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Mitchell S, Marvin C, Mitaj D, Rogers ML. Identifying latent classes of suicidal ambivalence: Associations with suicide risk correlates and outcomes. Suicide Life Threat Behav 2024; 54:844-859. [PMID: 38994902 PMCID: PMC11479826 DOI: 10.1111/sltb.13111] [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: 01/08/2024] [Revised: 05/30/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Research has largely conceptualized suicidal ambivalence as the difference between one's wish to live and wish to die without fully considering other suicide ideation (SI) experiences included on measures like the Beck Scale for Suicide Ideation (BSS). We utilized BSS items to identify SI latent classes and examined relevant correlates and outcomes. METHODS We collected self-report data from two samples of US adults who: (1) self-identified as LGBTQ+ (N = 349; cross-sectional) and (2) self-reported past-week SI (BSS score ≥ 11; N = 133; 3 timepoints). RESULTS Latent class analyses supported three-class (Sample 1) and four-class solutions (Sample 2), which included ambivalent classes. In Sample 1, sexual orientation, gender, depression, anxiety, SI, and suicide-specific rumination were concurrently associated with class membership. In Sample 2, depression, SI, suicide-specific rumination, and physical/psychological distance from suicide methods were concurrently associated with class membership. In Sample 2, at both follow-ups, suicide plans/preparations and Acute Suicidal Affective Disturbance symptom frequencies were provided by class membership, and suicidal intent significantly differed by class membership. CONCLUSIONS SI classes differed by sample and evidenced nuances in SI and suicidal ambivalence. Risk factors and suicide-related outcomes also differed by class membership. Implications and limitations are discussed.
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Affiliation(s)
- Sean Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Cole Marvin
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Dea Mitaj
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Megan L. Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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Galasiński D, Ziółkowska J. The end of ambivalence. A narrative perspective on ambivalence in the suicidal process. Suicide Life Threat Behav 2024; 54:888-899. [PMID: 38847574 DOI: 10.1111/sltb.13101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 10/16/2024]
Abstract
INTRODUCTION Suicidal ambivalence is a recognized phenomenon in suicidology, yet not much is known about it in the context of progression from suicidal ideation to action. The current study addresses this gap. We explore narrative dynamics of suicidal ambivalence in stories about transition from suicidal ideation to action. METHODS We employ an experiential qualitative approach to gain in-depth understanding of narrated experience of suicidal ambivalence. We conducted semi-structured interviews with 22 patients hospitalized after a suicide attempt. For a detailed analysis, we selected 11 interviews in which the interviewees' accounts spontaneously referred to their ambivalence about attempting suicide. We used a text-oriented version of Critical Discourse Studies (CDS) to analyze the semantics and syntax, as well as the functions of what was said within the local context, and the social actions thus accomplished. RESULTS Our study shows primarily that ambivalence is not resolved. Rather, it is set aside and removed from the narrative and replaced by an action-focused narrative with no references to mental activities. CONCLUSION We propose that ambivalence recedes and gives way to action and that qualitative research provides a useful evidence base for conceptualizing and understanding the role of ambivalence in transition from suicidal ideation to action.
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Teismann T, Siebert AM, Forkmann T. Suicidal ambivalence: A scoping review. Suicide Life Threat Behav 2024; 54:802-813. [PMID: 38709556 DOI: 10.1111/sltb.13092] [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: 12/18/2023] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Suicidal ambivalence is considered a characteristic condition of suicidal individuals. At the same time, there is a lack of a uniform definition, conception and assessment of suicidal ambivalence. On this background, the current scoping review aims to explore the extent, range, and nature of research activity on suicidal ambivalence and to summarize research findings. METHODS A systematic literature search was conducted in four different databases (PubMed, Psychinfo, Web of Science, and Google Scholar) using an array of search terms (e.g., ambivalence, internal suicide debate, reasons for living and reasons for dying, wish to live and wish to die). RESULTS In total, 28 articles published between 1977 and 2023 were included in the scoping review. The study situation lacks a clear definition, conceptualization and operationalization of suicidal ambivalence. Nonetheless, suicidal ambivalence is a common experience in persons contemplating suicide and suicidal ambivalence seems to be present before, during and after a suicide attempt. Suicidal ambivalence is associated with diverse markers of negative/positive mental health as well as suicidal ideation and behavior. CONCLUSION Results point to the relevance of suicidal ambivalence. At the same time, there are large gaps in knowledge about the development, impact and therapeutic responsiveness of suicidal ambivalence.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University, Bochum, Germany
| | | | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg, Essen, Germany
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Nieuwenhuijs B, Gorus E, Portzky G, De Witte N. Risk and protective factors of a wish to die and suicidal ideation in community-dwelling, older, Flemish adults: results of the Belgian ageing studies. Aging Ment Health 2024; 28:1262-1269. [PMID: 38708865 DOI: 10.1080/13607863.2024.2345779] [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: 08/25/2023] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES This study aims to increase the understanding of suicidality in older adults by investigating the prevalence, characteristics, risk and protective factors of suicidal phenomena in community-dwelling older adults (60+) in Flanders, specifically of a current wish to die (WTD) and lifetime suicidal ideation and behaviour (LSIB). METHOD Cross-sectional data from the Belgian Ageing Studies (BAS) is used (N = 3050). The BAS aims to monitor the needs and quality of life of community-dwelling older adults through a standardised survey. Statistical methods used are bivariate analyses and binary logistic regression. RESULTS Prevalence rates of 4.8% for WTD and 8.2% for LSIB are found. LSIB is the biggest predictor of a current WTD, followed by requiring support on three domains, elder abuse, depression and subjective cognitive complaints, and elder abuse were significant risk factors for both WTD and LSIB. Limited effects of protective factors were found. CONCLUSION Previous research regarding risk factors to be confirmed in this study, and new insights on the effect of elder abuse, subjective indicators of cognitive complaints and requiring support are added. Further research into protective factors and underlying mechanisms is required.
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Affiliation(s)
- Beau Nieuwenhuijs
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Gorus
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Geriatrics Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gwendolyn Portzky
- Unit for Suicide Research, Department Head and Skin, Ghent University, Gent, Belgium
| | - Nico De Witte
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
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Salvatore P, Indic P, Khalsa HK, Tohen M, Baldessarini RJ, Maggini C. Circadian Activity Rhythms and Psychopathology in Major Depressive Episodes. Psychopathology 2023; 57:1-9. [PMID: 37499644 DOI: 10.1159/000530768] [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: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Identifying suicidal risk based on clinical assessment is challenging. Suicidal ideation fluctuates, can be downplayed or denied, and seems stigmatizing if divulged. In contrast, vitality is foundational to subjectivity in being immediately conscious before reflection. Including its assessment may improve detection of suicidal risk compared to relying on suicidal ideation alone. We hypothesized that objective motility measures would be associated with vitality and enhance assessment of suicidal risk. METHODS We evaluated 83 adult-psychiatric outpatients with a DSM-5 bipolar (BD) or major depressive disorder (MDD): BD-I (n = 48), BD-II (20), and MDD (15) during a major depressive episode. They were actigraphically monitored continuously over 3 weekdays and self-rated their subjective states at regular intervals. We applied cosinor analysis to actigraphic data and analyzed associations of subjective psychopathology measures with circadian activity parameters. RESULTS Actigraphic circadian mesor, amplitude, day- and nighttime activity were lower with BD versus MDD. Self-rated vitality (wish-to-live) was significantly lower, self-rated suicidality (wish-to-die) was higher, and their difference was lower, with BD versus MDD. There were no other significant diagnostic differences in actigraphic sleep parameters or in self-rated depression, dysphoria, or anxiety. By linear regression, the difference between vitality and passive suicidal ideation was strongly positively correlated with mesor (p < 0.0001), daytime activity (p < 0.0001), and amplitude (p = 0.001). CONCLUSIONS Higher circadian activity measures reflected enhanced levels of subjective vitality and were associated with lesser suicidal ideation. Current suicidal-risk assessment might usefully include monitoring of motility and vitality in addition to examining negative affects and suicidal thinking.
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Affiliation(s)
- Paola Salvatore
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Section of Psychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Premananda Indic
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Electrical Engineering, University of Texas at Tyler, Tyler, Texas, USA
| | - Harimandir K Khalsa
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Mauricio Tohen
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlo Maggini
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Section of Psychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Wahab S, Chua TY, Razali R, Mat Saher Z, Zamzam IH, Bujang MA. Suicidal Behavior Among Elderly Inpatients: its Relation to Functional Disability and Pain. Psychol Res Behav Manag 2022; 15:737-750. [PMID: 35356540 PMCID: PMC8959869 DOI: 10.2147/prbm.s341768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Suicidal behavior (SB) among elderly inpatients has exhibited a growing global drift. This study aimed to establish the prevalence of SB among elderly inpatients and identify the relationship between SB and depression and functional disability. Methods This cross-sectional study included 136 randomly selected elderly inpatients aged 60 years and older who were hospitalized in a tertiary referral center in Kuala Lumpur, Malaysia. The study utilized the following scales as the assessment tools: The Columbia Suicide Severity Rating Scale (CSSRS), Geriatric Depression Scale (GDS-15), Mini International Neuropsychiatric Interview (M.I.N.I.), the Modified Barthel Index (Shah version) (MBI), and visual analog scale. Results The rates of current major depressive disorder (MDD), recurrent MDD, passive suicidal ideation (SI), and active SI were 24.3%, 8.8%, 27.9%, and 5.9%, respectively. Depressed elderly had 6 to 17 times higher risk of developing passive or active SI. “Wish to be dead,” ie, passive SI was associated with admission to oncology or surgical ward and the presence of current MDD. The findings of the study revealed that active SI was associated with being over 80 years old (p = 0.027), being single (p = 0.042), admission to the oncology ward (p = 0.012) or orthopedic ward (p = 0.032), having positive GDS (p = 0.049), and the presence of current MDD (p = 0.019) or recurrent MDD (p = 0.010). According to the study findings, no association has been observed between passive and active SI and level of independence and acute pain. Conclusion The risk of depressed elderly inpatients having passive and active SI is high. Hence, screening for depression and SI is crucial for prompt treatment and management.
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Affiliation(s)
- Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Tien Yong Chua
- Department of Psychiatry and Mental Health, Hospital Bintulu, Bintulu, 97000, Sarawak, Malaysia
| | - Rosdinom Razali
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Zanariah Mat Saher
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 50586, Malaysia
| | - Iman Hakimi Zamzam
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Kuching, 93586, Sarawak, Malaysia
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Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN, Rico-Uribe LA, Pemau A, Diaz-Carracedo P, Diaz-Marsa M, Hervas G, de la Torre-Luque A. Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry 2022; 12:187-203. [PMID: 35111588 PMCID: PMC8783161 DOI: 10.5498/wjp.v12.i1.187] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
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Affiliation(s)
| | - Yolanda Sanchez-Carro
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid 28046, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
| | - Luisa Natalia Lagunas
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
| | - Laura Alejandra Rico-Uribe
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Psychology, La Rioja International University, Logrono 26006, Spain
| | - Andres Pemau
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | | | - Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
- Institute of Psychiatry and Mental Health, San Carlos Clinical Hospital, Madrid 28040, Spain
| | - Gonzalo Hervas
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
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Bornet MA, Bernard M, Jaques C, Rubli Truchard E, Borasio GD, Jox RJ. Assessing the Will to Live: A Scoping Review. J Pain Symptom Manage 2021; 61:845-857.e18. [PMID: 32931906 DOI: 10.1016/j.jpainsymman.2020.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT The will to live (WTL) is an important factor to consider in the context of providing resource-oriented palliative care. Until now, there has been no major review of the existing research on this subject. OBJECTIVES The primary objective of this study is to summarize the state of research concerning instruments that assess the WTL. The secondary objective is to explore the theoretical models and psychometric properties of these instruments, in studies where these instruments were initially presented. The tertiary objective is to identify, among all studies where these instruments have been used, the intensity of the WTL, and factors associated with it. METHODS We conducted a scoping review, including studies that were designed to assess the WTL among participants in all settings. Records were systematically searched from seven bibliographic databases with no date limitations up to August 2020. RESULTS Of the 3078 records screened, 281 were examined in detail and 111 were included in the synthesis. A total of 25 different instruments quantitatively assessing the WTL are presented. Most are single-question tools and rate intensity. The underlying concepts and psychometric properties are incompletely explained. Lack of crossreferencing is apparent. The intensity of the WTL is high, even among people with significant health impairment, and is frequently associated with different factors, such as resilience and quality of life. CONCLUSION A considerable yet unconnected body of studies assesses the WTL. Its assessment in clinical routine could promote resource-oriented and patient-centered care.
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Affiliation(s)
- Marc-Antoine Bornet
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cécile Jaques
- Medical Library, Research and Education Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ralf J Jox
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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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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Ohnsorge K, Rehmann-Sutter C, Streeck N, Gudat H. Wishes to die at the end of life and subjective experience of four different typical dying trajectories. A qualitative interview study. PLoS One 2019; 14:e0210784. [PMID: 30653575 PMCID: PMC6336242 DOI: 10.1371/journal.pone.0210784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022] Open
Abstract
RESEARCH AIMS The motivations that lead to wishes to die (WTD) in palliative care patients with cancer are relatively well studied. But little is known about WTD in other pathologies and the relation between subjective understandings of dying trajectories and a WTD. We investigated the WTD of palliative patients in four different dying trajectories: neurological diseases, organ failure, frailty due to age, and cancer. STUDY POPULATION 62 palliative cancer (n = 30) and non-cancer (n = 32) patients (10 neurological disease; 11 organ failure; 11 frailty), their families and health professionals in different palliative care settings (248 interviews). STUDY DESIGN AND METHODS Qualitative semi-structured interviews. Data analysis through Interpretive Phenomenological Analysis and Grounded Theory. RESULTS In addition to personal motivations, we found that people dealing with similar trajectories were often confronted with similar questions and concerns due to similar challenges. For four trajectories we show typical patterns, similarities and differences that should be considered when talking with patients about their WTD. These illness-related considerations do not explain the WTD completely, but give important information on the challenges for particular patient groups that might experience a WTD. In all patient groups, there were clear moments that triggered a WTD: for neurological patients it was experiencing breathlessness, high-dependency care, or when considering tube feeding or respiratory support; for persons with organ failure it was an acute burdensome crisis; for patients with cancer after the initial diagnosis, it was the first relapse or the move into advanced palliative care; for elderly frail persons it was the move into care facilities, or the loss of important relationships or capabilities. The feeling of being a burden to others was reported in all patient groups. INTERPRETATION WTD can be triggered within disease trajectories by specific conditions and transitional points that affect agency and self-understanding. A better understanding of the concerns and challenges of a particular dying trajectory as well as its characteristic trigger points can facilitate early and comprehensive communication about patients' WTD, and the underlying motivations and protective factors.
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Affiliation(s)
- Kathrin Ohnsorge
- Hospiz im Park, Hospital for Palliative Care, Arlesheim, Switzerland
| | | | - Nina Streeck
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Heike Gudat
- Hospiz im Park, Hospital for Palliative Care, Arlesheim, Switzerland
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Liao SJ, Wu BJ, Liu TT, Chou CP, Rong JR. Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan. BMC Psychiatry 2018; 18:397. [PMID: 30577782 PMCID: PMC6303983 DOI: 10.1186/s12888-018-1981-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/11/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted. METHODS A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population. RESULTS SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56-2.98), item 4 (inferiority) (OR = 1.62, 1.23-2.13), item 5 (insomnia) (OR = 1.52, 1.13-2.05), and physical domain of WHOQOL (OR = 0.84, 0.72-0.99). QOL15 (mobility) (OR = 0.64, 0.46-0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44-0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24-15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15-0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20-0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients. CONCLUSION To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.
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Affiliation(s)
- Su-Jung Liao
- grid.490600.bDepartment of Nursing, Ministry of Health and Welfare, Yuli Hospital, 448 Chung-Hua Road, Yuli Township, Hualien County 981 Taiwan, Republic of China ,Department of Nursing, National Taipei University of Nursing Health Science, No.365, Mingde Rd., Beitou Dist., Taipei City, 112 Taiwan, Republic of China
| | - Bo-Jian Wu
- grid.490600.bDepartment of Psychiatry, Ministry of Health and Welfare, Yuli Hospital, 448 Chung-Hua Road, Yuli Township, Hualien County 981 Taiwan, Republic of China
| | - Tse-Tsung Liu
- 0000 0004 0639 3300grid.415323.2Department of Geriatrics, Mennonite Christian Hospital, 44, Minquan Rd., Hualien City, Hualien County 970 Taiwan, Republic of China
| | - Chao-Ping Chou
- 0000 0004 0639 3300grid.415323.2Department of Psychiatry, Mennonite Christian Hospital, 44, Minquan Rd., Hualien City, Hualien County 970 Taiwan, Republic of China
| | - Jiin-Ru Rong
- Department of Nursing, National Taipei University of Nursing Health Science, No.365, Mingde Rd., Beitou Dist., Taipei City, 112, Taiwan, Republic of China.
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Chang Q, Chan CH, Yip PS. A meta-analytic review on social relationships and suicidal ideation among older adults. Soc Sci Med 2017; 191:65-76. [DOI: 10.1016/j.socscimed.2017.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 12/30/2022]
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