1
|
Lin C, Huang C, Chang W, Chang Y, Liu H, Ng S, Lin H, Lee TM, Lee S, Wu S. Predicting suicidality in late-life depression by 3D convolutional neural network and cross-sample entropy analysis of resting-state fMRI. Brain Behav 2024; 14:e3348. [PMID: 38376042 PMCID: PMC10790060 DOI: 10.1002/brb3.3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Predicting suicide is a pressing issue among older adults; however, predicting its risk is difficult. Capitalizing on the recent development of machine learning, considerable progress has been made in predicting complex behavior such as suicide. As depression remained the strongest risk for suicide, we aimed to apply deep learning algorithms to identify suicidality in a group with late-life depression (LLD). METHODS We enrolled 83 patients with LLD, 35 of which were non-suicidal and 48 were suicidal, including 26 with only suicidal ideation and 22 with past suicide attempts, for resting-state functional magnetic resonance imaging (MRI). Cross-sample entropy (CSE) analysis was conducted to examine the complexity of MRI signals among brain regions. Three-dimensional (3D) convolutional neural networks (CNNs) were used, and the classification accuracy in each brain region was averaged to predict suicidality after sixfold cross-validation. RESULTS We found brain regions with a mean accuracy above 75% to predict suicidality located mostly in default mode, fronto-parietal, and cingulo-opercular resting-state networks. The models with right amygdala and left caudate provided the most reliable accuracy in all cross-validation folds, indicating their neurobiological importance in late-life suicide. CONCLUSION Combining CSE analysis and the 3D CNN, several brain regions were found to be associated with suicidality.
Collapse
Affiliation(s)
- Chemin Lin
- Department of PsychiatryKeelung Chang Gung Memorial HospitalKeelungTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Community Medicine Research CenterChang Gung Memorial HospitalKeelungTaiwan
| | - Chih‐Mao Huang
- Department of Biological Science and TechnologyNational Yang Ming Chiao Tung UniversityHsinchuTaiwan
| | - Wei Chang
- Department of Engineering and System ScienceNational Tsing Hua UniversityHsinchuTaiwan
| | - You‐Xun Chang
- Department of Engineering and System ScienceNational Tsing Hua UniversityHsinchuTaiwan
| | - Ho‐Ling Liu
- Community Medicine Research CenterChang Gung Memorial HospitalKeelungTaiwan
- Department of Imaging PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shu‐Hang Ng
- Department of Head and Neck Oncology GroupLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
- Department of Diagnostic RadiologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Huang‐Li Lin
- Department of PsychiatryLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Tatia Mei‐Chun Lee
- Community Medicine Research CenterChang Gung Memorial HospitalKeelungTaiwan
- Laboratory of Neuropsychology and Human NeuroscienceThe University of Hong KongPok Fu LamHong Kong
- State Key Laboratory of Brain and Cognitive ScienceThe University of Hong KongPok Fu LamHong Kong
| | - Shwu‐Hua Lee
- Department of PsychiatryLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Shun‐Chi Wu
- Department of Engineering and System ScienceNational Tsing Hua UniversityHsinchuTaiwan
| |
Collapse
|
2
|
Wang C, Keilp JG, Galfalvy H, Bridge JA, Sheftall AH, Szanto K. Entrapment and social problem-solving in suicidal behavior across the adult lifespan. J Affect Disord 2023; 329:176-183. [PMID: 36842650 PMCID: PMC10033364 DOI: 10.1016/j.jad.2023.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Feelings of entrapment and deficits in social problem-solving skills have been associated with risk for suicidal behavior in the context of depression. However, few studies have examined the effect of age on the association between these risk factors and suicidal behavior across most of the adult lifespan. METHODS In a three-site study, we tested interactions of age with feelings of entrapment and social problem-solving style in 105 depressed patients with a recent suicide attempt, 95 depressed patients with no history of suicide attempt, and 97 demographically similar non-psychiatric participants (age 16-80). Attempter/non-attempter differences, age interactions, and the relative contribution of entrapment and social problem-solving style to past attempter were examined. RESULTS Entrapment significantly interacted with age such that it discriminated past attempters from depressed non-attempters better at older ages. Social Problem-Solving Inventory (SPSI) total score and most subscales did not distinguish past attempters, but the SPSI Impulsive Style Problem-Solving was an effective discriminator of past suicide attempts across the full adult lifespan and did not interact with age. In a multipredictor model, both the entrapment by age interaction and SPSI Impulsive Style Problem-Solving score were significant predictors for the classification of attempters. LIMITATIONS The cross-sectional nature of our research design limited conclusions that may be drawn about individual change over time or cohort effects. CONCLUSIONS Entrapment did not distinguish past attempters at younger ages but became a better discriminator in middle to late adulthood. An impulsive problem-solving style was associated with past suicide attempts across the full adult lifespan.
Collapse
Affiliation(s)
- C Wang
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - J G Keilp
- Columbia University, Department of Psychiatry, New York, NY, USA; Columbia University, Department of Biostatistics, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - H Galfalvy
- Columbia University, Department of Psychiatry, New York, NY, USA; Columbia University, Department of Biostatistics, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - J A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's and The Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - A H Sheftall
- University of Rochester Medical Center, School of Medicine and Dentistry, Department of Psychiatry, Rochester, NY, USA
| | - K Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
| |
Collapse
|
3
|
Beaudreau SA, Lutz J, Wetherell JL, Nezu AM, Nezu CM, O'Hara R, Gould CE, Roelk B, Jo B, Hernandez B, Samarina V, Otero MC, Gallagher A, Hirsch J, Funderburk J, Pigeon WR. Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk. Contemp Clin Trials 2023; 128:107147. [PMID: 36921689 PMCID: PMC10164054 DOI: 10.1016/j.cct.2023.107147] [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: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Few clinical trials have examined brief non-pharmacological treatments for reducing suicide risk in older Veterans, a high-risk group. Problem Solving Therapy (PST) is a promising psychosocial intervention for reducing late life suicide risk by increasing adaptive coping to problems through effective problem solving and related coping skills. The current randomized clinical trial will compare the efficacy of six telephone-delivered sessions of Safety Planning (enhanced usual care; EUC) only or an updated version of PST (emotion-centered PST [EC-PST]) + EUC to determine the added clinical benefit of EC-PST for reducing severity of suicidal ideation and for increasing reasons for living, a critical protective factor. Participants randomized to EC-PST + EUC or EUC only will be 150 Veterans (75 each) with active suicidal ideation who are aged 60 or older; have a current DSM-5 anxiety, depressive, and/or trauma-related disorder; and without significant cognitive impairment. Primary outcomes (Geriatric Suicide Ideation Scale and Reasons for Living-Older Adults scale) will be assessed at 11 timepoints: baseline, after each of 6 treatment sessions, posttreatment, and at follow-up at 1, 3, and 6 months posttreatment, and analyzed using mixed effects modeling. Additionally, moderators and mediators of primary outcomes will be examined-functional disability, executive dysfunction, and problem-solving ability. Qualitative feedback from participants will identify potential Veteran-centric changes to the EC-PST protocol and to EUC. Ultimately, the goal of this study is to inform the evidence-based clinical practice guidelines for treatments to reduce suicide risk in older Veterans and specifically to inform clinical decision-making regarding the merit of adding EC-PST to EUC.
Collapse
Affiliation(s)
- Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA.
| | - Julie Lutz
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Julie Loebach Wetherell
- Mental Health Service, Veterans Affairs San Diego Health Care System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Arthur M Nezu
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Christine Maguth Nezu
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Ruth O'Hara
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Christine E Gould
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA; Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Brandi Roelk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA
| | - Booil Jo
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Beatriz Hernandez
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Viktoriya Samarina
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Marcela C Otero
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Alana Gallagher
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Psychology Department, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, USA
| | - James Hirsch
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Jennifer Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Wilfred R Pigeon
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA; VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14624, USA
| |
Collapse
|
4
|
Park Y, McCloskey MS, Ammerman BA. Context-Specific Interpersonal Problem-Solving and Suicidal Thoughts and Behaviors. CRISIS 2023; 44:78-81. [PMID: 34463541 DOI: 10.1027/0227-5910/a000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Interpersonal problem-solving difficulties constitute a suicide risk factor that may be particularly relevant among college students. Most studies have examined general interpersonal problem-solving; however, context-specific abilities may have greater clinical implications. Aim: This study examined whether individuals with and without a history of suicidal thoughts and behaviors differed in context-specific interpersonal problem-solving. Method: Undergraduate students (n = 112) completed a brief interview and interpersonal problem-solving tasks with positive (e.g., initiating romantic relationship) and negative (i.e., physical revenge) resolutions. Results: Individuals with a history of suicide ideation generated more effective solutions and more alternatives in the negative-resolution scenario; no significant differences were identified for the positive-resolution scenarios. No group differences were found based on suicide attempt status. Limitations: Our results do not account for the mechanisms that influence problem-solving abilities in negative-resolution scenarios. Conclusion: Clinical efforts may benefit from targeting the translation of interpersonal problem-solving abilities to situations with positive resolutions.
Collapse
Affiliation(s)
- Yeonsoo Park
- Department of Psychology, University of Notre Dame, IN, USA
| | | | | |
Collapse
|
5
|
Barker J, Oakes-Rogers S, Leddy A. What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis. J Psychiatr Res 2022; 154:91-101. [PMID: 35933859 DOI: 10.1016/j.jpsychires.2022.07.048] [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] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Those making suicide attempts with highly lethal medical consequences are arguably the best proxy for those who die by suicide and represent a qualitatively different population from those making lower lethality attempts. Different factors influence the likelihood of a suicide attempt occurring and the lethality of that attempt. Both are important dimensions of risk. Older adults represent a distinct group in suicide research with unique risk factors that influence the lethality of their suicide attempts. This systematic review and meta-analysis summarises factors distinguishing those making high and low-lethality suicide attempts in older adulthood. Databases PsycINFO, PubMed (MEDLINE), Embase and CINAHL were systematically searched with seven of 1182 unique records included. Random effects meta-analyses were conducted on 18 variables in addition to a narrative synthesis regarding executive function. Only increased suicidal intent and planning meaningfully distinguished high from low-lethality attempters in meta-analyses. A large effect size was additionally observed for white ethnicity. Diminished alcohol use disorder prevalence and depression severity, and greater cognitive impairment, may be associated with high lethality attempters but further research is needed. Age and gender were not associated with lethality, contrary to adult populations. A narrative synthesis of studies exploring differences in executive functioning suggested high-lethality attempters were less likely to impulsively act on suicidal urges, allowing them to better plan suicide attempts that are more lethal, and are less likely to alter suicidal plans. Key limitations were that meta-analyses were underpowered to detect small effect sizes, and samples were largely white and limited to the USA.
Collapse
|
6
|
Abstract
OBJECTIVE Disturbances in interpersonal functioning are prevalent in individuals with suicidality. Foundational for interpersonal functioning is theory of mind (ToM), a social-cognitive ability that allows individuals to understand the thoughts and feelings of others. Recent work has begun to investigate ToM performance in individuals with suicidality, though no review has quantitatively aggregated findings from these varied studies. The current study investigated the relations between ToM and suicidality with meta-analysis. METHOD We identified and meta-analyzed 15 studies that presented data for 2,895 participants (617 of whom had reported at least one suicide attempt). RESULTS Results indicated a significant, negative relation between ToM and suicidality with a medium overall effect size (g = -.475). Moderator analyses revealed that this effect was consistent across age, sex, ToM content, and suicidal outcome. CONCLUSION Deficits in ToM associated with suicidality hold promise for risk-identification, treatment, and prevention work.HighlightsTheory of mind (ToM) abilities are critical for effective interpersonal functioning.Meta-analytics results indicate that ToM deficits are associated with suicidality.Identifying such suicidality-related ToM deficits may inform risk-identification, treatment, and prevention work.
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Richard-Devantoy S, Badillo-Amberg I, Greenway KT, Tomasso MD, Turecki G, Bertrand JA. Low MoCA performances correlate with suicidal ideation in late-life depression. Psychiatry Res 2021; 301:113957. [PMID: 33962353 DOI: 10.1016/j.psychres.2021.113957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Late-life depression remains an underdiagnosed clinical entity, mainly because the presence of cognitive impairment in the elderly leads clinicians to suspect dementia rather than depression. Our objective was to analyze the cognitive abilities of elderly depressed patients using the Montreal Cognitive Assessment (MoCA) in relation to the presence or absence of suicidal ideation. The MoCA, Beck Scale of Suicidal Ideation, Hamilton Anxiety Scale, and Hamilton Depression Scale were administered to 72 patients with a recent history of late life depression: 43 with suicidal ideation and 29 non-suicidal controls. The results show that suicidal patients demonstrated significantly worse performance on the MoCA total score and the delayed recall subtest in comparison to non-suicidal controls. In addition, after adjusting for age and depression, poorer performance on the MoCA total score correlated to the presence of suicidal ideation. We found that the MoCA total score is able to predict the presence of suicidal ideation in depressed elderly patients in a fair-to-good manner. As late-life depression is already established as a potential prodrome of dementia, longitudinal follow-up may determine whether depressed individuals with suicidal ideation are at higher risk of converting to dementia.
Collapse
Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada.
| | - Icoquih Badillo-Amberg
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Kyle T Greenway
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Maria Di Tomasso
- CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada
| | - Gustavo Turecki
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - J A Bertrand
- CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada; Douglas Research Center, Douglas Mental Health Research Institute, Montréal, Québec, Canada; Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| |
Collapse
|
9
|
Perry M, Buerke M, Szücs A, Allen TA, Bruine de Bruin W, Szanto K, Dombrovski A. A lifetime of challenges: real-life decision outcomes in early- and late-onset suicide attempters. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100105. [PMID: 34109322 PMCID: PMC8186299 DOI: 10.1016/j.jadr.2021.100105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND People who have attempted suicide display suboptimal decision-making in the lab. Yet, it remains unclear whether these difficulties tie in with other detrimental outcomes in their lives besides suicidal behavior. We hypothesize that this is more likely the case for individuals who first attempted suicide earlier than later in life. METHODS A cross-sectional case-control study of 310 adults aged ≥ 50 years (mean: 63.9), compared early- and late-onset attempters (first attempt < 55 vs. ≥ 55 years of age) to suicide ideators, non-suicidal depressed controls and non-psychiatric healthy controls. Participants reported potentially avoidable negative decision outcomes across their lifetime, using the Decision Outcome Inventory (DOI). We employed multi-level modeling to examine group differences overall, and in three factor-analytically derived domains labeled Acting Out, Lack of Future Planning, and Hassles. RESULTS Psychopathology predicted worse decision outcomes overall, and in the more serious Acting Out and Lack of Future Planning domains, but not in Hassles. Early-onset attempters experienced more negative outcomes than other groups overall, in Lack of Future Planning, and particularly in Acting Out. Late-onset attempters were similar to depressed controls and experienced fewer Acting out outcomes than ideators. LIMITATIONS The cross-sectional design precluded prospective prediction of attempts. The assessment of negative outcomes may have lacked precision due to recall bias. CONCLUSIONS Whereas early-onset suicidal behavior is likely the manifestation of long-lasting decision-making deficits in several serious aspects of life, late-onset cases appear to function similarly to non-suicidal depressed adults, suggesting that their attempt originates from a more isolated crisis.
Collapse
Affiliation(s)
- M. Perry
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - M. Buerke
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - A. Szücs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - T. A. Allen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - W. Bruine de Bruin
- Department of Public Policy, University of Southern California, Los Angeles, CA, United States
| | - K. Szanto
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - A.Y. Dombrovski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
10
|
Lutz J, Mashal N, Kramer A, Suresh M, Gould C, Jordan JT, Wetherell JL, Beaudreau SA. A Case Report of Problem Solving Therapy for Reducing Suicide Risk in Older Adults with Anxiety Disorders. Clin Gerontol 2020; 43:110-117. [PMID: 31131742 DOI: 10.1080/07317115.2019.1617378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives: Suicide is a global public health problem among older adults. Problem-solving therapy (PST) has demonstrated promise in reducing late-life suicide risk, chiefly in secondary analyses of studies on late-life depression. PST mitigates negative beliefs about one's problem-solving abilities and maladaptive problem-solving styles, which suicidal older adults report. The effects of PST on suicide risk in older adults with primary anxiety disorder diagnoses have not been examined. Anxiety is a risk factor for suicide, but it is less studied in research on suicide compared to depression. This paper describes two cases of older individuals with anxiety disorders and suicidal ideation who completed six sessions of PST. Methods: Assessments of suicide risk, anxiety, depressive symptoms, and problem-solving ability were administered. Results: Both cases exhibited a clinically significant reduction in suicide risk, along with reductions in anxiety, worry, and depressive symptoms by posttreatment. Conclusions & Clinical Implications: Findings highlight the potential for PST as a psychotherapeutic intervention for reducing suicide risk in older adults with anxiety disorders.
Collapse
Affiliation(s)
- Julie Lutz
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nehjla Mashal
- General Psychiatry Outpatient Services, VA San Francisco Health Care System, San Francisco, CA, USA
| | - Abigail Kramer
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA, USA.,Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Madhuvanthi Suresh
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA, USA.,Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Christine Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joshua T Jordan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Julie Loebach Wetherell
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
11
|
Gramaglia C, Calati R, Zeppegno P. Rational Suicide in Late Life: A Systematic Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E656. [PMID: 31569542 PMCID: PMC6843265 DOI: 10.3390/medicina55100656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/15/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians' and population's perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting "silent" suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the "rationality" of patients' decision to die should be avoided, the possibility of rational suicide cannot be precluded.
Collapse
Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy.
- S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy.
| | - Raffaella Calati
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy.
- Nîmes University Hospital, 30029 Nîmes, France.
| | - Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy.
- S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy.
| |
Collapse
|
12
|
Zhang K, Szanto K, Clark L, Dombrovski AY. Behavioral empathy failures and suicidal behavior. Behav Res Ther 2019; 120:103329. [PMID: 30477905 PMCID: PMC6497579 DOI: 10.1016/j.brat.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/16/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
Abstract
Impaired decision-making has recently gained recognition as a component of the suicidal diathesis. Yet, although precipitants and particularly deterrents to suicidal behavior are often interpersonal, little is known about social decision-making in suicidal individuals. This study employed a novel version of the Ultimatum Game to investigate how empathy moderates responses to social conflict in 149 older adults, comprising groups of suicide attempters (n = 49), suicide ideators (n = 32), non-suicidal depressed controls (n = 33), and a non-psychiatric control group (n = 35). Participants acted as responder to a series of single-shot financial offers that varied in fairness. Some offers were paired with social context information on the proposer, designed to evoke either empathy or punishment. Offer acceptance was sensitive to Fairness and Social Context, such that participants accepted more offers in the empathy condition and fewer offers in the punishment condition. A Group * Context interaction was observed, wherein the suicide attempters adjusted their acceptance rates less in the empathy condition than the non-psychiatric controls. Thus, older adults with a history of suicide attempt were less influenced by empathy scenarios, indicating that a failure to integrate others' emotions into decisions may undermine social deterrents to suicide.
Collapse
Affiliation(s)
- Ke Zhang
- Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luke Clark
- Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Alexandre Y Dombrovski
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
13
|
Butcher HK, Ingram TN. Evidence-Based Practice Guideline: Secondary Prevention of Late-Life Suicide. J Gerontol Nurs 2018; 44:20-32. [PMID: 30208188 DOI: 10.3928/00989134-20180907-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suicide is a tragic, traumatic loss, and one of the most emotionally devastating events families, friends, and communities experience. Suicide claims more than 800,000 lives every year, and some of the highest rates of suicide in the United States and globally are among older adults. The purpose of this evidence-based guideline is to help health care providers recognize those at risk for suicide and recommend appropriate and effective secondary suicide prevention interventions. The information in this guideline is intended for health care providers who work in a variety of settings, including hospitals, nursing homes, rehabilitation centers, out-patient clinics, mental health clinics, home health care, and other long-term care facilities. Assessment and preventive treatment strategies were derived by exhaustive literature review and synthesis of the current evidence on secondary prevention of late-life suicide across practice settings. [Journal of Gerontological Nursing, 44(11), 20-32.].
Collapse
|
14
|
Vannoy S, Park M, Maroney MR, Unützer J, Apesoa-Varano EC, Hinton L. The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care. CRISIS 2018; 39:397-405. [PMID: 29618265 DOI: 10.1027/0227-5910/a000511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. AIMS This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. METHOD Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. RESULTS Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" CONCLUSION Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.
Collapse
Affiliation(s)
- Steven Vannoy
- 1 Department of Counseling and School Psychology, University of Massachusetts Boston, MA, USA
| | - Mijung Park
- 2 Family Health Care Nursing, University of California San Francisco, CA, USA
| | - Meredith R Maroney
- 1 Department of Counseling and School Psychology, University of Massachusetts Boston, MA, USA
| | - Jürgen Unützer
- 3 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Ladson Hinton
- 4 Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
15
|
Sousa GSD, Perrelli JGA, Botelho ES. Nursing diagnosis for Risk of Suicide in elderly: integrative review. Rev Gaucha Enferm 2018; 39:e20170120. [PMID: 30088601 DOI: 10.1590/1983-1447.2018.2017-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/06/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the specialized literature regarding the risk factors in nursing diagnosis for suicide risks in elderly. METHOD This is an integrative literature review carried out during June 2015 in the following databases with no time limit: MEDLINE, PsycINFO and CINAHL. RESULTS A total of 80 full papers were analyzed. It was suggested the inclusion of 23 risk factors in NANDA-I taxonomy: apathy; unrest; low self esteem; carelessness with medication; Inability to ask for help; Inability to express feelings; suicidal plan; rigidity; functional disability; visual problems; sadness; hostility; anxiety; failure; frustration; unhappiness; dishonor; frequent visits to a physician with unclear symptoms; social deprivation; social devaluation; psychological violence; Interfamilial violence; and financial violence. CONCLUSION The risks for suicide presented in NANDA-I taxonomy need to be refined and adapted to the elderly reality. Furthermore, a review is also recommended for the risk factors not included in this classification.
Collapse
Affiliation(s)
- Girliani Silva de Sousa
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento. Recife, Pernambuco, Brasil
| | | | - Everton Sougey Botelho
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento. Recife, Pernambuco, Brasil
| |
Collapse
|
16
|
Abstract
Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.
Collapse
Affiliation(s)
- Ismael Conejero
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France
| | - Emilie Olié
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Philippe Courtet
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Raffaella Calati
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| |
Collapse
|
17
|
Gonzalez VM, Neander LL. Impulsivity as a mediator in the relationship between problem solving and suicidal ideation. J Clin Psychol 2018. [PMID: 29543334 DOI: 10.1002/jclp.22618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study examined whether three facets of impulsivity previously shown to be associated with suicidal ideation and attempts (negative urgency, lack of premeditation, and lack of perseverance) help to account for the established association between problem solving deficits and suicidal ideation. METHOD Emerging adult college student drinkers with a history of at least passive suicidal ideation (N = 387) completed measures of problem solving, impulsivity, and suicidal ideation. A path analysis was conducted to examine the mediating role of impulsivity variables in the association between problem solving (rational problem solving, positive and negative problem orientation, and avoidance style) and suicidal ideation. RESULTS Direct and indirect associations through impulsivity, particularly negative urgency, were found between problem solving and severity of suicidal ideation. CONCLUSIONS Interventions aimed at teaching problem solving skills, as well as self-efficacy and optimism for solving life problems, may help to reduce impulsivity and suicidal ideation.
Collapse
|
18
|
Szanto K, Galfavy H, Vanyukov PM, Keilp JG, Dombrovski AY. Pathways to Late-Life Suicidal Behavior: Cluster Analysis and Predictive Validation of Suicidal Behavior in a Sample of Older Adults With Major Depression. J Clin Psychiatry 2018; 79:17m11611. [PMID: 29489076 PMCID: PMC5932247 DOI: 10.4088/jcp.17m11611] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Clinical heterogeneity is a key challenge to understanding suicidal risk, as different pathways to suicidal behavior are likely to exist. We aimed to identify such pathways by uncovering latent classes of late-life depression cases and relating them to prior and future suicidal behavior. METHODS Data were collected from June 2010 to September 2015. In this longitudinal study we examined distinct associations of clinical and cognitive/decision-making factors with suicidal behavior in 194 older (50+ years) nondemented, depressed patients; 57 nonpsychiatric healthy controls provided benchmark data. The DSM-IV was used to establish diagnostic criteria. We identified multivariate patterns of risk factors, defining clusters based on personality traits, perceived social support, cognitive performance, and decision-making in an analysis blinded to participants' history of suicidal behavior. We validated these clusters using past and prospective suicidal ideation and behavior. RESULTS Of 5 clusters identified, 3 were associated with high risk for suicidal behavior: (1) cognitive deficits, dysfunctional personality, low social support, high willingness to delay future rewards, and overrepresentation of high-lethality attempters; (2) high-personality pathology (ie, low self-esteem), minimal or no cognitive deficits, and overrepresentation of low-lethality attempters and ideators; (3) cognitive deficits, inability to delay future rewards, and similar distribution of high- and low-lethality attempters. There were significant between-cluster differences in number (P < .001) and lethality (P = .002) of past suicide attempts and in the likelihood of future suicide attempts (P = .010, 30 attempts by 22 patients, 2 fatal) and emergency psychiatric hospitalizations to prevent suicide (P = .005, 31 participants). CONCLUSIONS Three pathways to suicidal behavior in older patients were found, marked by (1) very high levels of cognitive and dispositional risk factors suggesting a dementia prodrome, (2) dysfunctional personality traits, and (3) impulsive decision-making and cognitive deficits.
Collapse
Affiliation(s)
- Katalin Szanto
- Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213. .,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hanga Galfavy
- Columbia University, Department of Psychiatry, New York, NY, USA
| | - Polina M. Vanyukov
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - John G. Keilp
- Columbia University, Department of Psychiatry, New York, NY, USA
| | | |
Collapse
|
19
|
Li H, Tucker J, Holroyd E, Zhang J, Jiang B. Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1025-1034. [PMID: 28028668 DOI: 10.1007/s10508-016-0894-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
Globally, suicidal ideation and behavior have been widely reported among people living with human immunodeficiency virus (HIV). Knowledge gaps exist regarding the longer life and resilience-related experiences of people living with HIV (PLWH). Specifically, there is a dearth of data about the interaction of perceived risk and resilient factors resulting in a wide spectrum of intentional suicidal ideation outcomes in a Chinese cultural context. This qualitative research drew from a larger ethnographic study of newly diagnosed HIV-positive men who have sex with men (MSM) in Mainland China. Interviews were conducted with 31 MSM within 6 months of diagnosis of HIV infection. Initial suicidal ideation was commonly reported with participants subsequently feeling more resilient to these thoughts through gaining a greater understanding of their prognosis and treatment. Post-HIV diagnosis, some participants reported forming new relationships and receiving increased support from their partners, friends, peers, families, and community-based organizations. At follow-up, these participants generally reported suicidal ideation had declined. However, participants who continued to express suicidal ideation perceived extended pressure from their families' expectations for them to engage in heterosexual marriages and parenthood. Furthermore, these men reported ongoing hardships in their daily life, unemployment, lack of social support, and isolation. Among this Mainland Chinese cohort of HIV-positive MSM, suicidal ideation may be a transient phenomenon experienced initially following HIV diagnosis that resolves with increased and specific familial, social, and service-based support. It is crucial to identify the causes of stress and social suffering associated with HIV diagnosis in order to reduce suicidal ideation. In China, action is needed to develop routine mental health screening and to increase services that support PLWH. Important services mechanism to accomplish this are promoting resilience through intentional activities as well as continued public health campaigns to reduce stigma toward HIV-positive MSM.
Collapse
Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China.
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Joseph Tucker
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eleanor Holroyd
- School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand
- School of Global and Population Health, The University of Melbourne, Melbourne, Australia
| | - Jie Zhang
- School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China
- Department of Sociology, State University of New York College at Buffalo, Buffalo, NY, USA
| | - Baofa Jiang
- School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China
| |
Collapse
|
20
|
Abstract
Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates, biological markers, and patterns of comorbidity. This review includes the most important and recent studies on psychological factors: cognitive, emotional, temperament, and personality correlates (unrelated to diagnostic criteria). We included classic factors related to suicidal behavior such as cognitive, inflexibility, problem-solving, coping, rumination, thought suppression, decision-making, autobiographical memory, working memory, language fluency, burdensomeness, belongingness, fearless, pain insensitivity, impulsiveness, aggressiveness, and hopelessness. The personality correlates reported are mainly based on the personality theories of Cloninger, Costa and McCrae, and Eysenck. Moreover, it explores conceptual links to other new pathways in psychological factors, emptiness, and psychological pain as a possible origin and common end path for a portion of suicidal behaviors.
Collapse
|
21
|
Chesin M, Interian A, Kline A, Benjamin-Phillips C, Latorre M, Stanley B. Reviewing Mindfulness-Based Interventions for Suicidal Behavior. Arch Suicide Res 2016; 20:507-27. [PMID: 26983364 DOI: 10.1080/13811118.2016.1162244] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article describes the rationale for using mindfulness-based interventions (MBIs) to prevent suicidal behavior in high suicide-risk individuals. A narrative review of studies testing the feasibility of MBIs with individuals at risk for suicidal behavior and the effectiveness of MBIs for reducing suicidality was conducted. Studies testing the effectiveness of MBIs for reducing deficits specific to suicide attempters among depressed individuals were also reviewed as were studies examining moderators of MBI treatment adherence and effectiveness to the extent that these might suggest possible limitations to using MBIs with high suicide-risk individuals. Findings from the handful of available studies support targeting suicidal ideation with MBI. Additional studies show deficits associated with suicide attempt, namely attentional dyscontrol, problem solving deficits, and abnormal stress response, are improved by MBI and thus strengthen the rationale for using MBIs with high suicide-risk individuals.
Collapse
|
22
|
Mills PD, Gallimore BI, Watts BV, Hemphill RR. Suicide attempts and completions in Veterans Affairs nursing home care units and long-term care facilities: a review of root-cause analysis reports. Int J Geriatr Psychiatry 2016; 31:518-25. [PMID: 26422195 DOI: 10.1002/gps.4357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Suicide was the 10th leading cause of death for Americans in 2010. The suicide rate is highest among men who are aged 75 and older. The prevalence of suicidal behavior in nursing homes and long-term care (LTC) facilities was estimated to be 1%. This study describes the systemic vulnerabilities found after suicidal behavior in LTC facilities as well as steps to decrease or mitigate the risk. METHOD This is a retrospective review of root-cause analysis (RCA) reports of suicide attempts and completions between 1 January 2000 and 31 December 2013 in the Veterans Health Administration LTC and nursing home care units. The RCA reports of suicide attempts and completions were coded for patient demographics, method of attempt or completion, root causes, and actions developed to address the root cause. RESULTS Thirty-five RCA reports were identified. The average age was 65 years, 11 had a previous suicide attempt, and the primary mental health diagnoses were depression, posttraumatic stress disorder, and schizophrenia. The primary methods of self-harm were cutting with a sharp object, overdose, and strangulation. CONCLUSIONS It is recommended that all staff members are aware of the signs and risk factors for depression and suicide in this population and should systematically assess and treat mental disorders. In addition, LTC facilities should have a standard protocol for evaluating the environment for suicide hazards and use interdisciplinary teams to promote good communication about risk factors identified among patients. Finally, staff should go beyond staff education and policy to make clinical changes at the bedside. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
Collapse
Affiliation(s)
- Peter D Mills
- VA National Center for Patient Safety, VAMC, White River Junction, VT, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - B Vince Watts
- VA National Center for Patient Safety, VAMC, White River Junction, VT, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | |
Collapse
|
23
|
Deuter K, Procter N, Evans D, Jaworski K. Suicide in older people: Revisioning new approaches. Int J Ment Health Nurs 2016; 25:144-50. [PMID: 26762697 DOI: 10.1111/inm.12182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/27/2015] [Accepted: 09/08/2015] [Indexed: 12/01/2022]
Abstract
This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention.
Collapse
Affiliation(s)
- Kate Deuter
- Schools of Nursing & Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Nicholas Procter
- Schools of Nursing & Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - David Evans
- Schools of Nursing & Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Katrina Jaworski
- Communication, International Studies and Languages, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
24
|
Alphs L, Brashear HR, Chappell P, Conwell Y, Dubrava S, Khin NA, Kozauer N, Hartley DM, Miller DS, Schindler RJ, Siemers ER, Stewart M, Yaffe K. Considerations for the assessment of suicidal ideation and behavior in older adults with cognitive decline and dementia. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 2:48-59. [PMID: 29067293 PMCID: PMC5644272 DOI: 10.1016/j.trci.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Better understanding of suicide risk and its management in older adults with cognitive impairment and/or dementia remain significant unmet public health needs. Urgency to address them derives from concern that CNS treatments for dementia may impact suicide risk. Regulatory guidances requiring assessment of emergent suicidal ideation and behavior (SI/SB) at every clinical trial visit emphasize the need for understanding their prevalence. Methods The literature regarding SI/SB in older persons with cognitive impairment or dementia was reviewed by an Alzheimer's Association Taskforce with emphasis on epidemiology, classification, assessment, and regulatory requirements. Results Gaps in our knowledge were identified, challenges discussed and recommendations for future work provided. Discussion Currently available SI/SB data from geriatric persons with dementia do not provide adequate understanding of its epidemiology, identification, assessment, or management. The growing public health burden of this population requires greater attention from clinicians and researchers on tactics and assessment tools to meet these needs.
Collapse
Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - H Robert Brashear
- Janssen Alzheimer Immunotherapy & Research & Development, LLC, South San Francisco, CA, USA
| | | | | | | | - Ni A Khin
- Division of Psychiatry Products, Food and Drug Administration, Silver Spring, MD, USA.,Division of Clinical Compliance Evaluation, FDA, Silver Spring, MD, USA
| | - Nicholas Kozauer
- Division of Neurology Products, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Vanyukov PM, Szanto K, Hallquist MN, Siegle GJ, Reynolds CF, Forman SD, Aizenstein HJ, Dombrovski AY. Paralimbic and lateral prefrontal encoding of reward value during intertemporal choice in attempted suicide. Psychol Med 2016; 46:381-391. [PMID: 26446615 PMCID: PMC4797639 DOI: 10.1017/s0033291715001890] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alongside impulsive suicide attempts, clinicians encounter highly premeditated suicidal acts, particularly in older adults. We have previously found that in contrast to the more impulsive suicide attempters' inability to delay gratification, serious and highly planned suicide attempts were associated with greater willingness to wait for larger rewards. This study examined neural underpinnings of intertemporal preference in suicide attempters. We expected that impulsivity and suicide attempts, particularly poorly planned ones, would predict altered paralimbic subjective value representations. We also examined lateral prefrontal and paralimbic correlates of premeditation in suicidal behavior. METHOD A total of 48 participants aged 46-90 years underwent extensive clinical and cognitive characterization and completed the delay discounting task in the scanner: 26 individuals with major depression (13 with and 13 without history of suicide attempts) and 22 healthy controls. RESULTS More impulsive individuals displayed greater activation in the precuneus/posterior cingulate cortex (PCC) to value difference favoring the delayed option. Suicide attempts, particularly better-planned ones, were associated with deactivation of the lateral prefrontal cortex (lPFC) in response to value difference favoring the immediate option. Findings were robust to medication exposure, depression severity and possible brain damage from suicide attempts, among other confounders. Finally, in suicide attempters longer reward delays were associated with diminished parahippocampal responses. CONCLUSIONS Impulsivity was associated with an altered paralimbic (precuneus/PCC) encoding of value difference during intertemporal choice. By contrast, better-planned suicidal acts were associated with altered lPFC representations of value difference. The study provides preliminary evidence of impaired decision processes in both impulsive and premeditated suicidal behavior.
Collapse
Affiliation(s)
- P M Vanyukov
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - K Szanto
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - M N Hallquist
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - G J Siegle
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - C F Reynolds
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - S D Forman
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - H J Aizenstein
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - A Y Dombrovski
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| |
Collapse
|
27
|
Gustavson KA, Alexopoulos GS, Niu GC, McCulloch C, Meade T, Arean PA. Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction. Am J Geriatr Psychiatry 2016; 24:11-17. [PMID: 26743100 PMCID: PMC5730069 DOI: 10.1016/j.jagp.2015.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, sex, and additional cognitive impairment load (e.g., memory impairments) were related to changes in suicidal ideation over time. DESIGN Secondary data analysis using data from a randomized clinical trial allocating participants to PST or ST at 1:1 ratio. Raters were blind to patients' assignments. SETTING University medical centers. PARTICIPANTS 221 people aged 65 years old and older with major depression determined by Structured Clinical Interview for DSM-III-R diagnosis and executive dysfunction as defined by a score of 33 or less on the Initiation-Perseveration Score of the Mattis Dementia Rating Scale or a Stroop Interference Task score of 25 or less. INTERVENTIONS 12 weekly sessions of PST or ST. MAIN OUTCOME MEASURES The suicide item of the Hamilton Depression Rating Scale. RESULTS Of the 221 participants, 61% reported suicidal ideation (SI). The ST group had a lower rate of improvement in SI after 12 weeks (44.6%) than did the PST group (60.4%, Fisher's exact test p = 0.031). Logistic regression showed significantly greater reductions in SI in elders who received PST at both 12 weeks (OR: .50, Z = -2.16, p = 0.031) and 36 weeks (OR: 0.5, Z = -1.96, p = 0.05) after treatment. CONCLUSIONS PST is a promising intervention for older adults who are at risk for suicide. ClinicalTrials.gov Identifier: NCT00052091.
Collapse
Affiliation(s)
| | | | - Grace C. Niu
- University of California, San Francisco Department of Psychiatry
| | | | - Tanya Meade
- University of Western Sydney, School of Social Sciences and Psychology
| | - Patricia A. Arean
- University of Washington, Department of Psychiatry and Behavioral Sciences
| |
Collapse
|
28
|
Szanto K, Bruine de Bruin W, Parker AM, Hallquist MN, Vanyukov PM, Dombrovski AY. Decision-making competence and attempted suicide. J Clin Psychiatry 2015; 76:e1590-7. [PMID: 26717535 PMCID: PMC4697276 DOI: 10.4088/jcp.15m09778] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/29/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral-decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases that may ultimately obscure alternative solutions and deterrents to suicide in a crisis. METHOD We assessed older and middle-aged (42-97 years) individuals who made high-lethality (medically serious) (n = 31) and low-lethality suicide attempts (n = 29). Comparison groups included suicide ideators (n = 30), nonsuicidal depressed participants (n = 53), and psychiatrically healthy participants (n = 28). Attempters, ideators, and nonsuicidal depressed participants had nonpsychotic major depression (DSM-IV criteria). Decision biases included sunk cost (inability to abort an action for which costs are irrecoverable), framing (responding to superficial features of how a problem is presented), underconfidence/overconfidence (appropriateness of confidence in knowledge), and inconsistent risk perception. Data were collected between June 2010 and February 2014. RESULTS Both high- and low-lethality attempters were more susceptible to framing effects as compared to the other groups included in this study (P ≤ .05, ηp2 = 0.06). In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters (P ≤ .01, ηp2 = 0.09). These group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects. CONCLUSIONS Suicide attempters' failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis. Failure of low-lethality attempters to resist sunk cost may reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts.
Collapse
Affiliation(s)
- Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213
| | | | | | | | | | | |
Collapse
|
29
|
Sankaranarayanan A, Mancuso S, Wilding H, Ghuloum S, Castle D. Smoking, Suicidality and Psychosis: A Systematic Meta-Analysis. PLoS One 2015; 10:e0138147. [PMID: 26372218 PMCID: PMC4570823 DOI: 10.1371/journal.pone.0138147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/25/2015] [Indexed: 12/22/2022] Open
Abstract
The aim of this study is to systematically review the literature that explored the association between smoking and suicidal risk among those with serious mental illness and to estimate the risk of suicidal behaviors attributable to smoking among this patient group. Multiple databases (CINAHL, PsycINFO, EMBASE, Informit Health Collection and the Cochrane Library databases) were searched from 1 January 1975 through 15 January 2014, along with references from relevant articles for observational studies that ascertained the association between smoking and suicidal behaviors among patients with psychotic disorders conducted in adult patients. Thirteen studies involving 6813 patients with severe mental illness were included. We found that smoking was significantly associated with suicidality in psychosis with an Odds Ratio of 2.12 (95% CI 1.67–2.7). Smoking is associated with suicidal risk amongst individuals with a severe mental illness; however, it is still unclear whether this represents a true risk factor or a confounder or a mediator via mechanisms, hitherto unknown, needs to be studied further.
Collapse
Affiliation(s)
- Anoop Sankaranarayanan
- Department of Geriatrics, Hamad Medical Corporation, Doha Qatar
- Department of Psychiatry, Weil Cornell Medical College, Doha Qatar
- * E-mail:
| | - Serafino Mancuso
- St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | | | - Suhaila Ghuloum
- Department of Psychiatry, Weil Cornell Medical College, Doha Qatar
- Department of Psychiatry, Hamad Medical Corporation, Doha Qatar
| | - David Castle
- St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Department of Psychiatry, Australian Catholic University, Melbourne, Australia
| |
Collapse
|
30
|
Vanyukov PM, Szanto K, Siegle GJ, Hallquist MN, Reynolds CF, Aizenstein HJ, Dombrovski AY. Impulsive traits and unplanned suicide attempts predict exaggerated prefrontal response to angry faces in the elderly. Am J Geriatr Psychiatry 2015; 23:829-39. [PMID: 25529800 PMCID: PMC4528975 DOI: 10.1016/j.jagp.2014.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Abnormal responses to social stimuli are seen in people vulnerable to suicidal behavior, indicating possible disruptions in the neural circuitry mediating the interpretation of socioemotional cues. These disruptions have not been empirically related to psychological and cognitive pathways to suicide. In the present study of older suicide attempters, we examined neural responses to emotional faces and their relationship to impulsivity, one of the components of the suicidal diathesis. METHODS Using functional magnetic resonance imaging, we recorded neurohemodynamic responses to angry faces in a carefully characterized sample of 18 depressed elderly with history of suicide attempts, 13 depressed nonsuicidal patients, and 18 healthy individuals, all aged 60+. Impulsivity was assessed with the Social Problem Solving Inventory Impulsivity/Carelessness Style subscale and Barratt Impulsiveness Scale. The Suicide Intent Scale planning subscale was used to describe the degree of planning associated with the most lethal attempt. RESULTS Depression and history of attempted suicide were not associated with neural responses to angry faces, failing to replicate earlier studies. Higher impulsivity, however, predicted exaggerated responses to angry faces in fronto-opercular and dorsomedial prefrontal cortex (pcorr <0.05). Poorly planned suicide attempts also predicted increased fronto-opercular responses. Results were robust to effects of medication exposure, comorbid anxiety and addiction, severity of depression, burden of physical illness, and possible brain injury from suicide attempts. CONCLUSION Impulsive traits and history of unplanned suicide attempts partly explain the heterogeneity in neural responses to angry faces in depressed elderly. Displays of social emotion command excessive cortical processing in impulsive suicide attempters.
Collapse
|
31
|
Abstract
OBJECTIVE Late-life suicide is a complex clinical and public health problem. METHOD In this article, some of the key complexities inherent in studying late-life suicide are discussed in the service of promoting high-quality late-life suicide prevention science. RESULTS We discuss the following research issues: the relatively greater lethality of suicidal behavior in later life (compared to younger ages); the lack of data on whether thoughts of death in later life are indicators of suicide risk; the fact that older adults do not tend to seek specialty mental health care, necessitating moving research into primary care clinics and the community; the lack of theory-based research in late-life suicide; the unclear role of cognitive impairment; and the promise of taking a 'patient centered' and 'participatory research' approach to late-life suicide research efforts. CONCLUSION We believe that these perspectives are too often not capitalized upon in research on suicide prevention with older adults and that voice of the older person could contribute much to our understanding of why older adults think about and act on suicidal thoughts, as well as the most acceptable ways to reach and intervene with those at risk.
Collapse
Affiliation(s)
- Kimberly A Van Orden
- a Department of Psychiatry , University of Rochester School of Medicine , Rochester , NY 14642 , USA
| | - Yeates Conwell
- a Department of Psychiatry , University of Rochester School of Medicine , Rochester , NY 14642 , USA
| |
Collapse
|
32
|
Abstract
Suicide in older adults is a significant clinical concern. In this review of recent findings, we concentrate on the role of emotions and cognition in suicide risk and behavior in older adults. We discuss the epidemiology of suicide in older adults, integrate recent findings on non-psychotic major depression, schizophrenia and suicidal ideation, explore the relationship of emotion regulation with suicide, present recent advances on suicide in demented patients, and describe the latest developments on cognition and decision processes in suicide.
Collapse
Affiliation(s)
- Dimitris N. Kiosses
- Associate Professor of Psychology in Clinical Psychiatry, Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, 21 Blomingdale Rd, White Plains, NY 10605, Phone: 914-997-4381,
| | - Katalin Szanto
- Associate Professor of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213, Phone: 412-586-9601,
| | - George S. Alexopoulos
- Professor of Psychiatry, Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Rd, White Plains, NY 10605, Phone: 914-997-5767,
| |
Collapse
|
33
|
Anestis MD, Soberay KA, Gutierrez PM, Hernández TD, Joiner TE. Reconsidering the link between impulsivity and suicidal behavior. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2014; 18:366-86. [PMID: 24969696 DOI: 10.1177/1088868314535988] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is widely accepted that suicidal behavior often occurs with little planning. We propose, however, that suicidal behavior is rarely if ever impulsive-that it is too frightening and physically distressing to engage in without forethought-and that suicidal behavior in impulsive individuals is accounted for by painful and fearsome behaviors capable of enhancing their capacity for suicide. We conducted a meta-analysis of the association between trait impulsivity and suicidal behavior and a critical review of research considering the impulsiveness of specific suicide attempts. Meta-analytic results suggest the relationship between trait impulsivity and suicidal behavior is small. Furthermore, studies examining a mediating role of painful and provocative behaviors have uniformly supported our model. Results from our review suggest that researchers have been unable to adequately measure impulsivity of attempts and that measures sensitive to episodic planning must be developed to further our understanding of this phenomenon.
Collapse
Affiliation(s)
| | - Kelly A Soberay
- Military Suicide Research Consortium, Denver, CO, USA Denver VA Medical Center MIRECC, CO, USA
| | - Peter M Gutierrez
- Military Suicide Research Consortium, Denver, CO, USA Denver VA Medical Center MIRECC, CO, USA University of Colorado, Boulder, USA
| | | | - Thomas E Joiner
- Military Suicide Research Consortium, Denver, CO, USA Florida State University, Tallahassee, USA
| |
Collapse
|
34
|
Draper BM. Suicidal behaviour and suicide prevention in later life. Maturitas 2014; 79:179-83. [PMID: 24786686 PMCID: PMC7131116 DOI: 10.1016/j.maturitas.2014.04.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/27/2014] [Accepted: 04/01/2014] [Indexed: 12/22/2022]
Abstract
Despite a general decline in late life suicide rates over the last 30 years, older people have the highest rates of suicide in most countries. In contrast, non-fatal suicidal behaviour declines with age and more closely resembles suicide than in younger age groups. There are difficulties in the detection and determination of pathological suicidal ideation in older people. Multiple factors increase suicide risk ranging from distal early and mid-life issues such as child abuse, parental death, substance misuse and traumatic life experiences to proximal precipitants in late life such as social isolation and health-related concerns. Clinical depression is the most frequently identified proximal mental health concern and in many cases is a first episode of major depression. Recent studies have identified changes on neuroimaging and neurocognitive factors that might distinguish suicidal from non-suicidal depression in older people. Strategies for suicide prevention need to be ‘whole of life’ and, as no single prevention strategy is likely to be successful alone, a multi-faceted, multi-layered approach is required. This should include optimal detection and management of depression and of high risk individuals as available evidence indicates that this can reduce suicidal behaviour. How best to improve the quality of depression management in primary and secondary care requires further research.
Collapse
Affiliation(s)
- Brian M Draper
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
35
|
Bamonti PM, Price EC, Fiske A. Depressive symptoms and suicide risk in older adults: value placed on autonomy as a moderator for men but not women. Suicide Life Threat Behav 2014; 44:188-99. [PMID: 24851257 DOI: 10.1111/sltb.12062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Risk for suicide is elevated among older men. We examined whether value placed on autonomy amplifies the relation between depressive symptoms and suicide risk differently for older men and women. Participants were 98 community-dwelling older adults, M age 73.6 (SD = 8.6), 65.1% female, 93.1% White. Questionnaires measured suicide risk (SBQ-R), depressive symptoms (CESD), and value placed on autonomy (PSI-II autonomy). Among men, depressive symptoms were associated with suicide risk only when PSI-II autonomy was elevated. Among women, greater depressive symptoms were associated with suicide risk at all levels of PSI-II autonomy. Further research on attitudes toward autonomy is warranted.
Collapse
Affiliation(s)
| | | | - Amy Fiske
- Department of Psychology; West Virginia University; Morgantown WV USA
| |
Collapse
|
36
|
Deuter K, Procter N, Rogers J. The emergency telephone conversation in the context of the older person in suicidal crisis: a qualitative study. CRISIS 2014; 34:262-72. [PMID: 23357217 DOI: 10.1027/0227-5910/a000189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide in older people is a significant public health issue with a predicted future increase. Contemporary research directs considerable attention toward physical, mental, and social risk factors that contribute to suicidality in older people; still, little is understood about the fundamental meanings that older people in suicidal crisis attribute to these factors. AIMS The aim of this qualitative study was to describe, analyze, and compare counselors' and older peoples' perceptions of the suicidal crisis during an emergency telephone conversation. METHODS Data collection consisted of individual interviews with telephone counselors (N = 7) working within an emergency mental health triage service, and listening to telephone calls (N = 14) received by the service responding to people aged 65 years and over in suicidal crisis. Triangulation of the two data sets resulted in the emergence of three key themes. RESULTS We found (1) congruence in the way risk factors were perceived by counselors and communicated during telephone conversations, (2) dissension between counselors' perceptions of end-of-life issues and older people's feelings of ambivalence about wanting to die and not knowing what to do and (3) the need for working side-by-side with the older person, exploring acute changes and immediate capacity for change. CONCLUSIONS An explicit focus on risk factors alone may preclude counselors from gaining a deeper understanding of suicidal crisis in an older person's life. This research has begun to capture and illuminate how telephone counselors can deliver effective crisis intervention as older people struggle and make meaning through their suffering.
Collapse
Affiliation(s)
- Kate Deuter
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | | | | |
Collapse
|
37
|
Szanto K, Clark L, Hallquist M, Vanyukov P, Crockett M, Dombrovski AY. The cost of social punishment and high-lethality suicide attempts in the second half of life. Psychol Aging 2014; 29:84-94. [PMID: 24660798 PMCID: PMC4051315 DOI: 10.1037/a0035339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Age-related cognitive changes may contribute to impairments in making complex social decisions. Interpersonal conflict is a key factor behind suicidal behavior in old age, with suicidal motivations ranging from escape to revenge. Such conflicts may prove catastrophic for people prone to suicide, in part because of their tendency to make disadvantageous decisions. Yet, little is known about social decision making in older suicidal individuals. We assessed economic bargaining behavior using the Ultimatum Game, where players decide whether to accept or punish (reject) unfair monetary offers from another player. Our sample included depressed older adults with a history of high-medical-lethality suicide attempts, low-medical-lethality suicide attempts, nonsuicidal depressed older adults, and those with no psychiatric history who served as control groups. Participants in all groups punished their counterparts in response to unfair offers. However, low-lethality attempters, nonsuicidal depressed, and nonpsychiatric controls punished less as the cost of punishment increased, accepting more unfair offers as the stakes grew large. High-lethality attempters did not adjust their choices based on stake magnitude, punishing unfair offers without regard to the cost. Two thirds of the difference between the high-lethality attempters and nonpsychiatric controls was explained by individual differences in fairness judgments: the comparison group judged offer fairness as a joint function of inequality and magnitude, whereas the high-lethality attempter participants judged offer fairness on the basis of inequality. In real life, high-lethality attempters' relative insensitivity to the cost of retaliation may lead to uncompromising, catastrophic responses to conflict.
Collapse
Affiliation(s)
| | - Luke Clark
- Department of Psychology, University of Cambridge
| | | | | | | | | |
Collapse
|
38
|
Ho RCM, Ho ECL, Tai BC, Ng WY, Chia BH. Elderly suicide with and without a history of suicidal behavior: implications for suicide prevention and management. Arch Suicide Res 2014; 18:363-75. [PMID: 24828390 DOI: 10.1080/13811118.2013.826153] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the impact of a history of suicidal behavior on suicide among elderly people in Singapore. In this coroner register-based study, characteristics of 409 elderly people who died of suicide in Singapore between 2000 and 2004 were examined. Sixty-five people were classified with a history of previous suicidal behavior and 344 people without a history of suicidal behavior. Elderly people who died of suicide and had a past history of suicidal behavior were more likely to suffer from major psychiatric disorders (26.2% vs 10.2%, p = 0.001), encounter social problems in life (33.9% vs 21.5%, p = 0.038), have alcohol detected in the blood toxicology report at autopsy (23.1% vs. 12.8%, p = 0.036), receive psychiatric treatment in the past (60% vs. 37.5%, p < 0.001), have antidepressant detected in the blood toxicology report at autopsy (16.9% vs. 8.1%, p = 0.037), and be admitted to a mental hospital under the mental health legislation (36.9% vs. 11.6%, p < 0.001). Conversely, those without a past history of suicidal behavior were more likely to have a pre-suicidal plan for the fatal suicide act (11.1% vs. 1.5%, p = 0.011) and have received medical or surgical treatment in the past (22.1% vs. 9.2%, p = 0.018). For suicide prevention in Asians, psychiatrists should aggressively treat major psychiatric disorders, engage social services to resolve social problems in elderly people with a history of suicidal behavior, and reduce access to alcohol. Clinicians working in medical or surgical departments should routinely screen for suicide plans in elderly patients without a past history of suicidal behavior.
Collapse
Affiliation(s)
- Roger C M Ho
- a Department of Psychological Medicine, Yong Loo Lin School of Medicine , National University of Singapore
| | | | | | | | | |
Collapse
|
39
|
Dombrovski AY, Szanto K, Clark L, Reynolds CF, Siegle GJ. Reward signals, attempted suicide, and impulsivity in late-life depression. JAMA Psychiatry 2013; 70:1. [PMID: 23925710 PMCID: PMC3859132 DOI: 10.1001/jamapsychiatry.2013.75] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE—Suicide can be viewed as an escape from unendurable punishment at the cost of any future rewards. Could faulty estimation of these outcomes predispose to suicidal behavior? In behavioral studies, many of those who have attempted suicide misestimate expected rewards on gambling and probabilistic learning tasks.OBJECTIVES—To describe the neural circuit abnormalities that underlie disadvantageous choices in people at risk for suicide and to relate these abnormalities to impulsivity, which is one of the components of vulnerability to suicide.DESIGN—Case-control functional magnetic resonance imaging study of reward learning using are inforcement learning model.SETTING—University hospital and outpatient clinic.PATIENTS—Fifty-three participants 60 years or older, including 15 depressed patients who had attempted suicide, 18 depressed patients who had never attempted suicide (depressed control subjects), and 20 psychiatrically healthy controls.MAIN OUTCOMES AND MEASURES—Components of the cortical blood oxygenation level–dependent response tracking expected and unpredicted rewards.RESULTS—Depressed elderly participants displayed 2 distinct disruptions of control over reward-guided behavior. First, impulsivity and a history of suicide attempts (particularly poorly planned ones) were associated with a weakened expected reward signal in the paralimbic cortex,which in turn predicted the behavioral insensitivity to contingency change. Second, depression was associated with disrupted corticostriatothalamic encoding of unpredicted rewards, which in turn predicted the behavioral over sensitivity to punishment. These results were robust to the effects of possible brain damage from suicide attempts, depressive severity, co-occurring substance use and anxiety disorders, antidepressant and anticholinergic exposure, lifetime exposure to electroconvulsive therapy, vascular illness, and incipient dementia.CONCLUSIONS AND RELEVANCE—Altered paralimbic reward signals and impulsivity and/or carelessness may facilitate unplanned suicidal acts. This pattern, also seen in gambling and cocaine use, may reflect a primary deficit in the paralimbic cortex or in its mesolimbic input. The over reactivity to punishment in depression may be caused in part by a disruption of appetitive learning in the corticostriatothalamic circuits.
Collapse
Affiliation(s)
- Alexandre Y Dombrovski
- MD, Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA.
| | | | | | | | | |
Collapse
|
40
|
Abstract
Insomnia has been established as a risk factor for depression and mental illness for decades, but a growing body of evidence has recently exposed insomnia to be an independent risk factor for suicide that encompasses all age ranges. This discovery has invigorated investigation to elucidate the relationship between insomnia and suicide, and over 20 studies reinforcing this association in adults have been published since 2010 alone. This article analyzes relevant research and emphasizes studies published within the last three years with the intent of proposing theoretical mechanisms explaining the link between suicide and insomnia. These mechanisms may then be used as targets for future investigation of treatment.
Collapse
Affiliation(s)
- W. Vaughn McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, 1120 15 Street, Augusta, GA 30912, Phone: 706–721–6719, Fax: 706–721–1793
| | - Carmen G. Black
- Class of 2014, Medical College of Georgia, Georgia Regents University, 1120 15 Street, Augusta, GA 30912, Phone: 706–721–7309, Fax: 706–721–1793
| |
Collapse
|
41
|
Fowler NR, Hansen AS, Barnato AE, Garand L. Association between anticipatory grief and problem solving among family caregivers of persons with cognitive impairment. J Aging Health 2013; 25:493-509. [PMID: 23428394 DOI: 10.1177/0898264313477133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Measure perceived involvement in medical decision making and determine if anticipatory grief is associated with problem solving among family caregivers of older adults with cognitive impairment. METHOD Retrospective analysis of baseline data from a caregiver intervention (n = 73). Multivariable regression models testing the association between caregivers' anticipatory grief, measured by the Anticipatory Grief Scale (AGS), with problem-solving abilities, measured by the social problem solving inventory-revised: short form (SPSI-R: S). RESULTS 47/73 (64%) of caregivers reported involvement in medical decision making. Mean AGS was 70.1 (± 14.8) and mean SPSI-R: S was 107.2 (± 11.6). Higher AGS scores were associated with lower positive problem orientation (p = .041) and higher negative problem orientation scores (p = .001) but not other components of problem solving-rational problem solving, avoidance style, and impulsivity/carelessness style. DISCUSSION Higher anticipatory grief among family caregivers impaired problem solving, which could have negative consequences for their medical decision making responsibilities.
Collapse
Affiliation(s)
- Nicole R Fowler
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, PA 15213, USA.
| | | | | | | |
Collapse
|
42
|
Possible association between suicide committed under influence of ethanol and a variant in the AUTS2 gene. PLoS One 2013; 8:e57199. [PMID: 23437340 PMCID: PMC3577719 DOI: 10.1371/journal.pone.0057199] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 01/23/2013] [Indexed: 12/30/2022] Open
Abstract
Background rs6943555 in AUTS2 has been shown to modulate ethanol consumption. We hypothesized that rs6943555 might be associated with completed suicide. Methods We genotyped rs6943555 in 625 completed suicides and 3861 controls using real-time TaqMan Allelic Discrimination Assay. All individuals were Polish Caucasians. Results We detected an association between suicide and rs6943555 A allele (OR = 1.17, P = 0.018 for allelic comparison, OR = 1.24, P = 0.013 for dominant, and OR = 1.18, P = 0.020 for co-dominant model of inheritance). The association remained significant after adjusting for age and gender (co-dominant: P = 0.002 and dominant model: P = 0.001). After stratifying suicides according to blood ethanol concentration (BAC≤ 20 mg/dl and BAC > 20 mg/dl) the association remained significant only for cases who committed suicide under influence of alcohol (co-dominant: OR = 1.37, P = 0.004 and dominant model: OR = 1.45, P = 0.006). To validate this finding we genotyped another cohort of 132 cases. We reproduced the association between rs6943555 A allele and suicide under influence of ethanol (allelic comparison: OR = 1.55, P = 0.023; co-dominant : OR = 1.54, P = 0.031; dominant model: OR = 1.84, P = 0.015). Analyzing pooled suicides with BAC >20 mg/dl (N = 300) we found the association of rs6943555 A allele not only vs. controls (allelic OR = 1.41, P = 0.00029) but also vs. cases with BAC ≤ 20 mg/dl (N = 449, allelic OR = 1.33, P = 0.019). Conclusions In our study rs6943555 A allele is associated with suicide committed after drinking ethanol shortly before death. The rs6943555 A allele may be linked to adverse emotional reaction to ethanol, which could explain the association with lower consumption in general population as well as the predisposition to suicide under influence of ethanol.
Collapse
|
43
|
Helping elderly patients to avoid suicide: a review of case reports from a National Veterans Affairs database. J Nerv Ment Dis 2013; 201:12-6. [PMID: 23274289 DOI: 10.1097/nmd.0b013e31827ab29c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examines the health system factors associated with completed suicide among veterans older than 65 years. All root cause analysis reports of suicides that occurred between 2008 and 2010 in the Veterans Health Administration were reviewed; of those, 46 reports were for those 65 years or older. The average age in the sample was 76.96 years; all were men. Method of suicide, stressors, previous attempts, root causes, and action plans designed to address the root causes are reported. Based on these results, recommendations are made for the assessment and treatment of suicide in elderly men.
Collapse
|
44
|
권중돈, 김유진, 엄태영. A Study on Factors Affecting Suicide Risk among Seniors Who Live Alone: The Effect of Loneliness and the Mediating Effect of Hopelessness. ACTA ACUST UNITED AC 2012. [DOI: 10.15709/hswr.2012.32.1.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
45
|
Szanto K, Dombrovski AY, Sahakian BJ, Mulsant BH, Houck PR, Reynolds CF, Clark L. Social emotion recognition, social functioning, and attempted suicide in late-life depression. Am J Geriatr Psychiatry 2012; 20:257-65. [PMID: 22354116 PMCID: PMC3286029 DOI: 10.1097/jgp.0b013e31820eea0c] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES : Lack of feeling connected and poor social problem solving have been described in suicide attempters. However, cognitive substrates of this apparent social impairment in suicide attempters remain unknown. One possible deficit, the inability to recognize others' complex emotional states has been observed not only in disorders characterized by prominent social deficits (autism-spectrum disorders and frontotemporal dementia) but also in depression and normal aging. This study assessed the relationship between social emotion recognition, problem solving, social functioning, and attempted suicide in late-life depression. DESIGN, PARTICIPANTS, MEASUREMENTS : There were 90 participants: 24 older depressed suicide attempters, 38 nonsuicidal depressed elders, and 28 comparison subjects with no psychiatric history. We compared performance on the Reading the Mind in the Eyes test and measures of social networks, social support, social problem solving, and chronic interpersonal difficulties in these three groups. RESULTS : Suicide attempters committed significantly more errors in social emotion recognition and showed poorer global cognitive performance than elders with no psychiatric history. Attempters had restricted social networks: they were less likely to talk to their children, had fewer close friends, and did not engage in volunteer activities, compared to nonsuicidal depressed elders and those with no psychiatric history. They also reported a pattern of struggle against others and hostility in relationships, felt a lack of social support, perceived social problems as impossible to resolve, and displayed a careless/impulsive approach to problems. CONCLUSIONS : Suicide attempts in depressed elders were associated with poor social problem solving, constricted social networks, and disruptive interpersonal relationships. Impaired social emotion recognition in the suicide attempter group was related.
Collapse
Affiliation(s)
- Katalin Szanto
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Folly WSD. The threshold bias model: a mathematical model for the nomothetic approach of suicide. PLoS One 2011; 6:e24414. [PMID: 21909431 PMCID: PMC3164734 DOI: 10.1371/journal.pone.0024414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/10/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Comparative and predictive analyses of suicide data from different countries are difficult to perform due to varying approaches and the lack of comparative parameters. METHODOLOGY/PRINCIPAL FINDINGS A simple model (the Threshold Bias Model) was tested for comparative and predictive analyses of suicide rates by age. The model comprises of a six parameter distribution that was applied to the USA suicide rates by age for the years 2001 and 2002. Posteriorly, linear extrapolations are performed of the parameter values previously obtained for these years in order to estimate the values corresponding to the year 2003. The calculated distributions agreed reasonably well with the aggregate data. The model was also used to determine the age above which suicide rates become statistically observable in USA, Brazil and Sri Lanka. CONCLUSIONS/SIGNIFICANCE The Threshold Bias Model has considerable potential applications in demographic studies of suicide. Moreover, since the model can be used to predict the evolution of suicide rates based on information extracted from past data, it will be of great interest to suicidologists and other researchers in the field of mental health.
Collapse
Affiliation(s)
- Walter Sydney Dutra Folly
- Núcleo Integrado de Pesquisa e Pós-Graduação em Educação e Ciências Universidade Federal de Sergipe, SE, Brazil.
| |
Collapse
|
47
|
Abstract
BACKGROUND An association between sense of coherence (SOC) and suicidal behavior has been suggested. The aim of this study was to identify factors associated with low SOC in elderly suicide attempters. METHODS Eighty non-demented hospital-treated suicide attempters aged 70 years and older (38 men, 42 women, mean age 79.4 years) took part in an interview with a research psychologist and completed the 29-item SOC questionnaire. The interview included questions regarding social situation and health-related factors. The Comprehensive Psychopathological Rating Scale (CPRS) provided symptom ratings that were used in a diagnostic algorithm for DSM-IV major depression. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to identify individuals with serious physical illness. RESULTS There was a strong relationship between major depression and SOC. While we could show no relationship between severe physical illness and SOC, associations were demonstrated with social variables including too little time spent with children, too little time spent with grandchildren and having moved within the past five years. These associations remained significant in regression models adjusted for sex, age and major depression. CONCLUSIONS A number of social variables were independently related to SOC in elderly suicide attempters. Prospective studies are needed in order to determine whether SOC-strengthening interventions can reduce the risk of suicidal behavior in seniors.
Collapse
|
48
|
Dombrovski AY, Szanto K, Siegle GJ, Wallace ML, Forman SD, Sahakian B, Reynolds CF, Clark L. Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age. Biol Psychiatry 2011; 70:138-44. [PMID: 21329911 PMCID: PMC3125431 DOI: 10.1016/j.biopsych.2010.12.025] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The decision to commit suicide may be impulsive, but lethal suicidal acts often involve planning and forethought. People who attempt suicide make disadvantageous decisions in other contexts, but nothing is known about the way they decide about the future. Can the willingness to postpone future gratification differentiate between individuals prone to serious, premeditated and less serious, unplanned suicidal acts? METHODS Four groups of depressed participants aged 60 and older made choices between smaller immediate and larger delayed monetary rewards: 15 who had made high-lethality suicide attempts, 14 who had made low-lethality suicide attempts, 12 who seriously contemplated suicide, and 42 people with depression, but no history of suicidal thoughts. The reference group was 31 psychiatrically healthy elders. RESULTS Individuals who had made low-lethality attempts displayed an exaggerated preference for immediate rewards compared with nonsuicidal depressed and healthy control subjects. Those who had carried out high-lethality suicide attempts were more willing to delay future rewards, compared with low-lethality attempters. Better planned suicide attempts were also associated with willingness to wait for larger rewards. These effects were unchanged after accounting for education, global cognitive function, substance use disorders, psychotropic medications, and possible brain injury from attempts. Discount rates were correlated with having debt, but were not significantly associated with income, hopelessness, depressive severity, premorbid IQ, age at first attempt, or choice of violent means. CONCLUSIONS Although clinicians often focus on impulsivity in patients at risk for suicide, these data suggest that identifying biological characteristics and treatments for nonimpulsive suicidal older people may be even more important.
Collapse
Affiliation(s)
- Alexandre Y. Dombrovski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Greg J. Siegle
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Meredith L. Wallace
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Steven D. Forman
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine,Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Barbara Sahakian
- Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge (UK)
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Luke Clark
- Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge (UK)
| |
Collapse
|
49
|
Abstract
Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age. Data from psychological autopsy studies supplemented with recent studies of suicidal ideation and attempts point to a consistent set of risk factors for the spectrum of suicidal behaviors in late life (suicide ideation, attempts, and deaths). Clinicians should be vigilant for psychiatric illness (especially depression), physical illness, pain, functional impairment, and social disconnectedness. Recent advances in late-life suicide prevention have in common collaborative, multifaceted intervention designs. We suggest that one mechanism shared by all preventive interventions shown to reduce the incidence of late-life suicide is the promotion of connectedness. For the clinician working with older adults, our recommendation is to not only consider risk factors, such as depression, and implement appropriate treatments but to enhance social connectedness as well.
Collapse
Affiliation(s)
- Kimberly Van Orden
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA.
| | - Yeates Conwell
- University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| |
Collapse
|
50
|
Clark L, Dombrovski AY, Siegle GJ, Butters MA, Shollenberger CL, Sahakian BJ, Szanto K. Impairment in risk-sensitive decision-making in older suicide attempters with depression. Psychol Aging 2011; 26:321-330. [PMID: 21443349 PMCID: PMC3115442 DOI: 10.1037/a0021646] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory ("Cambridge Gamble Task") in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions.
Collapse
Affiliation(s)
- Luke Clark
- Department of Experimental Psychology, University of Cambridge
| | | | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh School of Medicine
| |
Collapse
|