1
|
Sessa F, Polito R, Li Rosi G, Salerno M, Esposito M, Pisanelli D, Ministeri F, Messina A, Carotenuto M, Chieffi S, Messina G, Monda M. Neurobiology and medico-legal aspects of suicides among older adults: a narrative review. Front Psychiatry 2024; 15:1449526. [PMID: 39290301 PMCID: PMC11405742 DOI: 10.3389/fpsyt.2024.1449526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
The task of preventing suicide in older adults is an important social burden as older adults aged above 65 are exposed to singular psychological aspects that increase suicide risks. Moreover, when an older adult corpse is found, the medico-legal inspection represents a fundamental tool to identify the exact cause of death, classifying or excluding it as suicide. In this scenario, this review aims to explore the neurobiological factors that could be related to suicidal behavior in older adults. A further goal of this review is the exploration of the medico-legal aspects surrounding older adult suicides, clarifying the importance of forensic investigation. Particularly, this review examines issues such as neurotransmitter imbalances, cognitive impairment, neuroinflammation, psychosocial factors related to geriatric suicide, and neurodegenerative diseases. Additionally, medico-legal aspects such as policy considerations, legal frameworks, mental health assessments, ethical implications and forensic investigation were explored. Considering the importance of this phenomenon, especially in western countries, a need has emerged for focused screening tools on suicidal behavior among older adults, in order to contain it. Therefore, this review makes an exhaustive appraisal of the literature giving insights into the delicate interplay between neurobiology as well as mental health in relation to older adult suicide within a medico-legal context. The comprehension of different aspects about this complex phenomenon is fundamental to propose new and more effective interventions, supporting tailored initiatives such as family support and improving healthcare, specifically towards vulnerable ageing societies to reduce older adult suicide risks.
Collapse
Affiliation(s)
- Francesco Sessa
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Li Rosi
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | | | - Daniela Pisanelli
- Microbiology and Virology Unit, Ospedali Riuniti, Viale Luigi Pinto, Foggia, Italy
| | - Federica Ministeri
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Antonietta Messina
- Department of Precision Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sergio Chieffi
- Department of Clinical Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Giovanni Messina
- Department of Clinical Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Marcellino Monda
- Department of Clinical Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| |
Collapse
|
2
|
Koller-Ditto N. Identification and Best Practice Management of Comorbid Geri-Psych Conditions in Critical Care. Crit Care Nurs Clin North Am 2023; 35:481-493. [PMID: 37838420 DOI: 10.1016/j.cnc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Mental illnesses among critically ill patients are approximately 2.5 times that of the general population. Although older adults with physical-mental multimorbidity represent more than 50% of critical care admissions, health-care professionals caring for geriatric patients are not adequately educated to effectively recognize and treat serious mental illness. Additionally, critical care nurses feel vulnerable, unsupported, and unable to provide the best and safest possible patient-centered care for patients with mental illness. Hospitals can reduce these burdens by creating critical care policies and practices that are inclusive of geriatric and mental health concepts, care, and continuing education to those providing care.
Collapse
Affiliation(s)
- Noel Koller-Ditto
- Eastern Michigan University, College of Nursing, Ypsilanti, MI 48197, USA.
| |
Collapse
|
3
|
Kim SH, Park S. Modeling suicidal ideation in Korean older adults based on their social relationships and mental health: a meta-analytic path analysis. Aging Ment Health 2023; 27:2193-2201. [PMID: 37132465 DOI: 10.1080/13607863.2023.2207483] [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: 08/28/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Elder suicide is a serious concern in many countries, including South Korea. Various policies and programs to prevent elder suicide are essential; however, further understanding of this phenomenon is necessary. The current study, therefore, developed a model for understanding the underlying mechanism of suicidal ideation in older adults in South Korea. The model was based on Andersen's theory (2021), which explains the path from social relationships to mental health. METHODS This study was conducted utilizing meta-analytic structural equation modeling in accordance with a pooled correlation matrix. We used data from 93 existing studies systematically identified in nine academic databases. RESULTS The fit statistics show that our model fits the data well. The results demonstrated that suicidal ideation was directly affected by abuse, depression, and self-esteem but not by family relationships. Depression significantly mediated the relationship between abuse and suicidal ideation and between family relationships and suicidal ideation. CONCLUSION Social relationships play an important role in determining mental health among Korean older adults, consistent with Andersen's theory. Prevention of elder abuse and depression is essential in preventing suicide among older adults in South Korea.
Collapse
Affiliation(s)
- Sin-Hyang Kim
- Department of Nursing, Shinsung University, Dangjin-Si, South Korea
| | - Sihyun Park
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| |
Collapse
|
4
|
Ward JM, Witt CD. Let it out: A digital communication campaign to reduce suicide and mental health stigma in Kentucky farmers. Health Mark Q 2023; 40:434-457. [PMID: 37021653 DOI: 10.1080/07359683.2023.2196196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Given the disproportionately high suicide rate of farmers in Kentucky and the unique cultural needs of farmers, a coalition was created to reduce the stigma of seeking help for mental health. A targeted communications campaign was developed to provide information to farmers at risk. This paper describes the development and launch of the campaign, including formative research, message development, campaign concepts, deployment of the campaign, and initial results. Events, traditional advertising, and social and digital media campaigns provided targeted brand awareness. Initial reception to the campaign was positive, especially with TV and radio watch- and listen-through rates and website traffic. The campaign requires expanded messaging and tactics and new partnerships to influence farmers. Practical and theoretical implications include the future use of paid digital strategies to confidentially influence farmers, additional research about culturally competent approaches toward subsets of farmers, and the amount of detail to provide about mental health conditions.
Collapse
Affiliation(s)
- Jeanne M Ward
- University of Louisville School of Nursing, Louisville, KY, USA
| | - Cheryl D Witt
- University of Louisville School of Nursing, Louisville, KY, USA
| |
Collapse
|
5
|
Ma GC, Ravulo J, McGeown U. Emergency Animal Boarding: A Social Return on Investment. Animals (Basel) 2023; 13:2264. [PMID: 37508042 PMCID: PMC10376109 DOI: 10.3390/ani13142264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Companion animals play a central role in many families and are especially valued by those who are socially isolated. Crisis situations such as acute hospitalizations, homelessness, and natural disasters can make it difficult to preserve the human-animal bond and can result in animals being surrendered or euthanized. Social support programs like the RSPCA NSW Emergency Boarding and Homelessness program support people experiencing crisis situations with emergency pet boarding, access to veterinary treatment and individualized case management. This study aimed to estimate the social return on investment (SROI) for this program using the standard SROI methodology. In-depth interviews were conducted with 13 program stakeholders and questionnaire responses were received from 29 program clients. Outcomes were quantified for four stakeholder groups: program clients, client's animals, RSPCA Inspectors, animal pounds, and shelters. Clients and their animals experienced the bulk of the benefit from the program, estimated to have a combined value of over AUD 5 million for the 2020-2021 financial year. The estimated social return on investment was AUD 8.21 for each AUD 1 invested. The study demonstrates that keeping people together with their companion animals or ensuring they are reunited as soon as possible can reduce stressors and improve outcomes for people and animals.
Collapse
Affiliation(s)
- Gemma C Ma
- Royal Society for the Prevention of Cruelty to Animals New South Wales, Yagoona, NSW 2199, Australia
- Sydney School of Veterinary Science, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Jioji Ravulo
- Sydney School of Education and Social Work, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Ursula McGeown
- Royal Society for the Prevention of Cruelty to Animals New South Wales, Yagoona, NSW 2199, Australia
| |
Collapse
|
6
|
Marshall CA, Crowley P, Carmichael D, Goldszmidt R, Aryobi S, Holmes J, Easton C, Isard R, Murphy S. Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. Can J Occup Ther 2022; 90:208-236. [PMID: 36324257 DOI: 10.1177/00084174221132097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background. Suicide safety planning (SSP) is a suicide prevention approach that involves developing a collaborative plan between a service provider such as an occupational therapist and a person who is at risk of suicide. Purpose. To synthesize effectiveness studies on SSP. Method. Using the Joanna Briggs Institute methodology, we conducted a systematic review of effectiveness studies including a: (1) title and abstract screening; (2) full-text review; (3) critical appraisal; and (4) narrative synthesis. Findings. We included 22 studies. Critical appraisal scores ranged from 38.5 to 92.3 (m = 63.7). The types of interventions included were: standard and enhanced SSP (n = 11); electronically delivered SSP (n = 5); and SSP integrated with other approaches (n = 6). Only three studies identified meaningful activity as a component of SSP. Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI). While some studies have demonstrated effectiveness for reducing symptoms of mental illness, promoting resilience and service use, the number of studies exploring these outcomes is currently limited. Implications. Occupational therapists support individuals expressing SI, and SSP is a necessary skill for practice.
Collapse
|
7
|
Holm AL, Salemonsen E, Severinsson E. Suicide prevention strategies for older persons-An integrative review of empirical and theoretical papers. Nurs Open 2021; 8:2175-2193. [PMID: 33619899 PMCID: PMC8363358 DOI: 10.1002/nop2.789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Accepted: 01/31/2021] [Indexed: 12/16/2022] Open
Abstract
AIM To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? DESIGN Integrative review. DATA SOURCES Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. REVIEW METHODS An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. RESULTS Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults' physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.
Collapse
Affiliation(s)
- Anne Lise Holm
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Elin Salemonsen
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Elisabeth Severinsson
- Nursing and Healthcare Research GroupDepartment of ResearchStavanger University HospitalStavangerNorway
| |
Collapse
|
8
|
How Loneliness Worked on Suicidal Ideation among Chinese Nursing Home Residents: Roles of Depressive Symptoms and Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105472. [PMID: 34065364 PMCID: PMC8160705 DOI: 10.3390/ijerph18105472] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 01/21/2023]
Abstract
Suicide in later life is becoming severe under rapid population aging, especially for nursing home residents. Loneliness, an increasingly represented issue among nursing home residents, is found to be a risk factor for depressive symptoms. Both loneliness and depressive symptoms may contribute to the development of suicidal ideation. According to the Protective Factor Model, resilience can act as a moderating role interacting with risk factors to buffer the negative effects on the outcome. The present study aimed to assess the mediating role of depressive symptoms and the moderating effect of resilience on the risk factors of suicidal ideation to attenuate the adverse contribution among nursing home residents. A total of 538 nursing home residents participated in this cross-sectional study, and their suicidal ideation, resilience, loneliness, and depressive symptoms were measured. The mediating effect and moderated mediation model were tested using the Macro Process of SPSS 21.0. Statistics showed that 19.7% of participants had suicidal ideation. The mediating model (H1: B = 0.477, p < 0.001; H2: B = 0.325, p < 0.001; H3: B = 0.308, p < 0.001) and the moderating effect of resilience interacting loneliness (H4: B = −0.133, p < 0.001; H6: B = −0.109, p < 0.001) and depressive symptoms (H5: B = −0.077, p < 0.001) were statistically significant. The findings indicated the protective effect of resilience in alleviating the negative influence of risk factors for suicidal ideation, suggesting that positive psychological interventions for resilience building might be effective in suicide prevention among nursing home residents.
Collapse
|