Suicide in late-life depression with and without comorbid anxiety disorders

Antidepressant-like effect of riparin I and riparin II against CUMS-induced neuroinflammation via astrocytes and microglia modulation in mice

Depression is a common mood disorder and many patients do not respond to conventional pharmacotherapy or experience a variety of adverse effects. This work proposed that riparin I (RIP I) and riparin II (RIP II) present neuroprotective effects through modulation of astrocytes and microglia, resulting in the reversal of depressive-like behaviors. To verify our hypothesis and clarify the pathways underlying the effect of RIP I and RIP II on neuroinflammation, we used the chronic unpredictable mild stress (CUMS) depression model in mice. Male Swiss mice were exposed to stressors for 28 days. From 15 th to the 22 nd day, the animals received RIP I or RIP II (50 mg/kg) or fluoxetine (FLU, 10 mg/kg) or vehicle, by gavage. On the 29 th day, behavioral tests were performed. Expressions of microglia (ionized calcium-binding adaptor molecule-1 - Iba-1) and astrocyte (glial fibrillary acidic protein - GFAP) markers and levels of cytokines tumor necrosis factor alfa (TNF-α) and interleukin 1 beta (IL-1β) were measured in the hippocampus. CUMS induced depressive-like behaviors and cognitive impairment, high TNF-α and IL-1β levels, decreased GFAP, and increased Iba-1 expressions. RIP I and RIP II reversed these alterations. These results contribute to the understanding the mechanisms underlying the antidepressant effect of RIP I and RIP II, which may be related to neuroinflammatory suppression.

The association of impulsivity with depression and anxiety symptoms: A transdiagnostic network analysis and replication

BACKGROUND

Impulsivity increases the risk for depression and anxiety. However, the granular pathways among them remain unknown. A network approach that moves from disorder-level analysis to symptom-level analysis can provide further understanding of psychopathological mechanisms. In this study, we examined the network structure of impulsivity and separate and comorbid symptoms of depression and anxiety.

METHODS

Regularized partial-correlation networks were estimated using cross-sectional data from 1047 Chinese participants aged 18-26 years (main dataset, mean age = 21.45 ± 2.01 years) and 325 Chinese participants aged 18-36 years (an independent replication dataset, mean age = 21.49 ± 3.73 years), including impulsivity-depression, impulsivity-anxiety, and impulsivity-depression-anxiety networks. The datasets were collected from 1 June 2023 to 4 August 2023 and from 27 April 2022 to 16 May 2022, respectively. Impulsivity, depression, and anxiety were assessed using Barratt Impulsiveness Scale Version 11, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, respectively. Bridge centrality was analyzed, and a network comparison test (NCT) was conducted to investigate the differences between the main dataset and replication dataset.

RESULTS

The motor impulsivity dimension was revealed to be closely connected with individual symptoms of depression and anxiety regardless of whether they were in separate disorder forms or comorbid forms. In all the networks, motor impulsivity was the most important bridge node. The NCT showed comparable network connectivity and network structure between the main and replication datasets.

LIMITATIONS

The use of cross-sectional data limited the inferences about the direction of causality between variables.

CONCLUSIONS

These findings elucidate the psychopathological mechanisms underlying how impulsivity functions within depression, anxiety, and comorbidity and support that motor impulsivity is an important risk factor across different mental disorders and is responsible for comorbidity. The implications of these findings are discussed.

Depression in older women who died by suicide: associations with other suicide contributors and suicide methods

Suicides among older women have received little research attention. In this study based on the 2017-2019 National Violent Death Reporting System data, we examined the prevalence of depression in older female suicide decedents (N = 3,061), associations between depression and other suicide precipitants, and the associations between suicide methods and depression. Descriptive statistics and generalized linear models (GLM) for a Poisson distribution with a log link were used to examine the research questions. Of the decedents, 15.0% had depressed mood without a reported diagnosis and 41.8% had a depression diagnosis. Nearly one-half of the decedents with reported depression were receiving mental health/substance use treatment at the time of injury. The likelihood of depression was lower among those who were age 85 and older compared to those were age 65-74, but higher among those who had anxiety disorder (IRR = 1.50, 95% CI = 1.33-1.69), history of suicidal ideation (IRR = 1.22, 95% CI = 1.10-1.35), history of suicide attempt (IRR = 1.27, 95% CI = 1.14-1.41), and bereavement problems (IRR = 1.45, 95% CI = 1.27-1.65). Those who had depression were less likely to have used firearms (IRR = 0.85, 95% CI = 0.75-0.97) but more likely to have used hanging/suffocation (IRR = 1.37, 95% CI = 1.13-1.67). The findings show that gun ownership was likely an important factor for firearm use. The high prevalence of depressed mood and/or depression diagnosis among older female suicide decedents at the time of their fatal injury underscores the importance of assessing depression and providing evidence-based depression treatment as an essential suicide prevention approach.

Gender differences in the association between anxiety symptoms and thyroid hormones in young patients with first-episode and drug naïve major depressive disorder

Objective

Gender differences are prevalent in major depressive disorder (MDD), but the gender differences in the relationship between comorbid anxiety and thyroid hormones in young first-episode and drug-naive (FEND) MDD patients are unknown.

Methods

A total of 1,289 young outpatients with FEDN MDD were recruited. Demographic and clinical data were collected for each patient. The patient's blood glucose, blood pressure, thyroid hormone, and thyroid antibody levels were measured. The Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess patients' depression, anxiety, and positive symptoms, respectively.

Results

The prevalence of comorbid anxiety disorders was 80.4 and 79.4% in male and female MDD patients, respectively. Patients with anxiety had higher HAMD and PANSS scores, higher serum thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (A-TG), and thyroid peroxidase antibody (A-TPO) levels, higher blood glucose and blood pressure levels, and more patients with psychotic symptoms and suicide attempts. Male patients were younger and had a younger age of onset. Logistic regression analysis showed that HAMD score and comorbid suicide attempts were significant predictors of anxiety symptoms in both males and females, whereas A-TG predicted anxiety symptoms in female patients only. Limitations: No causal relationship could be drawn due to the cross-sectional design.

Conclusion

This study showed gender differences in factors associated with anxiety symptoms in patients with MDD. Some factors were associated with anxiety symptoms in both male and female patients, while A-TG was only associated with anxiety symptoms in female patients.

Sex-differential association of suicide attempts with thyroid dysfunction in first-episode and drug-naïve young major depressive disorder patients with comorbid anxiety

This study aimed to explore sex differences in the relationship between thyroid function indicators and suicide attempts in first-episode and drug-naïve young major depressive disorder (MDD) patients with comorbid anxiety (MDA). A total of 917 MDD patients (aged 18-35 years) were recruited. The Hamilton depression rating scale (HAMD-17), Hamilton anxiety rating scale (HAMA), positive and negative syndrome scale (PANSS) positive subscale and clinical global impression of severity scale (CGI-S) were used. 467 patients were classified as MDA. The prevalence of suicide attempts was 31.3% in MDA patients, which was significantly higher than that (7.3%) in MDD patients without anxiety. Compared with MDA patients without suicide attempts, MDA patients with suicide attempts were older, had a later age of onset, higher HAMD-17, HAMA, and PANSS positive symptom subscale scores, as well as higher TSH, TgAb and TPOAb levels. For male patients, TSH and TPOAb levels were independently associated with suicide attempts. For female patients, HAMA, PANSS positive symptom scores, CGI-S score and TPOAb levels were independently associated with suicide attempts. Our results suggest that the indicators of thyroid function which can predict suicide attempts in male and female MDA patients have sex differences.

Association between thyroid function and comorbid anxiety in first-episode and drug naïve patients with major depressive disorder

OBJECTIVE

Existing studies have shown that thyroid dysfunction is associated with depression. However, its role in major depressive disorder (MDD) with comorbid anxiety remains unclear. The main purpose of this study was to compare thyroid function in a large sample of first episode drug naïve (FEDN) MDD patients with and without anxiety.

METHODS

This cross-sectional study examined 1718 outpatients who were drug-naïve and diagnosed as MDD at first episode. Socio-demographic and clinical data, as well as thyroid function-related parameters, including free thyroxine (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin (TGAb), were evaluated. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to evaluate depressive, anxiety and psychotic symptoms, respectively.

RESULTS

Compared to MDD patients without anxiety, MDD patients with anxiety were more likely to have more suicide attempts and psychotic symptoms, as well as higher serum levels of TSH, TPOAb and TGAb (all p < 0.001). Among patients with abnormally elevated serum TSH, TPOAb, and TGAb, 83.5% (872/1044), 89.3% (391/438) and 89.6% (266/297) had comorbid anxiety disorders, respectively. The odds ratio between patients with comorbid and without comorbid anxiety was 1.657 (95% CI 1.304-2.105) for elevated TSH levels, 1.943 (95% CI 1.444-2.613) for elevated TGAb levels, and 2.448 (95% CI 1.760-3.403) for elevated TPOAb levels. Furthermore, multivariable linear analysis showed that elevated TSH and TGAb were significant predictors of anxiety in MDD patients.

CONCLUSIONS

Our results suggest that comorbid anxiety in FEDN MDD patients is positively associated with elevated TSH and TGAb levels, which may be promising biomarkers of comorbid anxiety in MDD patients. Clinical treatment of impaired thyroid function may be useful for comorbid anxiety in MDD patients.

Associations between anxiety, depression, and risk of suicidal behaviors in Chinese medical college students

Background

Previous studies have established a strong association between depression and suicidal behaviors, yet the relationship between anxiety and suicidal behaviors remains unclear. This study examines whether anxiety and depression are independent risk factors for suicidal behaviors in medical college students, and further, whether anxiety may increase the greater risk of suicidal behaviors (SB) in participants with depression.

Methods

This cross-sectional study was conducted among 4,882 medical students. Demographic information, anxiety, and depression data were collected using online questionnaires or through a widely used social media app named WeChat.

Results

Anxiety and depression were independent risk factors for suicidal behaviors, and levels of risk correlated positively with the severity of both anxiety and depressive symptoms. A dose-response relationship was identified between the severity of anxiety and the risk of SB, as well as the severity of depression and SB. Furthermore, anxiety increased the risk of suicidal behaviors in participants with depression, with a dose-response relationship between the severity of anxiety symptoms and the risk of SB.

Conclusion

The findings highlight the importance of screening for anxiety and depressive symptoms in medical college students, as well as reducing anxiety in addition to depressive symptoms in treatment. This study provides valuable data as a reference for clinicians for suicide risk assessments.

Prevalence and related factors of anxiety in first episode and drug naïve Chinese Han outpatients with psychotic major depression

BACKGROUND

Anxiety frequently occurs with major depressive disorder (MDD) but to a different extent in the various subtypes. Psychotic major depression (PMD) is a severe subtype of MDD that is under-identified and under-studied. We investigated the prevalence and related risk factors of anxiety in PMD patients.

METHODS

A total of 1718 first episode and drug naïve MDD patients were recruited. Measures included the Hamilton Depression Scale (HAMD), Clinical Global Impression-Severity scale (CGI-S), Hamilton Anxiety Scale (HAMA), and positive symptom scale of the Positive and Negative Syndrome Scale (PANSS), thyroid hormone levels, and metabolic parameters.

RESULTS

171 of the entire MDD study sample met the criteria for the PMD subtype. The prevalence of severe anxiety was much higher in PMD patients (22.8 %) than in non-PMD patients (0.4 %) (χ² = 294.69, P < 0.001, OR = 75.88, 95 % CI = 31.55-182.52). Compared to PMD patients without severe anxiety, PMD patients with severe anxiety had higher HAMD score, CGI-S score, positive symptom subscale score, suicide attempts, blood pressure, thyroid-stimulating hormone (TSH), anti-thyroglobulin (TgAb), and thyroid peroxidases antibody (TPOAb) levels. Furthermore, logistic regression analysis indicated that HAMD score and TSH levels were associated with severe anxiety in PMD patients.

LIMITATIONS

Our cross-sectional study cannot explain the causal relationship between anxiety severity and risk factors in PMD patients.

CONCLUSIONS

Our results suggest that PMD patients are more likely to experience severe anxiety than non-PMD patients. The severity of depression and TSH levels are independent risk factors for anxiety in PMD patients.

Procedure for Organizing a Post-FDA-approval Evaluation of Antidepressants

Purpose: The study reports the construction of a cohort used to study the effectiveness of antidepressants.

Methods: The cohort includes experiences of 3,678,082 patients with depression in the United States on antidepressants between January 1, 2001, and December 31, 2018. A total of 10,221,145 antidepressant treatment episodes were analyzed. Patients who had no utilization of health services for at least two years, or who had died, were excluded from the analysis. Follow-up was passive, automatic, and collated from fragmented clinical services of diverse providers.

Results: The average follow-up was 2.93 years, resulting in 15,096,055 person-years of data. The mean age of the cohort was 46.54 years (standard deviation of 17.48) at first prescription of antidepressant, which was also the enrollment event (16.92% were over 65 years), and most were female (69.36%). In 10,221,145 episodes, within the first 100 days of start of the episode, 4,729,372 (46.3%) continued their treatment, 1,306,338 (12.8%) switched to another medication, 3,586,156 (35.1%) discontinued their medication, and 599,279 (5.9%) augmented their treatment.

Conclusions: We present a procedure for constructing a cohort using claims data. A surrogate measure for self-reported symptom remission based on the patterns of use of antidepressants has been proposed to address the absence of outcomes in claims. Future studies can use the procedures described here to organize studies of the comparative effectiveness of antidepressants.

Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial

Background

Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety.

Methods

A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program.

Discussion

Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing.

Trial registration

Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123; registered 19^th February 2019) and the ISRCTN registry (ID: ISRCTN78951376; registered 10^th July 2019).

Anxiety symptoms and suicidal thoughts and behaviors among patients with mood disorders

BACKGROUND

Though the association between anxiety disorders and suicidal behavior is well-described, the impact of anxiety symptoms on suicidal thoughts and behaviors (STB) across different mood disorders is still unclear.

METHODS

We performed a registry-based retrospective study utilizing outcome measure data collected by the National Network of Depression Centers (NNDC), a nationwide nonprofit consortium of 26 leading clinical and academic member centers in the United States. The sample consisted of 2607 outpatients with mood disorders (major depressive disorder or bipolar disorders). Demographic and clinical variables were compared based on the presence or absence of STB and severity of anxiety symptoms (minimal, mild, moderate, and severe). Univariate and multivariable logistic regressions were conducted to examine the correlations of STB, considering multicollinearity.

RESULTS

Patients with mild, moderate, and severe anxiety symptoms had higher odds of STB than those with minimal symptoms. Gender, marital status, age, and depressive symptoms were other strong predictors of STB. There was no difference in the odds of STB between patients with major depressive disorder (MDD) and those with bipolar disorders (BD). However, the odds of suicidal ideation were slightly lower among patients with BD than those with MDD.

LIMITATIONS

Our sample was comprised only of outpatients, limiting the generalization of our findings. Other limitations include the lack of structured interviews for diagnostic characterization of the patients and the utilization of data on anxiety and mood obtained solely through self-report scales.

CONCLUSIONS

We found a cross-sectional association between the severity of anxiety symptoms and STB among patients with mood disorders. This study demonstrates the need for a suicide risk assessment in patients with mood disorders reporting anxiety symptoms.

ICU bereaved surrogates' comorbid psychological-distress states and their associations with prolonged grief disorder

Background/objective

Bereaved ICU family surrogates’ psychological distress, e.g., anxiety, depression, and post-traumatic stress disorder (PTSD), is usually examined independently, despite the well-recognized comorbidity of these symptoms. Furthermore, the few studies exploring impact of psychological distress on development of prolonged grief disorder (PGD) did not consider the dynamic impact of symptom evolution. We identified surrogates’ distinct patterns/states of comorbid psychological distress and their evolution over the first 3 months of bereavement and evaluated their associations with PGD at 6-month postloss.

Methods

A longitudinal observational study was conducted on 319 bereaved surrogates. Symptoms of anxiety, depression, PTSD, and PGD were measured by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised scale, and the PGD-13, respectively. Distinct psychological-distress states and their evolution were examined by latent transition analysis. Association between psychological-distress states and PGD symptoms was examined by logistic regression.

Results

Three distinct comorbid psychological-distress states (prevalence) were initially identified: no distress (56.3%), severe-depressive/borderline-anxiety distress (30.5%), and severe-anxiety/depressive/PTSD distress (13.3%). Except for those in the stable no-distress state, surrogates tended to regress to states of less psychological distress at the subsequent assessment. The proportion of participants in each psychological-distress state changed to no distress (76.8%), severe-depressive/borderline-anxiety distress (18.6%), and severe-anxiety/depressive/PTSD distress (4.6%) at 3-month postloss. Surrogates in the severe-depressive/borderline-anxiety distress and severe-anxiety/depressive/PTSD-distress state at 3-month postloss were more likely to develop PGD at 6-month postloss (OR [95%] = 14.58 [1.48, 143.54] and 104.50 [10.45, 1044.66], respectively).

Conclusions

A minority of family surrogates of ICU decedents suffered comorbid severe-depressive/borderline-anxiety distress and severe-anxiety/depressive/PTSD symptoms during early bereavement, but they were more likely to progress into PGD at 6-month postloss.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-03981-7.

Suicidality in patients with primary diagnosis of panic disorder: A single-rate meta-analysis and systematic review

BACKGROUND

This study investigated the lifetime suicide attempt and ideation rates among patients with panic disorder (PD).

METHODS

Online databases regarding lifetime suicide attempt and ideation rates in patients with PD were searched up to May 2021.

RESULTS

The suicide attempt and ideation rates were 0.17 (95% CI: 0.16, 0.18) and 0.23 (95% CI: 0.22, 0.25). The suicide attempt rates among female and male patients were 0.17 (95% CI: 0.14, 0.20) and 0.15 (95% CI: 0.12, 0.19). When PD was comorbid with anxiety, depression, substance abuse, and personality disorders, the suicide attempt rates increased to 0.23 (95% CI: 0.20, 0.26), 0.23 (95% CI: 0.18, 0.27), 0.25 (95% CI: 0.20, 0.31), and 0.25 (95% CI: 0.23, 0.28), respectively.

LIMITATIONS

The suicide attempt and ideation by age, suicide ideation by sex, and suicide ideation by comorbidity with other mental disorders were passed in our meta-analysis as sample size was small. Stratification analysis on ethnicity, marital status, education levels, resident location, and severity of PD should be considered in the future.

CONCLUSION

The lifetime suicide ideation and attempt rates in patients with PD were higher than general populations but lower than patients with bipolar or depression. The lifetime suicide attempt rate in female patients was slightly higher than male patients. When PD was comorbid with one other mental illness, the lifetime suicide attempt rate increased by about 50%.

Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial

Background

Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults.

Methods

We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes.

Discussion

This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce.

Trial registration

The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.

The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study

The associated factors of suicide attempts in patients with major depressive disorder (MDD) comorbid with anxiety remains unclear. To the best of our knowledge, this is the first study with a large sample size that examines the risk factors of suicide attempts in first-episode drug-naïve (FEND) MDD patients comorbid with anxiety and includes clinical correlates, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the symptoms of patients. Metabolic parameters and thyroid hormone levels were measured. The prevalence of suicide attempts in MDD patients comorbid anxiety symptoms was 24.28%, which was 9.51 times higher than that in MDD patients without anxiety symptoms (3.25%). Compared to non-attempters, MDD patients with anxiety symptoms who attempted suicide scored higher on HAMD and HAMA, and had higher systolic blood pressure, higher levels of thyroid stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb), which were also correlated with suicide attempts in MDD patients comorbid anxiety symptoms. The combination of HAMA score, HAMD score, and TSH could differentiate suicide attempters from non-suicide attempters. Further, the age of onset, illness duration, BMI, TSH, and TPOAb were associated with the times of suicide attempts in MDD patients comorbid anxiety symptoms. Our results demonstrate high prevalence of suicide attempts in MDD patients comorbid anxiety symptoms. Several clinical correlates, metabolic parameters, and thyroid hormones function contribute to the suicide attempts in MDD patients comorbid anxiety symptoms.

Milieu therapy for hospitalized patients with late-life anxiety and depression: a qualitative study

Background: Milieu therapy (MT) is an important interprofessional part of therapy for persons with late-life anxiety and depression in psychogeriatric inpatient units. Research on how this is conducted is scarce.Aim: To explore nurses' and nurse assistants' experience regarding MT interventions for persons with late-life anxiety and depression and how this is applied and conducted in the everyday life in a psychogeriatric inpatient unit.Method: Four focus group interviews with nurses and nurse assistants were conducted. Systematic text condensation was used for analyzing and interpreting the data.Results: MT was described as a dynamic and active process. Conscious individualized cooperation and communication day and night emerged as overarching theme, with following categories: 1. Collecting clues about the patient's history, challenges and coping strategies. 2. Active use of these clues. 3. Active use of the ward setting as arena for staff to learn from each other, for patients to learn from other patients and as frame for MT in general. Strategies from both psychiatric and dementia care were used in MT interventions.Conclusion: Results from this study describe content and complexity of MT strategies that can be supportive in everyday practice in psychogeriatric inpatient units and nursing homes, and have the potential to facilitate teaching, supervision and counseling of health professionals, caregivers and patients.

Research on Supportive Psychosocial, Drug Treatment, and Health Education Intervention and Health Management Model of Community-Residing Elderly Adults With Late Life Depression in Liaoning Province: A Protocol

BACKGROUND

Late life depression (LLD), a common mental disorder, has become an increasingly acute public health concern with a quickly expanding geriatric population worldwide. To our knowledge, however, the incidence of LLD in northern cities in China has not been empirically investigated, and many elderly people with depressive moods and mild depressive symptoms have not been given sufficient attention.

METHODS/DESIGN

This is a multi-stage and prospective study. The first stage is a cross-sectional study, investigating the epidemiological characteristics of LLD in northern China and exploring the biological, psychological, and social risk factors for developing LLD based on a set of questionnaires from 6,800 community-residing elderly adults. The second stage involves statistical analysis, by constructing a risk factor model for LLD and analyzing their direct and indirect functional routes on the basis of structural equation modeling. The third stage is an experimental study a total of 60 elderly patients with LLD and their principle caregivers will be randomly assigned to control and trial groups. The trial group patients and caregivers will undergo supportive psychosocial, drug treatment, and health education (PDH) intervention, whereas the control group patients and caregivers will be treated routinely (treatment as routine, TAR, which includes drug treatment and health education). At the end of the intervention, depressive symptoms, quality of life, and the social and cognitive functioning of the patients in the two groups will be respectively assessed at a baseline and after 6, 9, and 12 months post-intervention by employing scales and questionnaires to analyze the effectiveness of the supportive PDH intervention measures in comparison with TAR. Ultimately, a supportive PDH intervention and health management model will be obtained by combining PDH intervention with mental health institutions, community health services, and aging families as the main line.

DISCUSSION

This study will provide strong and suitable evidence for enhancing the integrated supportive PDH intervention and health management model of LLD patients among community-dwelling residents.

ETHICS

This study has been approved by the Ethics and Research Committee of the First Affiliated Hospital of China Medical University (approval No. [2019] 2019-312-2).

Predictive factors for suicidal attempts: A case-control study

PURPOSE

To identify predictors for 12-month suicide attempt from general psychiatric outpatients.

DESIGN AND METHODS

A case-control study compared 55 cases of suicide attempt within the previous 12 months matched for age and sex with 55 nonsuicidal cases. All were interviewed for psychiatric and personality disorder (PD) diagnoses using a DSM-IV-TR diagnostic interview.

FINDINGS

Factors associated with suicide attempt included depressive disorders (odds ratio [OR] = 4.62) and borderline PD (OR = 8.99).

PRACTICAL IMPLICATIONS

More attention should be paid to identifying PD especially borderline PD in suicidal attempters, and further study of modifiable factors associated with depression and borderline PD is encouraged.

Prevalence and clinical profiles of comorbid anxiety in first episode and drug naïve patients with major depressive disorder

BACKGROUND

Anxiety is a common comorbidity in major depressive disorder (MDD) that has been studied extensively in the past. However, few studies have explored anxiety in drug naïve (FEDN) patients with MDD and those presenting with a first episode. The objective of this current study was to examine the prevalence and risk factors of anxiety in FEDN patients with MDD in order to understand the relationship between MDD and anxiety in the acute early phase and provide important implications for therapeutic interventions.

METHODS

A total of 1718 FEDN patients with MDD were recruited in this cross-sectional study. Their anthropometric and clinical data, including suicide attempt and psychotic symptom, were collected. The Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were used to evaluate depression and anxiety for all the patients in this study.

RESULTS

Overall, we found that the prevalence of anxiety in FEDN MDD patients was 80.3%. Correlation analysis showed that anxiety was associated with suicide attempt and psychotic symptom in FEDN patients with MDD. The rate of suicide attempt and psychosis in above patients with anxiety was 24.3% and 12.3%, respectively. Furthermore, stepwise regression analysis showed that suicide attempt and psychotic symptom were significant predictors for anxiety in FEDN patients with MDD.

CONCLUSIONS

Our study showed that the prevalence of comorbid anxiety in FEDN patients with MDD is very high. We also found that two clinical variables, suicide attempt and psychosis, are risk factors for comorbid anxiety in FEDN patients with MDD.

Depression, Anxiety, and Pain among Newly Admitted Nursing Home Residents

Background

Depression, anxiety, and pain are commonly experienced by older adults living in nursing homes.

Objectives

To describe the prevalence of depression, anxiety disorders, and pain among newly admitted nursing home residents in the United States and to describe the treatment of these disorders.

Design

Cross-sectional study of newly admitted residents.

Setting

Residents able to complete a pain assessment (n=783,826) living in Medicare- and Medicaid-certified nursing homes in the United States in 2011-2012.

Measures

Measures of sociodemographic, mood and behavior, pain, diagnoses, and functioning items from the Minimum Data Set (MDS) version 3.0.

Results

Approximately 36% of residents had a diagnosis of depression (other than bipolar disorder) and/or an anxiety disorder (n = 272,311). Of these residents, 25.2% had both depression and an anxiety disorder (95% CI = 25.0-25.4%), 54.3% (95% CI = 54.1-54.5%) had depression without an anxiety disorder, and 20.5% had an anxiety disorder without depression (95% CI = 20.3-20.6%). Fifteen percent had the triad of depression, anxiety, and pain at admission (95% CI = 9.3-23.3%). Depressive symptoms were more commonly reported by residents with pain than by those without pain. Receipt of psychological therapy (range: 0.9%-2.0%) or any psychiatric medication was lacking (range: 35.3%-48.5%), regardless of pain status. Participants reporting pain received a combination of scheduled, pro re nata (PRN)/as-needed, and non-medication pain interventions (range: 59.8% depression without anxiety to 62.9% depression and anxiety disorder).

Conclusion

Residents often suffer from combinations of depression, anxiety and pain at admission to nursing home. While treatment of pain is more common than treatment of psychiatric treatments, both psychiatric treatment and pain management may be suboptimal in nursing homes.

Suicide in the elderly: a 37-years retrospective study

BACKGROUND

The rates of suicide increase with age and reach their highest levels in the oldest age groupings and are sufficiently large for them to constitute a public health concern. The number of deaths due to suicides after the age of 60 years in Italy is 1,775 (41.36%) in 2013; there is a constant increase of elder population over the last ten years and elderly are almost twice of young. It is in this context that suicide arises, a risk factor during old age.

METHOD

This is a retrospective study of autopsy and police reports of suicide from January 1979 through December 2015. Data about suicides after the age of 60 years was collected from the Archives of the Legal Medicine of the University of Parma, a Northern Italian city. Trend and characteristics (age, sex, marital status, pathological factors and method of suicide) were assessed.

RESULTS

A total of 538 cases (394 males, 144 females) were identified. Male sex correlates to a higher suicidal risk, with a male-female ratio of 2.74:1. The highest risk of suicide is observed in the age between 70 and 79 years. Pathological factors were revealed in 427 cases (physical state for 194 cases, mental state for 233 cases); mental illness was related significantly to suicidal risk. Hanging is the most common suicide method (175 cases), followed by fall from height (130 cases), drowning (101 cases) and use of firearms (56 cases); differences regarding methods employed were detected between males and females. The choice of method sometimes is indicative of a clear decision, while other times it is strictly linked to the availability of the means.

CONCLUSIONS

Suicidal behavior seems to be the product of the interaction of many factors, such as biological or psychological diseases or painful events. The presence of chronic and debilitating diseases, often accompanied by profound psychological suffering, is a powerful stimulus for suicide among men, whereas mental state is a significant risk factor for women, with the majority suffering from depression. The psychological and the biological changes, the cognitive deficits and the common diseases facilitate the structuring of depressive characteristics.

Combined effects of depression and anxiety on suicide: A case-control psychological autopsy study in rural China

Most of the previous researches indicated depression and anxiety were potential risk factors for suicide, and they were also highly correlated. However, few studies have explored their combined effects on suicide and the dimensions which really work. A total of 392 suicide cases aged 15-34 years and 416 community controls of the same age range were investigated. The results showed that after controlling confounding factors, people with low depression and high anxiety, with high depression and low anxiety, with high depression and high anxiety were at 2.46, 26.32, 54.77 times more risk for suicide (all P < 0.05), compared with subjects with low depression and low anxiety. Only two of seven dimensions of depression (including cognitive disturbance, helplessness, excluding anxiety dimension) and one of two dimensions of STAI anxiety (anxiety dimension, not depression dimension) were risk factors for suicide (all OR > 1). Our main findings was that combined effects of depression and anxiety on suicide were complicated, and the effects of anxiety dimension of depression and depression dimension of anxiety must be cautiously evaluated, avoiding overlapping inclusion.

Nursing diagnosis for Risk of Suicide in elderly: integrative review

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.

12-month prevalence and concomitants of DSM-IV depression and anxiety disorders in two violence-prone cities in Brazil

BACKGROUND

Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities.

METHODS

The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence.

RESULTS

Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for São Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In São Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30-59 year olds, but in 23-29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity.

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed.

Few Sex Differences in Hospitalized Suicide Attempters Aged 70 and Above

Relatively little research attention has been paid to sex issues in late life suicidal behaviour. The aim was to compare clinical characteristics of women and men aged 70+ who were hospitalized after a suicide attempt. We hypothesized higher depression and anxiety scores in women, and we expected to find that men would more often attribute the attempt to health problems and compromised autonomy. Participants (56 women and 47 men, mean age 80) were interviewed by a psychologist. In addition to psychiatric and somatic health assessments, participants responded to an open-ended question concerning attributions of the attempt. There were no sex differences in depression and anxiety. Forty-five percent of the men and 14% of the women had a history of substance use disorder (p = 0.02). At least one serious physical disability was noted in 60.7% of the women and 53.2% of the men (p = 0.55). Proportions attributing their attempt to somatic illness did not differ (women, 14.5% vs. men 17.4%, p = 0.79), and similar proportions attributed the attempt to reduced autonomy (women, 21.8% vs. men, 26.1%, p = 0.64). We found strikingly similar figures for depression scores, functional disability and attributions for attempting suicide in older men and women. Larger studies are needed in diverse settings as sex differences might be influenced by cultural context.

Depression and cognitive impairment among newly admitted nursing home residents in the USA

OBJECTIVE

The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment.

METHODS

We identified 1,088,619 newly admitted older residents between 2011 and 2013 with an active diagnosis of depression documented on the Minimum Data Set 3.0. The prevalence of receiving psychiatric treatment was estimated by cognitive impairment status and depression symptoms. Binary logistic regression using generalized estimating equations provided adjusted odds ratios and 95% confidence intervals for the association between level of cognitive impairment and receipt of psychiatric treatment, adjusted for clustering of residents within nursing homes and resident characteristics.

RESULTS

Twenty-six percent of newly admitted residents had depression; 47% of these residents also had cognitive impairment. Of those who had staff assessments of depression, anhedonia, impaired concentration, psychomotor disturbances, and irritability were more commonly experienced by residents with cognitive impairment than residents without cognitive impairment. Forty-eight percent of all residents with depression did not receive any psychiatric treatment. Approximately one-fifth of residents received a combination of treatment. Residents with severe cognitive impairment were less likely than those with intact cognition to receive psychiatric treatment (adjusted odds ratio = 0.95; 95% confidence interval: 0.93-0.98).

CONCLUSIONS

Many newly admitted residents with an active diagnosis of depression are untreated, potentially missing an important window to improve symptoms. The extent of comorbid cognitive impairment and depression and lack of treatment suggest opportunities for improved quality of care in this increasingly important healthcare setting. Copyright © 2017 John Wiley & Sons, Ltd.

The association of physical illness and self-harm resulting in hospitalisation among older people in a population-based study

OBJECTIVES

With population ageing, self-harm injuries among older people are increasing. Further examination of the association of physical illness and self-harm among older people is warranted. This research aims to identify the association of physical illness with hospitalisations following self-harm compared to non-self-harm injury among older people.

METHOD

A population-based cohort study of individuals aged 50+ years admitted to hospital either for a self-harm or a non-self-harm injury using linked hospital admission and mortality records during 2003-2012 in New South Wales, Australia was conducted. Logistic regression and survival plots were used to examine the association of 21 physical illnesses and mortality at 12 months by injury intent, respectively. Age-adjusted health outcomes, including length of stay, readmission and mortality were examined by injury intent.

RESULTS

There were 12,111 hospitalisations as a result of self-harm and 474,158 hospitalisations as a result of non-self-harm injury. Self-harm compared to non-self-harm hospitalised injury was associated with higher odds of mental health conditions (i.e. depression, schizophrenia, bipolar and anxiety disorders), neurological disorders (excluding dementia), other disorders of the nervous system, diabetes, chronic lower respiratory disease, liver disease, tinnitus and pain. Tinnitus, pain, malignancies and diabetes all had a higher likelihood of occurrence for self-harm compared to non-self-harm hospitalisations even after adjusting for mental health conditions, number of comorbidities and alcohol and drug dependency.

CONCLUSION

Older people who are experiencing chronic health conditions, particularly tinnitus, malignancies, diabetes and chronic pain may be at risk of self-harm. Targeted screening may assist in identifying older people at risk of self-harm.

Suicidally motivated intoxication by psychoactive drugs: characterization among the elderly

Abstract Objective: to characterize suicidally motivated intoxication by psychoactive drugs among elderly people. Method: a retrospective and documentary study with a quantitative approach was carried out, based on the notification forms of 692 cases of suicidally motivated intoxications by psychoactive drugs, registered by the Centro de Assistência Toxicológica (the Toxicological Care Center) in Fortaleza, Ceará, Brazil from 2010 to 2014. The absolute and relative frequencies of social conditions, intoxication episodes and clinical conducts were obtained, and the Chi-squared Test was applied with a significance of p≤0.05. Results: elderly people aged between 60 and 69 years (65.9%), who were female and retired predominated. The most frequently used psychoactive drugs were antidepressants (48.3%) and anxiolytics/hypnotics (29.0%). The most frequent clinical conducts were the use of activated charcoal and gastric lavage. Moderate poisoning was the most frequent, and the main outcome was discharge arising from cure. There was a significant relationship between the elderly persons and gender, occupation, occurrence of intoxication at home, clinical manifestation and hospital admission. Conclusion: suicidally motivated poisoning by psychoactive drugs in elderly persons suggests the need to promote active aging, as well as the access to and rational use of these drugs, thereby reducing harm and preserving the lives of elderly persons.

Association between FKBP5 and CRHR1 genes with suicidal behavior: A systematic review

Suicide is one of the leading causes of death around the world with approximately one million suicides per year. An increasing number of neurobiological studies implicate HPA system dysfunction in suicide behavior, stimulating genetic research to focus on genes related to this system. This systematic review was focused on searching a correlation between FKBP5 and CRHR1 genes with suicidal behavior. Therefore, an electronic search strategy, using PubMed, EBSCO and Cochrane Library databases, was conducted from the inception of the studies into the databases to July 2016. The inclusion criteria were: use of at least one analysis investigating the relation between either the genetic variants in FKBP5 and/or CRHR1 genes with suicidal behavior. 2) use of a case-control design; 3) investigation about suicidal behavior in the form of suicide completion or history of at least one suicide attempt, as defined by each individual study; 4) inclusion of samples comprising control subjects; and 6) inclusion of reports written only in English language. The PRISMA guidelines were followed and the search strategy ensured that all possible studies were identified to compile the review. Using the keyword combinations, the search strategy provided 3334 articles, of which only 15 case-control studies were included in this systematic review. The included studies comprised 2526 subjects with suicidal behavior. A quantitative synthesis of results from the included studies was not undertaken due to marked methodological heterogeneity. This review showed a significant genetic association in most studies in FKBP5 and CRHR1 genes with a high rate of attempted suicide, pointing out that the expression of these genes and its polymorphisms could be a key predictor of suicide risk. In conclusion, this systematic review supports an association between suicidal behavior and genetic variants in FKBP5 and CRHR1 genes.

Male suspected suicide decedents in Utah: A comparison of Veterans and nonveterans

There has been significant debate regarding suicide risk in Veterans compared to nonveterans. However, few studies have examined similarities and differences between Veteran and nonveteran suicide decedents using a combination of next of kin psychological autopsy and data from a state Office of the Medical Examiner (OME). For the current study, next of kin of a one-year cohort of male suspected suicide decedents in Utah completed psychological autopsy interviews with trained research staff. Next of kin of 70 Veterans and 356 nonveterans completed the interviews, which included demographic, behavioral, psychosocial, and clinical variables. The psychological autopsy data then were combined with OME data for the presented analyses. Results showed that Veteran and nonveteran suicide decedents differed on multiple factors, including age at death. Specifically, male nonveteran suicide decedents were younger at age of death compared to Utah Veterans and to a national sample. Veteran decedents also were more likely to have a history of suicide attempts and more likely to have access to firearms compared to nonveterans. Other between-group differences, including Veterans being more likely to have lived alone and method of death (e.g., gunshot, hanging, etc.), were no longer statistically significant after adjustment for age at death.

CONCLUSIONS

these findings have significant clinical and practical importance, as they highlight the risk for suicide in younger nonveterans and older Veterans in Utah.