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Ludwig J, Barbek R, von dem Knesebeck O. Education and suicidal ideation in Europe: A systematic review and meta-analysis. J Affect Disord 2024; 349:509-524. [PMID: 38199415 DOI: 10.1016/j.jad.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Understanding predictors of suicidal ideation (SI) is crucial for preventing suicides. Given Europe's high suicide rates and the complex nature of SI, it is essential to also examine social determinants like education as potential risk factors for SI in this region. This systematic review and meta-analysis investigates the association between formal/vocational education and SI in Europe. METHODS Electronic databases (PubMed, Web of Science, PsycINFO, PSYNDEX) were searched until November 2022. Included studies involved European populations examining associations between education and SI. Pooled Odds Ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with the heterogeneity variance τ2 and I2 statistic; subgroup analyses were performed based on study characteristics. Risk of bias was assessed using an adaption of the Newcastle-Ottawa Scale. RESULTS From 20,564 initial studies, 41 were included in the meta-analysis (outlier-adjusted, 96,809 study participants). A negative, insignificant association (OR = 0.86, 95 % CI: 0.75; 1.00) was observed between education and SI, with significant heterogeneity (τ2 = 0.09, I2 = 73 %). Subgroup analyses indicated that population type, age group, categorization of education, timeframe of SI assessment, and study quality significantly moderated the effect size. LIMITATIONS Heterogeneity across studies limits generalizability. The cross-sectional design precludes establishing causal relationships, and social desirability bias may have underestimated the association between education and SI. CONCLUSIONS This systematic review and meta-analysis suggests a trend towards a protective effect of education on the emergence of SI in Europe. Future research, preferably with longitudinal study design examining various covariates, should systematically consider educational inequalities in SI.
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Affiliation(s)
- Julia Ludwig
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rubli Truchard E, Monod S, Bula CJ, Dürst AV, Levorato A, Mazzocato C, Münzer T, Pasquier J, Quadri P, Rochat E, Spencer B, von Gunten A, Jox RJ. Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study. J Am Med Dir Assoc 2022; 23:1935-1941. [PMID: 36202218 DOI: 10.1016/j.jamda.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The wish to die (WTD) in persons near the end of life is a clinically important, ethically and practically complex phenomenon as demonstrated by the intense debates on assisted dying legislation around the world. Despite global aging and increasing institutionalization in old age, WTD among residents of long-term care facilities (LTCF) is underexplored. We aimed to assess the prevalence of WTD and identify its predictors in older LTCF residents. DESIGN Multisite cross-sectional observational study. SETTING AND PARTICIPANTS 31 LTCF in the 3 major linguistic regions of Switzerland, including residents 75 years or older, admitted to the LTCF 4 to 10 months before the study, without severe cognitive impairment. METHODS Between February 2013 and June 2017, trained research staff interviewed residents to assess WTD using 2 validated instruments and collected information on potential predictors, including depressive symptoms, anxiety, demoralization, feeling to be a burden, spiritual distress, symptom burden, multimorbidity, and drug use. Demographic data were obtained by chart review. Descriptive statistics as well as univariate and multivariate regression analyses were performed. RESULTS From 427 eligible residents, 101 were excluded, 46 refused, and 280 were included in the study (acceptance rate 85.9%). In general, residents readily and openly addressed the topic of WTD. The prevalence of WTD was 16.0% and 16.2% according to the 2 instruments, with all but 1 of the residents expressing a passive WTD. The strongest independent predictors for a WTD were depressive symptoms (OR 7.45 and 5.77 for the 2 WTD assessment instruments) and demoralization (OR 2.62 and 3.66). CONCLUSIONS AND IMPLICATIONS The WTD is a relevant concern affecting approximately 1 in 6 LTCF residents. Further research is needed to investigate which interventions could best address the potentially modifiable factors that were associated with the WTD in this specific setting and population.
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Affiliation(s)
- Eve Rubli Truchard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéfanie Monod
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Véronique Dürst
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandro Levorato
- Servizio di Geriatria dell'Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Claudia Mazzocato
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Pierluigi Quadri
- Servizio di Geriatria dell'Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Etienne Rochat
- Institute for Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brenda Spencer
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Pilly, Switzerland
| | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute for Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Passive Suicidal Ideation in Older Adults from 12 European Countries. JOURNAL OF POPULATION AGEING 2021. [DOI: 10.1007/s12062-021-09350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kox RMK, Pasman HRW, Huisman M, Benneker W, Onwuteaka-Philipsen BD. Current wishes to die; characteristics of middle-aged and older Dutch adults who are ready to give up on life: a cross-sectional study. BMC Med Ethics 2021; 22:64. [PMID: 34020628 PMCID: PMC8140496 DOI: 10.1186/s12910-021-00632-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature shows that middle-aged and older adults sometimes experience a wish to die. Reasons for these wishes may be complex and involve multiple factors. One important question is to what extent people with a wish to die have medically classifiable conditions. AIM (1) Estimate the prevalence of a current wish to die among middle-aged and older adults in The Netherlands; (2) explore which factors within domains of vulnerability (physical, cognitive, social and psychological) are associated with a current wish to die; (3) assess how many middle-aged and older adults with a current wish to die do not have a medically classifiable condition and/or an accumulation of age-related health problems. METHODS Data of 2015/16 from the Longitudinal Aging Study Amsterdam were used for this cross-sectional study (1563 Dutch middle-aged and older adults aged between 57 and 99 years), obtained through structured medical interviews and self-reported questionnaires. Three experienced physicians assessed whether the participants with a current wish to die could be classified as having a medically classifiable condition and/or an accumulation of age-related health problems. RESULTS N = 62 participants (4.0%) had a current wish to die. Having a current wish to die was associated with multiple characteristics across four domains of vulnerability, among which: self-perceived health, problems with memory, self-perceived quality of life and meaningfulness of life. Fifty-four participants with a current wish to die were assessed with having a medically classifiable condition, of which one was also assessed with having an accumulation of age-related health problems. Six people were assessed to have neither, and for two people it was unclear. CONCLUSION A small minority of middle-aged and older adults in the Netherlands have a current wish to die. Most of them can be classified with a medical condition and one person with an accumulation of age-related health problems. Furthermore, the findings show that having a current wish to die is multi-faceted. There is still a need for more knowledge, such as insight in to what extent suffering stemming from the medical classifiable disease contributes to the development of the wish to die.
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Affiliation(s)
- Roosmarijne M K Kox
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wim Benneker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
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Assessing the Determinants of the Wish to Die among the Elderly Population in Ghana. Geriatrics (Basel) 2021; 6:geriatrics6010032. [PMID: 33807000 PMCID: PMC8006009 DOI: 10.3390/geriatrics6010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: A wish to die is common in elderly people. Concerns about death wishes among the elderly have risen in Ghana, where the ageing transition is comparable to other low-and middle-income countries. However, nationally representative research on death wishes in the elderly in the country is not readily available. Our study aimed to assess the determinants of the wish to die among the elderly in Ghana. Methods: We analysed data from the World Health Organisation Global Ageing and Adult Health Survey, Wave 1 (2007–2008) for Ghana. Data on the wish to die, socio-demographic profiles, health factors and substance abuse were retrieved from 2147 respondents aged 65 and above. Ages of respondents were categorised as 65–74 years; 75–84 years; 85+ to reflect the main stages of ageing. Logistic regression models were fitted to assess the association between these factors and the wish to die. Results: Age, sex, place of residence, education, body mass index, hypertension, stroke, alcohol consumption, tobacco use, income, diabetes, visual impairment, hopelessness and depression had statistically significant associations with a wish to die. Older age cohorts (75–84 and 85+) were more likely to have the wish to die (AOR = 1.05, CI = 1.02–1.16; AOR = 1.48, CI = 1.22–1.94), compared to younger age cohorts (65–74 years). Persons who felt hopeless had higher odds (AOR = 2.15, CI = 2.11–2.20) of experiencing the wish to die as compared to those who were hopeful. Conclusions: In view of the relationship between socio-demographic (i.e., age, sex, education and employment), hopelessness, anthropometric (body mass index), other health factors and the wish to die among the elderly in Ghana, specific biopsychosocial health promotion programmes, including timely identification of persons at risk, for appropriate intervention (e.g., psychotherapy, interpersonal support, alcohol-tobacco cessation therapy, clinical help) to promote their wish for a longer life is needed.
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Van Den Noortgate N, Van Humbeeck L. Medical assistance in dying and older persons in Belgium: trends, emerging issues and challenges. Age Ageing 2021; 50:68-71. [PMID: 32574355 DOI: 10.1093/ageing/afaa116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
In 2002, the Belgian Act on euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. Subsequently, the number of reported euthanasia deaths increased every year. Specifically, the proportion of euthanasia deaths in older persons has risen significantly in the last few years. Since the conception of the Euthanasia Act, Belgian physicians have been confronted with challenges concerning euthanasia requests in older persons with polypathology, tiredness of life or dementia. By exploring these issues, this commentary highlights the importance of a meticulous and team-based assessment of the (i) seriousness of the underlying condition, (ii) voluntariness of the request and (iii) decisional capacity of the older person requesting euthanasia.
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Lukaschek K, Engelhardt H, Baumert J, Ladwig KH. No Correlation Between Rates of Suicidal Ideation and Completed Suicides in Europe: Analysis of 49,008 Participants (55+ Years) Based on the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur Psychiatry 2020; 30:874-9. [DOI: 10.1016/j.eurpsy.2015.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/29/2015] [Accepted: 07/27/2015] [Indexed: 11/26/2022] Open
Abstract
AbstractBackground:Little is known about country-specific variations in suicidal ideation (SID) by sex and how they correspond with completed suicide rate. Therefore, the aim of the present study was to assess variations in SID prevalence rates by sex and its correlation to completed suicide rates across European countries.Method:SHARE is a cross-national European survey of individuals over the age of 50 and their spouse of any age. The present study relied on wave 4 conducted in 2010–2012 including 49,008 participants aged 55 to 104 years from 16 countries. SID was evaluated using a single item from the Euro-D. Data on completed suicide rates were taken from the WHO mortality database.Results:Of the study population (n = 49,008, 44.3% men, mean age 68.2 ± 9.1 years), a total of 4139 (8.5%, 95% CI 8.2–8.7) reported suicidal ideation within the last month. The women:men ratio in SID prevalence ranged from 1.30 in Estonia to 2.25 in Spain and Portugal. Regarding country-specific variation, the SID prevalence patterns of both men and women did not correspond to the completed suicide rates for males and females aged 55+ reported by the WHO (2013). Correlations were rather moderate in men (r = 0.45) and especially weak in women (r = 0.16).Conclusion:The study showed remarkable differences in SID prevalence by sex. The most exciting finding was that SID rates did not correspond with completed suicide rates in each country under investigation. However, the strength of these patterns substantially differs across countries. This unexpected finding need to be further evaluated.
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Dürst A, Spencer B, Büla C, Fustinoni S, Mazzocato C, Rochat E, Rubli Truchard E, Monod S, Jox RJ. Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments. J Am Geriatr Soc 2020; 68:1202-1209. [DOI: 10.1111/jgs.16392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Anne‐Véronique Dürst
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
| | - Brenda Spencer
- Centre for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
| | - Sarah Fustinoni
- Centre for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Claudia Mazzocato
- Service of Palliative and Supportive Care Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Etienne Rochat
- Institute of Humanities in Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Eve Rubli Truchard
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
- Chair in Geriatric Palliative Care Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Stéfanie Monod
- General Health Department Ministry of Health and Social Action Lausanne Switzerland
| | - Ralf J. Jox
- Service of Palliative and Supportive Care Lausanne University Hospital (CHUV) Lausanne Switzerland
- Institute of Humanities in Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
- Chair in Geriatric Palliative Care Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
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Stolz E, Mayerl H, Gasser-Steiner P, Freidl W. Attitudes towards assisted suicide and euthanasia among care-dependent older adults (50+) in Austria: the role of socio-demographics, religiosity, physical illness, psychological distress, and social isolation. BMC Med Ethics 2017; 18:71. [PMID: 29212490 PMCID: PMC5719645 DOI: 10.1186/s12910-017-0233-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. METHODS A nationwide cross-sectional survey among older care allowance recipients (50+) in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. RESULTS About a quarter (24.8-26.0%) of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to (hypothetically) make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. CONCLUSIONS Positive attitudes towards and will to (hypothetically) use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the (near) future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Peter Gasser-Steiner
- Department of Sociology, University of Graz, Universitätsstraße 15/IV, 8010, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria.
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Dadfar M, Lester D, Atef Vahid MK. Psychometric Characteristics of the Wish to Be Dead Scale (WDS) in Iranian Psychiatric Outpatients. CURRENT PSYCHOLOGY 2016; 37:498-507. [PMID: 30147280 PMCID: PMC6096960 DOI: 10.1007/s12144-016-9527-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Wish to be Dead Scale (WDS) was administered to a convenience sample of 200 Iranian psychiatric outpatients. Using a Principal Component Analysis, two factors were identified, labeled Lack of purpose in life (F1), and Lack of interest in living (F2). The WDS had good reliability and significant positive correlations with scores on the Beck Suicide Ideation Scale and with other measures of mental ill-health. This study provides evidence of the usefulness of the WDS for assessing psychiatric patients.
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Affiliation(s)
- Mahboubeh Dadfar
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health- Tehran Institute of Psychiatry, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ USA
| | - Mohammad Kazem Atef Vahid
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health- Tehran Institute of Psychiatry, International Campus, Iran University of Medical Sciences, Tehran, Iran
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Stolz E, Fux B, Mayerl H, Rásky É, Freidl W. Passive Suicide Ideation Among Older Adults in Europe: A Multilevel Regression Analysis of Individual and Societal Determinants in 12 Countries (SHARE). J Gerontol B Psychol Sci Soc Sci 2016; 71:947-58. [PMID: 27048569 PMCID: PMC4982389 DOI: 10.1093/geronb/gbw041] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/16/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Passive suicide ideation (PSI) is common among older adults, but prevalences have been reported to vary considerably across European countries. The goal of this study was to assess the role of individual-level risk factors and societal contextual factors associated with PSI in old age. METHOD We analyzed longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) on 6,791 community-dwelling respondents (75+) from 12 countries. Bayesian logistic multilevel regression models were used to assess variance components, individual-level and country-level risk factors. RESULTS About 4% of the total variance of PSI was located at the country level, a third of which was attributable to compositional effects of individual-level predictors. Predictors for the development of PSI at the individual level were female gender, depression, older age, poor health, smaller social network size, loneliness, nonreligiosity, and low perceived control (R (2) = 25.8%). At the country level, cultural acceptance of suicide, religiosity, and intergenerational cohabitation were associated with the rates of PSI. DISCUSSION Cross-national variation in old-age PSI is mostly attributable to individual-level determinants and compositional differences, but there is also evidence for contextual effects of country-level characteristics. Suicide prevention programs should be intensified in high-risk countries and attitudes toward suicide should be addressed in information campaigns.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria.
| | - Beat Fux
- Department of Sociology, University of Salzburg, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
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Pratt LA, Brody DJ. Implications of two-stage depression screening for identifying persons with thoughts of self-harm. Gen Hosp Psychiatry 2014; 36:119-23. [PMID: 24183490 PMCID: PMC5942185 DOI: 10.1016/j.genhosppsych.2013.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/29/2013] [Accepted: 09/17/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Persons with thoughts of self-harm may need evaluation for suicide risk. We examine the prevalence of thoughts of self-harm and whether persons with thoughts of self-harm are identified when two-stage depression screening is used. METHODS Data are from the 2005-2010 National Health and Nutrition Examination Surveys. Persons responding positively to question nine of the Patient Health Questionnaire-9 (PHQ-9) are identified as having thoughts of self-harm. We compare two depression cutoff scores for the Patient Health Questionnaire-2 (PHQ-2) to see what percentage of persons with thoughts of self-harm would be identified as needing further screening with the PHQ-9. RESULTS The prevalence of thoughts of self-harm was 3.5%. Persons 12-17 years old, poor and reporting fair or poor health were more likely to report thoughts of self-harm. A cutoff score of three on the PHQ-2 identified 49% of persons with thoughts of self-harm for further screening with the PHQ-9. A cut point of two increased the proportion of persons with thoughts of self-harm continuing for further screening to 76%. CONCLUSIONS Using a lower cutoff score, two, the PHQ-2 captures more persons with thoughts of self-harm. One quarter of persons with self-harm thoughts may not be identified for further screening when two-stage screening is used.
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Affiliation(s)
- Laura A Pratt
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention.
| | - Debra J Brody
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention
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Abstract
BACKGROUND Both passive death wishes and loneliness are prevalent in old age and both have been shown to be associated with a variety of detrimental effects. The overall goal of the present study was to evaluate the relationship between loneliness and passive death wishes in the general population of Europeans over the age of 50 years. METHODS Passive death wishes were evaluated in waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe, using the question "in the past month, have you felt that you would rather be dead?" Loneliness was evaluated by the question: "how frequently have you felt lonely over the past week?" taken from the Center for Epidemiological Studies of Depression questionnaire. All predictors were gathered in wave 1. Analysis was stratified into three age groups (50-65, 66-75, >75 years). RESULTS Both passive death wishes (15.6%) and loneliness (mean (SE) = 1.68(0.03)) were highest in those over the age of 75, relative to the other two age groups (age 50-65: 4.6%, mean (SE) = 1.43(0.01); age 66-75: 7.3%, mean (SE) = 1.50(0.02), respectively). Loneliness remained a significant risk for passive death wishes, net of the effect of demographic, health, mental health, and various social indicators in those aged 50-65 years (OR = 1.47, 95%CI: 1.10-1.97) and 65-75 (OR = 1.74, 95%CI: 1.28-2.38), but not in those over the age of 75 (OR = 1.12, 95%CI: 0.84-1.47). None of the objective social indicators was associated with passive death wishes. CONCLUSIONS The present study emphasizes the differential role of loneliness across the lifespan. Any intervention to alleviate passive death wishes in the general population will benefit from addressing the subjective sense of loneliness more so than objective indicators of social interaction.
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