. RESULTS Dep-ABC randomized 104 participants-68.4% of eligible and 17.5% of all older adults screened. The proportion of participants with incident major depressive disorder or generalized anxiety disorder was 11.4% in PST and 14.3% in the enhanced usual care control arm. A test of the interaction between time and intervention for anxiety symptoms favored the PST arm (p = 0.04). CONCLUSION PST did not lower the risk of incident common mental illness but did lower anxiety symptom burden. Apart from low power, the effects of PST may have been blunted by referral for medical and aging services in the enhanced usual care group.
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Affiliation(s)
| | - Jennifer King
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | | | - Mary Amanda Dew
- Department of Biostatistics, University of Pittsburgh,Department of Psychiatry, University of Pittsburgh
| | - Jun Zhang
- Department of Biostatistics, University of Pittsburgh
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20
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Lee YS, Kim TH. Household food insecurity and breakfast skipping: Their association with depressive symptoms. Psychiatry Res 2019; 271:83-88. [PMID: 30471489 DOI: 10.1016/j.psychres.2018.11.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Abstract
Household food insecurity limits families' access to sufficient and varied safe foods, which may result in problems such as insufficient food intake and nutritional imbalance. This may lead to health issues such as obesity, chronic illness, mental health problems, and even poor quality of life. Breakfast skipping is a risk factor for eating disorders which is related to diseases such as metabolic disorder and depressive symptoms. This study examined household food insecurity and breakfast skipping and their association with depressive symptoms. In this study, we used data from the 2015 Korean Community Health Survey. Study participants were a total of 225,965 people aged 18 years or older who answered questions related to eating habits. Multiple logistic regression analyses were used to identify factors associated with depressive symptoms. Those in households with low food security and very low food security were more likely to experience depressive symptoms. Individuals that skip breakfast 2 days or more per week were more likely to experience depressive symptoms. Our study suggests that those living in households with lower food security and who skip breakfast often should pay more attention to their mental health.
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Affiliation(s)
- Ye Seol Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
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What is the prevalence of untreated depression and death ideation in older people? Data from the Irish Longitudinal Study on Aging. Int Psychogeriatr 2018; 30:1393-1401. [PMID: 29335038 DOI: 10.1017/s104161021700299x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTObjective:Late life depression (LLD) confers significant morbidity and mortality but is well recognized that it often goes undetected or untreated. The objective of this study is to quantify the burden of untreated depression and death ideation (DI) at a population level. DESIGN Cross-sectional study ascertaining the prevalence of, and factors associated with, untreated depression and DI. SETTING This study, embedded within the Irish Longitudinal Study on Ageing, involves over 7,000 community-dwelling people aged ≥50 years. MEASUREMENTS Depression was defined as Centre for Epidemiological Studies Depression scale ≥16 indicating current clinically relevant depressive symptoms or Composite International Diagnostic Interview indicative of major depressive episode within the last year. Participants not prescribed antidepressants/antipsychotics were defined as untreated. To define DI, participants were asked "In the last month, have you felt like you would rather be dead?" RESULTS In total, 12% (839/7,055) met criteria for depression with 29% (241/839) on pharmacological therapy. Those with untreated depression were less likely to endorse symptoms of persistent low mood or worthlessness, but there was no difference in age or general practitioner (GP) visits compared to those on treatment. Over 3% (223/7,055) of participants had DI and less than one-third had visited their GP within the last year. CONCLUSIONS This study demonstrates that two-thirds of depressed older people are not prescribed antidepressant/antipsychotic therapy. It is important to raise awareness of depression among older people and healthcare professionals, with particular focus on the fact that LLD is not an inevitable consequence of ageing and effective treatment is available.
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Major Depression and Subthreshold Depression among Older Adults Receiving Home Care. Am J Geriatr Psychiatry 2018; 26:939-949. [PMID: 29884541 PMCID: PMC6108943 DOI: 10.1016/j.jagp.2018.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to estimate the prevalence and correlates of major and subthreshold depression and the extent of treatment utilization in older adults receiving home care. METHODS The study sample included 811 community-dwelling adults aged 60 and over who received paid home care during the 2008-2014 waves of the Health and Retirement Study. Depression was assessed using short forms of the Composite International Diagnostic Interview and the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to examine correlates of depression type and treatment utilization. RESULTS One in two older home care recipients suffered from probable depression; 13.4% of the sample suffered from major depression and an additional 38.7% met study criteria for subthreshold depression. The majority (72.7%) of participants with major depression and almost half (44.5%) of participants with subthreshold depression reported taking medication for anxiety or depression. One-third (33.2%) of older home care recipients with major depression and 14.2% of those with subthreshold depression reported receiving formal psychiatric or psychological treatment. Males as compared with females and persons with pain problems as compared with no pain complaints had a higher risk of subthreshold and major depression. The receipt of medication or psychiatric treatment declined with age. African Americans were less likely to receive medication for anxiety or depression compared with non-Hispanic whites. CONCLUSION Depression affects a substantial proportion of older adults receiving home care and may be inappropriately treated. Future research is needed to develop optimal strategies for integrating depression assessment and treatment into home care.
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Zinchuk MS, Avedisova AS, Zhabin MO, Guekht AB. [Suicidality in the elderly: socio-cultural and clinical risk factors]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:104-111. [PMID: 30132468 DOI: 10.17116/jnevro201811871104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Advanced age is a significant risk factor for a completed suicide. The review considers the patterns of suicidal behavior of older adults in the context of their gender, ethnicity as well as social and cultural factors. In terms of pro- and antisuicidal variables, special emphasis is made on the role of somatic and psychic disorders. The article looks at the features of committing a suicide peculiar to the older people and debates some specific issues of self-inflicted death by elderly people. The obtained data indicate the involvement of multilevel factors (biological, clinical, cultural, micro- and microsocial) in suicidal behavior in later life.
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Affiliation(s)
- M S Zinchuk
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A S Avedisova
- Serbsky Federal Medical Research Center of Psychiatry and Narcology, Moscow, Russia
| | - M O Zhabin
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A B Guekht
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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24
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Oliveira JMBD, Vera I, Lucchese R, Silva GC, Tomé EM, Elias RA. Aging, mental health, and suicide. An integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Abstract Objective: this integrative literature review aimed to systematize scientific production regarding the process of aging, mental health, and suicide. Method: the LILACS, MEDLINE, and PubMed databases were used to search for papers published between 2007 and 2017. The final analysis included 34 papers. Result: descriptive North American studies in English were most prevalent. The largest number of papers on the theme was published in 2013. The researchers used questionnaires and interviews as instruments for questions involving aging and suicidal ideation. The papers revealed an association of suicide or suicidal ideation in elderly persons who manifested anxiety, depressive symptoms, depression, physical diseases, low educational and socioeconomic levels, and chronic diseases. Conclusion: this integrative review reinforces the need for investment in public policies and spaces that offer receptiveness, listening, and safety for the aged population, as well as surveys with more robust methodologies to investigate the phenomenon under analysis.
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25
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Reckrey JM, DeCherrie LV, Dugue M, Rosen A, Soriano TA, Ornstein K. Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program. ACTA ACUST UNITED AC 2018; 16:122-8. [PMID: 26414814 DOI: 10.1891/1521-0987.16.3.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The growing population of homebound adults increasingly receives home-based primary care (HBPC) services. These patients are predominantly frail older adults who are homebound because of multiple medical comorbidities, yet they often also have psychiatric diagnoses requiring mental health care. Unfortunately, in-home psychiatric services are rarely available to homebound patients. To address unmet psychiatric need among the homebound patients enrolled in our large academic HBPC program, we piloted a psychiatric in-home consultation service. During our 16-month pilot, 10% of all enrolled HBPC patients were referred for and received psychiatric consultation. Depression and anxiety were among the most common reasons for referral. To better meet patients' medical and psychiatric needs, HBPC programs need to consider strategies to incorporate psychiatric services into their routine care plans.
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26
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Bevilacqua LA, Dulak D, Schofield E, Starr TD, Nelson CJ, Roth AJ, Holland JC, Alici Y. Prevalence and predictors of depression, pain, and fatigue in older- versus younger-adult cancer survivors. Psychooncology 2018; 27:900-907. [PMID: 29239060 DOI: 10.1002/pon.4605] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND As the number of older adults in the United States continues to grow, there will be increasing demands on health care providers to address the needs of this population. Cancer is of particular importance, with over half of all cancer survivors older than 65 years. In addition, depression, pain, and fatigue are concerns for older adults with cancer and have been linked to poorer physical outcomes. METHODS For this retrospective chart review, 1012 eligible participants were identified via a query of the Electronic Medical Record for all patients referred to 1 of 4 Survivorship Clinics at Memorial Sloan Kettering Cancer Center. All patients were between the ages of 30 to 55 (younger adults) and >65 (older adults). Depression was measured using the Patient Health Questionnaire-9 (PHQ-9). RESULTS The overall rate of depression in this sample of adult cancer survivors was 9.3%. There were no differences in the rates of clinically significant depression (defined as PHQ-9 score ≥10) between younger and older adult cohorts. However, there was a small trend toward higher mean PHQ-9 scores in the younger adult cohort (3.42 vs 2.95; t = 1.763, P = .10). Women reported greater rates of depression and higher pain and fatigue scores. Hispanic/Latino patients also reported significantly greater rates of depression. CONCLUSION There were no observed differences in depression between older and younger adult cancer survivors. Gender and ethnic discrepancies in depression were observed. Future research should focus on understanding the nature of these differences and targeting interventions for the groups most vulnerable to depression after cancer treatment.
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Affiliation(s)
- Lisa A Bevilacqua
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Deirdre Dulak
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tatiana D Starr
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jimmie C Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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27
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Cheung G, Edwards S, Sundram F. Death wishes among older people assessed for home support and long-term aged residential care. Int J Geriatr Psychiatry 2017; 32:1371-1380. [PMID: 27859762 DOI: 10.1002/gps.4624] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/08/2016] [Accepted: 10/19/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. METHODS Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. RESULTS Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. CONCLUSIONS Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Siobhan Edwards
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Depressive Symptoms in Recipients of Home- and Community-Based Services in the United States: Are Older Adults Receiving the Care They Need? Am J Geriatr Psychiatry 2017; 25:1351-1360. [PMID: 28760513 PMCID: PMC5694376 DOI: 10.1016/j.jagp.2017.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the United States. METHODS Participants included 5,582 adults aged 60 and over from the 2010-2012 waves of the nationally representative Health and Retirement Study. Weighted bivariate analyses were used to examine the frequency of depressive symptoms (Center for Epidemiologic Studies Depression Scale) and psychiatric treatment among HCBS recipients compared with non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use. RESULTS HCBS recipients had a higher frequency of depressive symptoms compared with nonrecipients (27.5% versus 10.4%, respectively). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5%). HCBS recipients with depressive symptoms were no more likely than nonrecipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors. CONCLUSION Depressive symptoms are more frequent among HCBS recipients compared with nonrecipients; however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions.
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Abstract
PURPOSE OF REVIEW We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings. RECENT FINDINGS Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.
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McCall J, Brusoski M, Rosen D. Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:458-470. [PMID: 28489495 PMCID: PMC6117196 DOI: 10.1080/01634372.2017.1328479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study's findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.
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Affiliation(s)
- Janice McCall
- Veterans Affairs Healthcare System, Center for Health Equity Promotion and Research, University Drive (151C), ROB, Pittsburgh, PA 15240-1001
| | - Melissa Brusoski
- University of Pittsburgh, School of Social Work, 2117 Cathedral of Learning, Pittsburgh, PA 15260
| | - Daniel Rosen
- University of Pittsburgh, School of Social Work, 2117 Cathedral of Learning, Pittsburgh, PA 15260
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Xiang X, Brooks J. Correlates of Depressive Symptoms among Homebound and Semi-Homebound Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:201-214. [PMID: 28129087 PMCID: PMC5845464 DOI: 10.1080/01634372.2017.1286625] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study aimed to provide a national profile of homebound and semi-homebound older adults with depressive symptoms and to compare risk factors of depressive symptoms by homebound status. A sample of 1,885 homebound and semi-homebound older adults was selected from Round 1 of the National Health and Aging Trends Study (NHATS). The prevalence of depressive symptoms was 43.9% in homebound older adults and 28.1% in semi-homebound older adults, representing over 830,000 and 1.4 million individuals in the population, respectively. Nearly two-thirds of homebound and over half of semi-homebound older adults with clinically significant depressive symptoms also had significant anxiety symptoms. Results from logistic regression showed that younger age, certain medical morbidities, severity of functional limitations, and pain were common risk factors for depressive symptoms among homebound and semi-homebound older adults. Some differences in the risk factor profile emerged between the homebound and the semi-homebound populations. Alleviating the burden of depression in the semi-homebound population may focus on early prevention that considers the diversity of this population. Home-based, integrated programs of health and mental health services that simultaneously address the medical, psychiatric, and neurologic comorbidities and disabilities of homebound older adults are needed to meet the complex needs of this population.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan Ann Arbor, Michigan, USA
| | - Jessica Brooks
- Department of Disability and Addiction Rehabilitation, University of North Texas, Denton, Texas, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
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Thomas JE, Jacobs RJ, Caballero J, Ownby RL, Lessmann EM, Mallare K, Adler M. Factors to assess depression in homebound older adults. Ment Health Clin 2016; 6:236-241. [PMID: 29955476 PMCID: PMC6007589 DOI: 10.9740/mhc.2016.09.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The number of homebound older adults is expected to increase as the elderly population grows. Many homebound older persons may be at high risk for depression, which has been associated with adverse health outcomes. The objective of this study was to identify selected factors that may predict depression in the homebound older population. Methods: Data from 340 homebound adults, aged 65 and older who were enrolled in Broward Meals on Wheels and who participated in a telephone survey were analyzed. Participants were asked to report demographic information, health status, medication-taking behaviors, mental health, and life satisfaction. Multiple regression analysis was used to identify predictors of depressed mood in this sample of older adults. Results: The majority of the sample (aged 65–95 years; mean, 77 years) were female (76.5%), white (77.1%), and living alone (52.6%). Multivariate modeling indicated that difficulty remembering the number of prescribed medications to be taken, feeling groggy after taking certain medications, poor self-reported health status, taking anxiety medications, and less satisfaction with life explained 34% (adjusted R2) of the variance in predicting depressed mood (F = 33.1, df = 5, P < .001). Discussion: Multiple factors related to medication use were identified that may contribute to higher levels of depressed mood in homebound older adults. These factors found in our study may be used to create a screening model to be used by pharmacists to identify homebound older adults who would benefit from further assessment for depression.
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Affiliation(s)
- Jennifer E. Thomas
- Assistant Professor, School of Pharmacy, Husson University, Bangor, Maine
| | - Robin J. Jacobs
- Associate Professor, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Joshua Caballero
- (Corresponding author) Associate Professor, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida,
| | - Raymond L. Ownby
- Professor, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Kayla Mallare
- Pharmacy Student, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mark Adler
- Executive Director, Broward Meals on Wheels, Plantation, Florida
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Guidry ET, Cukrowicz KC. Death ideation in older adults: psychological symptoms of depression, thwarted belongingness, and perceived burdensomeness. Aging Ment Health 2016; 20:823-30. [PMID: 26035346 DOI: 10.1080/13607863.2015.1040721] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation. OBJECTIVES The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation. METHOD A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression. RESULTS The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled. CONCLUSION This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.
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Affiliation(s)
- Evan T Guidry
- a Department of Psychological Science , Texas Tech University , Lubbock , TX , USA
| | - Kelly C Cukrowicz
- a Department of Psychological Science , Texas Tech University , Lubbock , TX , USA
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Choi NG, Marti CN, Conwell Y. Effect of Problem-Solving Therapy on Depressed Low-Income Homebound Older Adults' Death/Suicidal Ideation and Hopelessness. Suicide Life Threat Behav 2016; 46:323-36. [PMID: 26456016 PMCID: PMC4829492 DOI: 10.1111/sltb.12195] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 08/02/2015] [Indexed: 11/28/2022]
Abstract
Previous study findings of psychotherapy's effect on suicide prevention have been inconsistent. This study reports the results of secondary analyses of outcome data from a short-term depression treatment on reducing death/suicidal ideation among 158 low-income homebound adults aged 50+. The treatment, in-person or telehealth problem-solving therapy (PST), compared with telephone support call, has been found effective in reducing depressive symptoms and disability among participants. Compared with support call participants, tele-PST participants, but not in-person PST participants, exhibited lower ideation ratings across the follow-up period. Effect sizes at 36 weeks were 0.31 for tele-PST and 0.17 for in-person PST. Hopelessness mediated the effect of tele-PST but not in-person PST; however, in-person PST also alleviated hopelessness, which led to lower ideation. Clinical implications of the findings are discussed.
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Affiliation(s)
- Namkee G. Choi
- Corresponding author: Professor, School of Social Work, The University of Texas at Austin, Austin, TX, USA, ; 512-232-9590; 512-471-9600 (fax)
| | - C. Nathan Marti
- Research Associate, Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Yeates Conwell
- Professor, Department of Psychiatry, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
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Sirey JA, Banerjee S, Marino P, Halkett A, Raeifar E, Paggi M, Bruce ML. Improving Mental Health Treatment Initiation among Depressed Community Dwelling Older Adults. Am J Geriatr Psychiatry 2016; 24:310-9. [PMID: 26915900 PMCID: PMC8178741 DOI: 10.1016/j.jagp.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/21/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Depression screening has been widely implemented in community settings to increase detection of late-life depression. Rates of treatment initiation are low without additional structured follow-up, however. The current study evaluates the effectiveness of a brief psychosocial intervention, Open Door, designed to improve initiation of mental health treatment among clients of aging service meals programs. DESIGN Older adult social service clients with depressive symptoms were randomized to either the Open Door intervention or a Service Referral control condition. In Open Door, the counselor collaborates with the client to identify and address both attitudinal and structural barriers to seeking mental health treatment. Independent research assessments were conducted 12 and 24 weeks after baseline to document treatment initiation (at least one session). RESULTS At follow up, 64.6% (104 out of 161) of participants had initiated a provider visit. Participants in Open Door were more likely to initiate treatment compared with those in the control condition (χ(2) = 5.83, df = 2, p = 0.016). Among participants with at least mild depressive symptoms, Open Door remained significantly more effective than the control condition (p < 0.05). In multivariate analyses controlling for gender differences, both participation in the Open Door group and depression severity predicted treatment initiation (χ(2) = 15.18, df = 3, p = 0.002). CONCLUSIONS High rates of depression have been documented among older adults receiving social services (case management or home meals). The Open Door program offers a useful strategy to overcome the barriers to treatment initiation while fitting within the responsibilities of aging service staff. The intervention can improve initiation of late-life depression care.
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Affiliation(s)
- Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
| | - Samprit Banerjee
- Department of Health Policy and Research, Weill Cornell Medical College, White Plains, NY
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Ashley Halkett
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Elmira Raeifar
- Department of Clinical Psychology, Long Island University, 1 University Plaza, Brooklyn, NY
| | - Michelle Paggi
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
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Kasckow J, Youk A, Anderson SJ, Dew MA, Butters MA, Marron MM, Begley AE, Szanto K, Dombrovski AY, Mulsant BH, Lenze E, Reynolds CF. Trajectories of suicidal ideation in depressed older adults undergoing antidepressant treatment. J Psychiatr Res 2016; 73:96-101. [PMID: 26708830 PMCID: PMC4738173 DOI: 10.1016/j.jpsychires.2015.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Suicide is a public health concern in older adults. Recent cross sectional studies suggest that impairments in executive functioning, memory and attention are associated with suicidal ideation in older adults. It is unknown whether these neuropsychological features predict persistent suicidal ideation. We analyzed data from 468 individuals ≥ age 60 with major depression who received venlafaxine XR monotherapy for up to 16 weeks. We used latent class growth modeling to classify groups of individuals based on trajectories of suicidal ideation. We also examined whether cognitive dysfunction predicted suicidal ideation while controlling for time-dependent variables including depression severity, and age and education. The optimal model using a zero inflated Poisson link classified individuals into four groups, each with a distinct temporal trajectory of suicidal ideation: those with 'minimal suicidal ideation' across time points; those with 'low suicidal ideation'; those with 'rapidly decreasing suicidal ideation'; and those with 'high and persistent suicidal ideation'. Participants in the 'high and persistent suicidal ideation' group had worse scores relative to those in the "rapidly decreasing suicidal ideation" group on the Color-Word 'inhibition/switching' subtest from the Delis-Kaplan Executive Function Scale, worse attention index scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and worse total RBANS index scores. These findings suggest that individuals with poorer ability to switch between inhibitory and non-inhibitory responses as well as worse attention and worse overall cognitive status are more likely to have persistently higher levels of suicidal ideation. CLINICALTRIAL. GOV NUMBER NCT00892047.
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Affiliation(s)
- John Kasckow
- VA Pittsburgh Health Care System, Behavioral Health, University DR C, Pittsburgh, PA 15240, USA; VA Pittsburgh Health Care System, MIRECC, University DR C, Pittsburgh, PA 15240, USA; VA Pittsburgh Health Care System, CHERP, University DR C, Pittsburgh, PA 15240, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Biostatistics, Graduate School of Public Health, University of Pittsburgh, USA.
| | - Ada Youk
- Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | | | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213,Biostatistics, Graduate School of Public Health, University of Pittsburgh,Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Megan M. Marron
- Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Amy E. Begley
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | | | - Benoit H. Mulsant
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213,Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - EricJ. Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
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Design and Recruitment for a Randomized Controlled Trial of Problem-Solving Therapy to Prevent Depression among Older Adults with Need for Supportive Services. Am J Geriatr Psychiatry 2016; 24:94-102. [PMID: 26706911 PMCID: PMC4706765 DOI: 10.1016/j.jagp.2015.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Addressing subthreshold depression (indicated prevention) and vulnerabilities that increase the risk of major depression or anxiety disorders (selective prevention) is important for protecting mental health in old age. The Depression-Agency Based Collaborative (Dep-ABC) is a prevention trial involving older adults recruited from aging services sites (home care agencies, senior housing, senior centers) who meet criteria for subthreshold depression and disability. Therefore, the authors examine the effectiveness of partnerships with aging services sites for recruiting at-risk older adults, the quality of recruitment and acceptability of the Dep-ABC assessment and intervention, and the baseline status of participants. METHODS Dep-ABC is a single-blind randomized controlled prevention trial set in aging services settings but with centralized screening, randomization, in-home assessments, and follow-up. Its intervention arm involves six to eight sessions of problem-solving therapy, in which older adults aged 60+ learn to break down problems that affect well-being and develop strategies to address them. We examined participation rates to assess quality of recruitment across sites and level of disability according to service use. RESULTS Dep-ABC randomized 104 participants, 68.4% of eligible older adults. Screening using self-reported disability successfully netted a sample in which 74% received home care agency services, with remaining participants similarly impaired in structured self-reports of impairment and on observed performance tests. CONCLUSION Direct outreach to aging services providers is an effective way to identify older adults with service needs at high risk of major depression. Problem-solving therapy is acceptable to this population and can be added to current services.
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Thomas KS, Smego R, Akobundu U, Dosa D. Characteristics of Older Adults on Waiting Lists for Meals on Wheels: Identifying Areas for Intervention. J Appl Gerontol 2015; 36:1228-1242. [PMID: 26597791 DOI: 10.1177/0733464815614918] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to characterize the population of seniors on Meals on Wheels' (MOW) waiting lists and identify their rate of depression, anxiety, falls, and fear of falling. Data come from surveys of 626 seniors on waiting lists across the country and the 2013 National Health and Aging Trends Study (NHATS). Results suggest that seniors on waiting lists for MOW were more likely to be widowed, less educated, older, Black, Hispanic, and receive Medicaid than the population of community-dwelling older adults. In addition, 31% of seniors on MOW waiting lists were depressed, compared with 12% of seniors in the national population ( p < .001), and 28% exhibited signs and symptoms of anxiety, compared with 10% of the national population of seniors ( p < .001). Seniors on waiting lists were significantly more likely to have fallen in the last month and be fearful of falling than the national population of seniors ( p < .001). Individuals on MOW waiting lists are a vulnerable and high-risk group. By seeking to better understand clients' needs, appropriate services can be tailored to promote independent living and improve older adults' well-being.
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Affiliation(s)
- Kali S Thomas
- 1 US Department of Veterans Affairs Medical Center, Providence, RI, USA.,2 Brown University School of Public Health, Providence, RI, USA
| | - Raul Smego
- 2 Brown University School of Public Health, Providence, RI, USA
| | | | - David Dosa
- 1 US Department of Veterans Affairs Medical Center, Providence, RI, USA.,2 Brown University School of Public Health, Providence, RI, USA
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Abstract
BACKGROUND Personality disorder traits are relatively prevalent among older adults, and can be associated with complex and chronic difficulties, including suicide risk. However, there is a lack of research regarding personality disorders and suicide ideation in older adults. Depressive symptoms and hopelessness may be important to the relation between personality disorders and suicide risk. Additionally, variables from the interpersonal theory of suicide, perceived burdensomeness and thwarted belongingness, may be critical risk factors for suicide in this population. We hypothesized that perceived burdensomeness and thwarted belongingness, theory-based variables, would act as parallel mediators of the relation between personality disorder traits and suicide ideation, whereas depressive symptoms and hopelessness would not. METHODS The hypothesis was tested in a sample of 143 older adults recruited from a primary care setting. Participants completed self-report questionnaires of personality traits, suicide ideation, depressive symptoms, hopelessness, perceived burdensomeness, and thwarted belongingness. RESULTS Findings from a non-parametric bootstrapping procedure indicated that perceived burdensomeness, thwarted belongingness, and depressive symptoms mediated the relation between total personality disorder traits and suicide ideation. Hopelessness did not act as a mediator. CONCLUSIONS These findings indicate that perceived burdensomeness, thwarted belongingness, and depressive symptoms are likely important risk factors for suicide ideation among older adults. Clinicians should be aware of these issues when assessing and treating suicide risk among older adults.
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Van Orden KA, Yan L, Podgorski CA, Conwell Y. The association between higher social support and lower depressive symptoms among aging services clients is attenuated at higher levels of functional impairment. Int J Geriatr Psychiatry 2015; 30:1085-92. [PMID: 25663607 PMCID: PMC4527957 DOI: 10.1002/gps.4266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adults seeking services from the Aging Services Provider Network (ASPN) are at risk for depression. ASPN clients also have high prevalence of both functional impairments and social morbidities. Study of the relationships between these factors may inform the development of interventions for depression in this service setting. METHODS We interviewed 373 older adults accessing ASPN services and assessed depression symptom severity, functional impairment (instrumental activities of daily living and activities of daily living), and social support. RESULTS Lower social support and greater functional impairment were associated with greater depressive symptoms. At a high level of functional impairment, the inverse associations between indices of social support and depressive symptoms were attenuated. CONCLUSIONS Results suggest that older adults with more severe functional impairment may benefit somewhat less from increased social support with respect to depression symptom severity.
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Affiliation(s)
| | - Li Yan
- University of Rochester School of Medicine
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Oh DJ, Park JY, Oh M, Kim K, Hong J, Kim T, Han JW, Kim TH, Kim KW. Suicidality-based prediction of suicide attempts in a community-dwelling elderly population: Results from the Osan Mental Health Survey. J Affect Disord 2015; 184:286-92. [PMID: 26120807 DOI: 10.1016/j.jad.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on outcomes of suicidality in the community-dwelling elderly are scarce. We investigated the association of suicidality with the suicide attempts in a community-dwelling elderly cohort. METHODS In the Osan Mental Health Survey, 848 randomly sampled elderly Koreans participated in the baseline evaluation, 623 completed 2-year follow-up evaluation and 32 died during the follow-up period. The survey was conducted between February 2010 and January 2013. We evaluated suicidality using the Mini-International Neuropsychiatric Interview suicidality module that includes both suicidal ideation and attempts. RESULTS The incidences of suicidality and suicide attempts were 70.7 and 13.1 per 1000 persons per year, respectively. Suicidality was associated with increased risk of suicide attempts (odds ratio (OR) = 3.84, 95% CI = 1.06-13.87). Two men with suicidality committed suicide by self-poisoning. Moderate to high intensity daily exercise decreased the risk of suicidality to become persistent or recurrent (OR = 0.32, 95% CI = 0.12-0.81). Low education level (OR = 2.41, 95% CI = 1.21-4.77) and depression (OR = 3.02, 95% CI = 1.65-5.53) were associated with risk of incident suicidality. LIMITATIONS Study sample was enrolled from a single city of Korea, and the size of the study sample was small. CONCLUSIONS We may reduce suicide attempts by screening for suicidality and implementing exercise programs in community-dwelling elderly people.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Miyoung Oh
- Osan Mental Health Center, Osan, Republic of Korea
| | - Kayoung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jongwoo Hong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Taehyun Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Won Han
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
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Liebel DV, Friedman B, Conwell Y, Powers BA. Evaluation of geriatric home healthcare depression assessment and care management: are OASIS-C depression requirements enough? Am J Geriatr Psychiatry 2015; 23:794-806. [PMID: 25091519 DOI: 10.1016/j.jagp.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Research is scarce on how depression is identified and treated among Medicare home healthcare (HHC) patients age 65+ with disability. The Centers for Medicare & Medicaid Services (CMS) recently incorporated depression screening into the OASIS-C HHC assessment. Our study objectives were to evaluate and characterize depression care management (DCM) in an HHC agency after CMS increased its depression requirements and to determine if there was an association of DCM with disability (activities of daily living [ADLs]) outcomes. METHODS The authors conducted a retrospective chart review of 100 new Medicare HHC admissions patients age 65+ (mean age: 81.7) who screened positive for depression and had disability and multimorbidity. Clinical and administrative records were examined and descriptive analyses used. Multivariate regression analyses investigated the association of six DCM components with ADLs improvement. RESULTS Depression was recognized in care plans of 60% of patients. Documentation of only one nurse care management activity, antidepressant use, indicated the use of evidence-based standards of depression assessment and DCM. Depression measures were not administered at discharge, recertification, or transfer. Forty percent of patients had a formal depression diagnosis by the referring physician in the chart, and 65% were receiving an antidepressant. Having a depression care plan and depression medication were significantly associated with a large ADLs improvement. CONCLUSION Despite the association of depression care plans with patient disability improvement, inadequate compliance to evidence-based DCM was found. Medicare and HHC agencies must ensure compliance to DCM, including follow-up depression assessment for patients with positive screens.
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Affiliation(s)
| | - Bruce Friedman
- Departments of Public Health Sciences and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Yeates Conwell
- Departments of Public Health Sciences and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Physical fitness exercise versus cognitive behavior therapy on reducing the depressive symptoms among community-dwelling elderly adults: A randomized controlled trial. Int J Nurs Stud 2015; 52:1542-52. [PMID: 26105535 DOI: 10.1016/j.ijnurstu.2015.05.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Depression is a major health problem for community-dwelling elderly adults. Since limited resources are available to decrease the high prevalence of depressive symptoms among the elderly adults, improved support for them can be provided if we can determine which intervention is superior in ridding depressive symptoms. OBJECTIVE To compare the effectiveness of the physical fitness exercise program and the cognitive behavior therapy program on primary (depressive symptoms) and secondary outcomes (6-min walk distance, quality of life, and social support) for community-dwelling elderly adults with depressive symptoms. DESIGN AND SETTINGS A prospective randomized control trial was conducted in three communities in northern Taiwan. PARTICIPANTS The elderly adults in the three communities were invited to participate by mail, phone calls, and posters. There were a total of 57 participants who had depressive symptoms and all without impaired cognition that participated in this trial. None of the participants withdrew during the 9 months of follow-up for this study. METHODS Fifty-seven participants were randomly assigned to one of the three groups: the physical fitness exercise program group, the cognitive behavior therapy (CBT) group, or the control group. The primary (Geriatric Depression Scale-15, GDS-15), and secondary outcomes (6-min walk distance, SF-36, and Inventory of Socially Supportive Behaviors scales, ISSB) were collected immediately (T2), at 3 months (T3), and at 6 months after the interventions (T4). RESULTS After the interventions, the CBT group participants demonstrated significantly lower symptoms of depression (p=0.009) at T2 and perceived more social support from those around them (p<0.001, <0.001 and =0.004, respectively) at three time-point comparisons than the control group. Moreover, after intervention, participants in the physical fitness exercise program group had decreased GDS-15 scores at three time-point comparisons (p=0.003, 0.012 and 0.037, respectively), had a substantially greater 6-min walk distance (p=0.023), a better quality of life (p<0.001), and a better perceived social support at T2 (p<0.001). CONCLUSIONS Immediately after a 12-week intervention, there were significant decreases in depressive symptoms and more perceived social support amongst those in the CBT group. When considering the effectiveness in the decrease of depressive symptoms longer term, the increase in the 6-min walk distance and raising the patients' quality of life, physical fitness exercise program may be a better intervention for elderly adults with depressive symptoms.
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Suicidal ideation among individuals with dysvascular lower extremity amputation. Arch Phys Med Rehabil 2015; 96:1404-10. [PMID: 25883037 DOI: 10.1016/j.apmr.2015.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the estimated prevalence and correlates of suicidal ideation (SI) among individuals 1 year after a first lower extremity amputation (LEA). DESIGN Cohort survey. SETTING Four medical centers. PARTICIPANTS A referred sample of patients (N=239), primarily men, undergoing their first LEA because of complications of diabetes mellitus or peripheral arterial disease, were screened for participation between 2005 and 2008. Of these patients, 136 (57%) met study criteria and 87 (64%) enrolled; 70 (80.5%) of the enrolled patients had complete data regarding SI at 12-month follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES SI, demographic/health information, depressive symptoms, mobility, independence in activities of daily living (ADL), satisfaction with mobility and ADL, medical comorbidities, social support, self-efficacy. RESULTS At 12 months postamputation, 11 subjects (15.71%) reported SI; of these, 3 (27.3%) screened negative for depression. Lower mobility, lower satisfaction with mobility, greater impairment in ADL, lower satisfaction with ADL, lower self-efficacy, and depressive symptoms were all correlated with the presence of SI at a univariate level; of these, only depressive symptoms remained significantly associated with SI in a multivariable model. CONCLUSIONS SI was common among those with recent LEA. Several aspects of an amputee's clinical presentation, such as physical functioning, satisfaction with functioning, and self-efficacy, were associated with SI, although depression severity was the best risk marker. A subset of the sample endorsed SI in the absence of a positive depression screen. Brief screening for depression that includes assessment of SI is recommended.
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Sirey JA, Berman J, Salamone A, DePasquale A, Halkett A, Raeifar E, Banerjee S, Bruce ML, Raue PJ. Feasibility of integrating mental health screening and services into routine elder abuse practice to improve client outcomes. J Elder Abuse Negl 2015; 27:254-69. [PMID: 25611116 DOI: 10.1080/08946566.2015.1008086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The goal of this pilot program was to test the feasibility of mental health screening among elder abuse victims and of offering those victims a brief psychotherapy for depression and anxiety. Elder abuse victims who sought assistance from a large, urban elder abuse service were screened for depression and anxiety using standardized measures. Clients with clinically significant depression (PHQ-9) or anxiety (GAD-7) were randomized to receive one of three different interventions concurrent with abuse resolution services. Staff were able to screen 315 individuals, with 34% of clients scoring positive for depression or anxiety. Of those with mental health needs, only 15% refused all services. The mental health intervention (PROTECT) was successfully implemented in two different formats with collaboration between staff workers. These findings support both the need for mental health care among elder abuse victims and the feasibility of integrating mental health screening and treatment into routine elder abuse practice.
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Affiliation(s)
- Jo Anne Sirey
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
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Muir-Cochrane E, O'Kane D, Barkway P, Oster C, Fuller J. Service provision for older people with mental health problems in a rural area of Australia. Aging Ment Health 2014; 18:759-66. [PMID: 24499436 DOI: 10.1080/13607863.2013.878307] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Unmet mental health care needs of older people (aged 65 and over) have been identified as a serious problem internationally, particularly in rural areas. In this study we explored the views of health and social care providers of the barriers to effective mental health care for older people in a rural region in Australia. METHOD Semi-structured interviews were conducted with 19 participants from 13 organisations providing care and support to older people in a rural region of Australia. A framework analysis approach was used to thematically analyse the data. RESULTS Two main themes were identified: 'Recognising the Problem' and 'Service Availability and Access'. In particular the participants identified the impact of the attitudes of older people and health professionals, as well as service inadequacies and gaps in services, on the provision of mental health care to older people in a rural region. CONCLUSION This study supports previous work on intrinsic and extrinsic barriers to older people with mental health problems accessing mental health services. The study also offers new insight into the difficulties that arise from the separation of physical and mental health systems for older people with multiple needs, and the impact of living in a rural region on unmet mental health care needs of older people.
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Affiliation(s)
- Eimear Muir-Cochrane
- a Faculty of Health Sciences, School of Nursing and Midwifery , Flinders University , Adelaide , Australia
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Choi NG, Marti CN, Bruce ML, Hegel MT, Wilson NL, Kunik ME. Six-month postintervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income homebound older adults. Depress Anxiety 2014; 31:653-61. [PMID: 24501015 PMCID: PMC4122624 DOI: 10.1002/da.22242] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite their high rates of depression, homebound older adults have limited access to evidence-based psychotherapy. The purpose of this paper was to report both depression and disability outcomes of telehealth problem-solving therapy (tele-PST via Skype video call) for low-income homebound older adults over 6 months postintervention. METHODS A 3-arm randomized controlled trial compared the efficacy of tele-PST to in-person PST and telephone care calls with 158 homebound individuals who were aged 50+ and scored 15+ on the 24-item Hamilton Rating Scale for Depression (HAMD). Treatment effects on depression severity (HAMD score) and disability (score on the WHO Disability Assessment Schedule [WHODAS]) were analyzed using mixed-effects regression with random intercept models. Possible reciprocal relationships between depression and disability were examined with a parallel-process latent growth curve model. RESULTS Both tele-PST and in-person PST were efficacious treatments for low-income homebound older adults; however the effects of tele-PST on both depression and disability outcomes were sustained significantly longer than those of in-person PST. Effect sizes (dGMA-raw ) for HAMD score changes at 36 weeks were 0.68 for tele-PST and 0.20 for in-person PST. Effect sizes for WHODAS score changes at 36 weeks were 0.47 for tele-PST and 0.25 for in-person PST. The results also supported reciprocal and indirect effects between depression and disability outcomes. CONCLUSIONS The efficacy and potential low cost of tele-delivered psychotherapy show its potential for easy replication and sustainability to reach a large number of underserved older adults and improve their access to mental health services.
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Affiliation(s)
| | | | | | - Mark T. Hegel
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Nancy L. Wilson
- The Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas
- VA Health Services Research and Development Center of Excellence, Baylor College of Medicine, Houston, Texas
| | - Mark E. Kunik
- The Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas
- VA Health Services Research and Development Center of Excellence, Baylor College of Medicine, Houston, Texas
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Fishbain DA, Lewis JE, Gao J. The pain suicidality association: a narrative review. PAIN MEDICINE 2014; 15:1835-49. [PMID: 24995953 DOI: 10.1111/pme.12463] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The objective of this narrative review was to examine recent evidence and, when necessary, past evidence on the association between pain and suicidality. DESIGN Fifty-eight research reports were found on this topic, which had not previously been reviewed. These reports were divided into groups by whether they addressed suicide ideation (SI), suicide attempts (SAs), or suicide completion (SC), and what population they represented (acute pain patients [APPs], chronic pain patients [CPPs], other than APPs/CPPs) and whether they controlled for relevant confounders. Information as to whether the results of these studies supported/did not support the association of pain and suicidality was abstracted. For each group of studies (above), a vote counting method was utilized to determine the overall percentage of studies supporting/not supporting the association of pain and suicidality. According to this percentage, the consistency of the data supporting this association was rated according to Agency for Healthcare Research and Quality guidelines. RESULTS The following groups of studies received an A consistency rating (consistent evidence from multiple studies): SI, SA, and SC for other than APPs/CPPs; and SI, SA, and SC for CPP prevalence greater than an appropriate control group. Also, a subgroup of the SI, SA, and SC studies for other than APPs/CPPs had controlled for behavioral issues (potential confounders). These three subgroups also received an A consistency rating. The 58 studies also identified a number of new predictor variables for SI, SA, and SC in CPPs. CONCLUSIONS These studies solidify the evidence for an association between pain and SI, SA, and SC in both CPPs and other than APPs/CPPs.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA; State Farm Insurance, Bloomington, Illinois, USA
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Kim BJ, Ahn J. Factors that influence suicidal ideation among elderly Korean immigrants: focus on diatheses and stressors. Aging Ment Health 2014; 18:619-27. [PMID: 24328389 DOI: 10.1080/13607863.2013.866631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The study examined major diatheses and stressors directly related to suicidal ideation among elderly Korean immigrants. The study also explored the significant interactions among these factors. METHOD Data were collected from a cross-sectional survey of 220 elderly Korean immigrants (age ≥ 65) in Los Angeles County. RESULTS Using a robust hierarchical regression, the study found that neuroticism and hopelessness were significantly associated with suicidal ideation. In addition, two interaction terms - neuroticism by hopelessness and neuroticism by acculturation - were both significant predictor variables with strong explanatory power. CONCLUSION The theoretical implications as well as the practical implications for developing and implementing late-life suicide prevention strategies are discussed.
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Affiliation(s)
- Bum Jung Kim
- a School of Social Work , University of Hawaii at Manoa , Honolulu , HI , USA
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O'Riley AA, Van Orden KA, He H, Richardson TM, Podgorski C, Conwell Y. Suicide and death ideation in older adults obtaining aging services. Am J Geriatr Psychiatry 2014; 22:614-22. [PMID: 23602307 PMCID: PMC3880390 DOI: 10.1016/j.jagp.2012.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 11/30/2012] [Accepted: 12/10/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the frequency and correlates of death and suicide ideation in older adults accessing aging services. DESIGN Cross-sectional. SETTING Data for this study were collected via in-home interviews. PARTICIPANTS Aging Services Network (ASN) care management clients aged 60 years and older (N = 377) were recruited for this study. MEASUREMENT The PHQ-9 and the Paykel Suicide Scale were used to assess death and suicide ideation. Correlates of death and suicide ideation were also examined. RESULTS Fourteen percent of subjects endorsed current death or suicide ideation, 27.9% of subjects endorsed death ideation in the past year, and 9.3% of subjects endorsed suicide ideation in the last year. Current death and suicide ideation were associated with greater depressive symptoms. As compared with individuals without ideation, individuals with death ideation demonstrated higher levels of depressive symptoms, more medical conditions, and lower social support. Individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and less perceived social support. Finally, as compared with individuals with death ideation, individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and more alcohol misuse. CONCLUSIONS Death and suicide ideation are common among ASN clients. There were both differences and similarities between correlates of death and suicide ideation. ASN providers are uniquely situated to address many of the correlates of suicide ideation identified in this study; in order to effectively manage suicide ideation in an ASN setting, however, links to primary and mental health care providers are necessary.
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Affiliation(s)
- Alisa A. O'Riley
- University of Rochester School of Medicine and Dentistry (URSMD), Department of Psychiatry
| | | | - Hua He
- Corresponding Author: Alisa A. O'Riley, PhD, University of Rochester Medical Center, 300 Crittenden Blvd, Box Psych, Rochester, NY 14607, Phone: (585) 393-7887, alisa.o'
| | | | - Carol Podgorski
- URSMD, Department of Biostatistics and Computational Biology
| | - Yeates Conwell
- URSMD, Department of Biostatistics and Computational Biology
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