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Jung HW, Jang JS. Constructing prediction models and analyzing factors in suicidal ideation using machine learning, focusing on the older population. PLoS One 2024; 19:e0305777. [PMID: 39038039 PMCID: PMC11262681 DOI: 10.1371/journal.pone.0305777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/04/2024] [Indexed: 07/24/2024] Open
Abstract
Suicide among the older population is a significant public health concern in South Korea. As the older individuals have long considered suicide before committing suicide trials, it is important to analyze the suicidal ideation that precedes the suicide attempt for intervention. In this study, six machine learning algorithms were employed to construct a predictive model for suicidal thinking and identify key variables. A traditional logistic regression analysis was supplementarily conducted to test the robustness of the results of machine learning. All analyses were conducted using a hierarchical approach to compare the model fit of each model in both machine learning and logistic regression. Three models were established for analysis. In Model 1, socioeconomic, residential, and health behavioral factors were incorporated. Model 2 expanded upon Model 1 by integrating physical health status, and Model 3 further incorporated mental health conditions. The results indicated that the gradient boosting algorithm outperformed the other machine learning techniques. Furthermore, the household income quintile was the most important feature in Model 1, followed by subjective health status, oral health, and exercise ability in Model 2, and anxiety and depression in Model 3. These results correspond to those of the hierarchical logistic regression. Notably, economic and residential vulnerabilities are significant factors in the mental health of the older population with higher instances of suicidal thoughts. This hierarchical approach could reveal the potential target population for suicide interventions.
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Affiliation(s)
- Hyun Woo Jung
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Republic of Korea
- Yonsei Institute of Health and Welfare, Yonsei University Mirae Campus, Wonju, Republic of Korea
| | - Jin Su Jang
- Human Behavior & Genetic Institute, Associate Research Center, Korea University, Seoul, Republic of Korea
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Zainal NH. Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis. Psychol Med 2024; 54:457-472. [PMID: 37964436 DOI: 10.1017/s0033291723003306] [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] [Indexed: 11/16/2023]
Abstract
Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and combined treatment on suicide attempts and other serious psychiatric adverse events (i.e. psychiatric emergency department [ED] visit, psychiatric hospitalization, and/or suicide death; SAEs). Peto odds ratios (ORs) and their 95% confidence intervals were computed from the present random-effects meta-analysis. Thirty-four relevant RCTs were included. Psychotherapy-only was stronger than combined treatment (1.9% v. 3.7%; OR 1.96 [1.20-3.20], p = 0.012) and ADM-only (3.0% v. 5.6%; OR 0.45 [0.30-0.67], p = 0.001) in decreasing the likelihood of SAEs in the primary and trim-and-fill sensitivity analyses. Combined treatment was better than ADM-only in reducing the probability of SAEs (6.0% v. 8.7%; OR 0.74 [0.56-0.96], p = 0.029), but this comparative efficacy finding was non-significant in the sensitivity analyses. Subgroup analyses revealed the advantage of psychotherapy-only over combined treatment and ADM-only for reducing SAE risk among children and adolescents and the benefit of combined treatment over ADM-only among adults. Overall, psychotherapy and combined treatment outperformed ADM-only in reducing the likelihood of SAEs, perhaps by conferring strategies to enhance reasons for living. Plausibly, psychotherapy should be prioritized for high-risk youths and combined treatment for high-risk adults with MDD.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Psychology, National University of Singapore, Singapore
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Yuan J, Wang Y, Liu Z. Temporal relationship between depression and cognitive decline in the elderly: a two-wave cross-lagged study in a Chinese sample. Aging Ment Health 2023; 27:2179-2186. [PMID: 37339082 DOI: 10.1080/13607863.2023.2225432] [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: 09/06/2022] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
Objectives: Less information is available about the temporal relationship between depression in the elderly and cognitive decline. In the current study, we (1) evaluated the temporal association between depression and cognitive decline in older adults over a 4-year period; (2) indicated which cognitive domains have a strong temporal relationship with depression.Methods: Using data from China Family Panel Studies, we examined the relationship between depression and cognition among adults aged 65 and older with a cross-lagged design.Results: The results showed that initial depression affected subsequent cognitive function, especially immediate and delayed recall, but that cognition decline did not predict depression over time.Conclusion: The findings suggest that depression precedes cognitive decline in older adults, which is of great significance for the future research of mild cognitive impairment and dementia in the elderly.
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Affiliation(s)
- Jing Yuan
- School of Nursing, Hebei University, Baoding, China
| | - Yan Wang
- School of Nursing, Hebei University, Baoding, China
| | - Zejun Liu
- Department of Psychology, Educational College, Shanghai Normal University, Shanghai, China
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Peters S, Awenat Y, Gooding PA, Harris K, Cook L, Huggett C, Jones S, Lobban F, Pratt D, Haddock G. What is important to service users and staff when implementing suicide-focused psychological therapies for people with psychosis into mental health services? Front Psychiatry 2023; 14:1154092. [PMID: 37252139 PMCID: PMC10213358 DOI: 10.3389/fpsyt.2023.1154092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Suicide is a leading cause of death globally. People with psychosis are at increased risk of suicide death and up to half experience suicidal thoughts and/or engage in suicidal behaviors in their lifetime. Talking therapies can be effective in alleviating suicidal experiences. However, research is yet to be translated into practice, demonstrating a gap in service provision. The barriers and facilitators in therapy implementation require a thorough investigation including the perspectives of different stakeholders such as service users and mental health professionals. This study aimed to investigate stakeholders' (health professionals and service users) perspectives of implementing a suicide-focused psychological therapy for people experiencing psychosis in mental health services. Methods Face-to-face, semi-structured interviews with 20 healthcare professionals and 18 service users were conducted. Interviews were audio recorded and transcribed verbatim. Data were analyzed and managed using reflexive thematic analysis and NVivo software. Results For suicide-focused therapy to be successfully implemented in services for people with psychosis, there are four key aspects that need to be considered: (i) Creating safe spaces to be understood; (ii) Gaining a voice; (iii) Accessing therapy at the right time; and (iv) Ensuring a straightforward pathway to accessing therapy. Discussion Whilst all stakeholders viewed a suicide-focused therapy as valuable for people experiencing psychosis, they also recognize that enabling successful implementation of such interventions will require additional training, flexibility, and resources to existing services.
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Affiliation(s)
- Sarah Peters
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Manchester Centre for Health Psychology, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Yvonne Awenat
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kamelia Harris
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Leanne Cook
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte Huggett
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Steven Jones
- Lancashire and South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
- Department of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Fiona Lobban
- Lancashire and South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
- Department of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Stanley B, Brodsky B, Monahan M. Brief and Ultra-Brief Suicide-Specific Interventions. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:129-136. [PMID: 37201146 PMCID: PMC10172548 DOI: 10.1176/appi.focus.20220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The rising rates of suicide warrant effective treatments that can quickly help stabilize suicidal individuals and prevent future suicidal crises from occurring. Across the past few decades, there has been a rise in the development of ultra-brief (1-4 sessions) and brief suicide-specific interventions (6-12 sessions) to meet this need. This article reviews several prominent ultra-brief and brief interventions, including the Teachable Moment Brief Intervention, Attempted Suicide Short Intervention Program, Safety Planning Intervention, Crisis Response Planning, Cognitive Therapy for Suicide Prevention, Brief Cognitive-Behavioral Therapy for Suicide Prevention, Collaborative Assessment and Management of Suicidality, and the Coping Long-Term With Active Suicide Program. A brief review of each interventions' evidence base is also provided. Current challenges and directions for future research in testing the efficacy and effectiveness of suicide prevention initiatives are discussed.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
| | - Beth Brodsky
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
| | - Maureen Monahan
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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Chattun MR, Amdanee N, Zhang X, Yao Z. Suicidality in the geriatric population. Asian J Psychiatr 2022; 75:103213. [PMID: 35917739 DOI: 10.1016/j.ajp.2022.103213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.
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Affiliation(s)
- Mohammad Ridwan Chattun
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Medical School of Nanjing University, Nanjing Brain Hospital, 22 Hankou Road, Nanjing 210093, China.
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Ferguson M, Rhodes K, Loughhead M, McIntyre H, Procter N. The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Arch Suicide Res 2022; 26:1022-1045. [PMID: 33913799 DOI: 10.1080/13811118.2021.1915217] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).
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Azizi H, Fakhari A, Farahbakhsh M, Esmaeili E. Effective programs on suicide prevention: Combination of review of systematic reviews with expert opinions. Int J Prev Med 2022; 13:39. [PMID: 35529514 PMCID: PMC9069150 DOI: 10.4103/ijpvm.ijpvm_454_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
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Szanto K, Whitman K. Improving Social Connections to Reduce Suicide Risk: A Promising Intervention Target? Am J Geriatr Psychiatry 2021; 29:801-803. [PMID: 34078585 PMCID: PMC8434874 DOI: 10.1016/j.jagp.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Katalin Szanto
- Department of Psychiatry (KS, KW), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathrine Whitman
- Department of Psychiatry (KS, KW), University of Pittsburgh School of Medicine, Pittsburgh, PA
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Bhar SS, Silver M, Campbell J, Lawson M, O'brien S, Rehm I. Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sunil S Bhar
- Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology,
| | - Mark Silver
- Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology,
- Jewish Care,
| | - Jason Campbell
- Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology,
| | - Margaret Lawson
- Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology,
| | - Shaun O'brien
- Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology,
| | - Imogen Rehm
- Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology,
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Public Pension, Labor Force Participation, and Depressive Symptoms across Gender among Older Adults in Rural China: A Moderated Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093193. [PMID: 32375336 PMCID: PMC7246630 DOI: 10.3390/ijerph17093193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022]
Abstract
Due to insufficient financial support and unceasing work, the rural elderly in China experience a range of mental disorders, and the most common one is depression. This study aims to investigate the association between public pension, labor force participation (LFP), and depressive symptoms for older men and women in rural China. A moderated mediation analysis is conducted using data in the 2015 wave extracted from the China Health and Retirement Longitudinal Study (CHARLS), a continuous national social survey. A total of 2709 available surveys were obtained in our analysis. Using PROCESS, results revealed that the income from China’s New Rural Pension Scheme (NRPS) was directly negatively related to depressive symptoms. However, LFP did not mediate the link between pension income (PI) and depressive symptoms in the total study population. The results of moderated mediation estimates indicated that gender significantly moderated the relationship between LFP and depressive symptoms. Specifically, for older women, the indirect effect of PI on depressive symptoms via LFP was significant, but not for the opposite sex. In order to improve the mental health of older adults in rural China, the policy makers and mental health therapists need to pay attention to the aforementioned factors.
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Bilbrey AC, Laidlaw K, Cassidy-Eagle E, Thompson LW, Gallagher-Thompson D. Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Abstract
BACKGROUND Death by suicide continues to be a global public health concern with little research demonstrating the effectiveness of treatment options. This exploratory study exams the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) Therapy delivered to patients experiencing an acute mental health crisis to explore if by treating their background trauma, improvements could be seen in their general psychopathology and if there was a resulting decrease in their desire for suicide. METHODS A practice-based service development project was conducted within a mental health hospital. A non-randomised, exploratory pre-test post-test design was utilised. Participants were identified from adult patients currently receiving care from either an inpatient mental health ward or the Crisis Resolution and Home Treatment Team (CRHTT). Those who had reported experiencing at least one event that they considered to be traumatic were offered EMDR Therapy. Notes from the electronic database were analysed to assess contact with services 12 months prior to treatment and following treatment. RESULTS 72 patients were offered treatment in the study with 57 completing treatment. Patients made significant improvements across all the psychometrics, including a reduction in suicidal ideation. The majority needed less than 10 sessions and needed no onward referral for further psychological therapy. Cost savings were realised by retracting referrals for further therapy and in early discharge from CRHTT and acute wards, and by preventing admissions. Contact with services post treatment also reduced. CONCLUSIONS EMDR Therapy can be an effective treatment for patients experiencing a mental health crisis who have a trauma picture, resulting in significant improvements in their mental well-being and substantial cost savings for the National Health Service (NHS).
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Affiliation(s)
- Simon Proudlock
- Prospect Park Hospital, Honey End Lane, Tilehurst, Reading, RG30 4EL UK
| | - Jasmine Peris
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
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Lutz J, Edelstein B, Katz E, Gallegos JV. A Shortened Version of the Reasons for Living-Older Adults Scale for Clinical and Research Utility. THE GERONTOLOGIST 2019. [PMID: 29529274 DOI: 10.1093/geront/gny009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults have elevated suicide rates, and identification of protective factors, such as reasons for living, is important in preventing suicide. The Reasons for Living-Older Adults scale (RFL-OA) is a 69-item measure of these protective factors in late life, which yields good psychometric properties. However, its length limits its utility in some clinical and research contexts where a shorter measure is ideal. The objective of this study was to create a shortened version of the RFL-OA. RESEARCH DESIGN AND METHODS First, data collected previously during validation of the original RFL-OA (n = 199, age 65 and older, 65% female) were used to select 30 items, spanning all content areas, that were highly endorsed. Second, new data were collected (n = 219, age 60 and older, 52% female) with the 30-item RFL-OA and measures of depression, hopelessness, suicidal ideation, religiosity, health, and social desirability to examine the measure's internal consistency and convergent and discriminant validity. RESULTS Scores on the 30-item RFL-OA exhibited strong internal consistency. The short RFL-OA demonstrated good convergent validity via significant, moderate correlations with suicidal ideation, hopelessness, depression, and religiosity. It demonstrated adequate discriminant validity via only small correlations with disability, subjective health, and social desirability. DISCUSSION AND IMPLICATIONS The shorter RFL-OA has good psychometric properties among community-dwelling older adults. It may have greater utility, compared to the original 69-item measure, for clinicians and researchers with limited time but who want to assess protective factors against suicidal behavior in late life.
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Affiliation(s)
- Julie Lutz
- Psychology Department, West Virginia University, Morgantown
| | | | - Emma Katz
- Psychology Department, West Virginia University, Morgantown
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Aslan M, Hocaoglu C, Bahceci B. Description of suicide ideation among older adults and a psychological profile: a cross-sectional study in Turkey. CIENCIA & SAUDE COLETIVA 2019; 24:1865-1874. [DOI: 10.1590/1413-81232018245.14232017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022] Open
Abstract
Abstract This study investigates the suicidal ideation and the possible causes for suicidal behaviour in the elderly. Subjects were 150 patients aged 65 and older who were evaluated using the sociodemographic data collection forms, Geriatric Depression Scale (GDS), Suicidal Ideation Scale (SIS), Reasons for Living Inventory (RLI), and Beck Hopelessness Scale (BHS). Of 150 patients, 72.7% were women and 27.3% were men, ages ranged from 65 to 88 years. Suicidal ideation was noted in 30.7% of patients. When the mean of BHS total score between patients with and without suicidal ideation and the mean of BHS subscale’s feelings and expectations regarding the future and loss of motivation and hope in terms of subscales were evaluated between the groups with and without suicidal ideation, the scores had a significant difference. When RLI was evaluated in terms of total scores, the suicidal ideation mean score was 243.74 ± 32.28, while the non-suicidal ideation mean score was 267.27 ± 24.36. There was a significant relationship between the two groups. We found low level of education, low level of reasons for living and higher psychiatric morbidity (generalized anxiety disorder and comorbid depressive disorder) in with suicidal ideation in the elderly.
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Wand APF, Peisah C, Draper B, Brodaty H. Why Do the Very Old Self-Harm? A Qualitative Study. Am J Geriatr Psychiatry 2018; 26:862-871. [PMID: 29627192 DOI: 10.1016/j.jagp.2018.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care. DESIGN A qualitative study using in-depth interviews. SETTING Participants were recruited from two teaching hospitals and associated community services. PARTICIPANTS People aged 80 years or older who had self-harmed within the previous month. METHODS Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO. RESULTS Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment". CONCLUSIONS Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated.
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Affiliation(s)
- Anne P F Wand
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; School of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia.
| | - Carmelle Peisah
- School of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brian Draper
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; School of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; Dementia Centre for Research Collaboration and Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
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O'Rourke N, Heisel MJ, Canham SL, Sixsmith A, Yaghoubi-Shahir H, King DB. Psychometric validation of the Geriatric Suicide Ideation Scale (GSIS) among older adults with bipolar disorder. Aging Ment Health 2018; 22:794-801. [PMID: 28436681 DOI: 10.1080/13607863.2017.1317333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Across age groups, bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions; 25%-50% of those with BD will make one or more suicide attempt. Psychometrically sound instruments are required to reliably measure suicide ideation and risk of self-harm for older adults with BD. For this study, we validate the geriatric suicide ideation scale (GSIS) with adults 50+ years with BD. METHODS We recruited a global sample of 220 older adults with BD (M = 58.50 years of age) over 19 days using socio-demographically targeted, social media advertising and online data collection. To demonstrate the construct validation of GSIS responses by older adults with BD, we computed correlations and performed regression analyses to identify predictors of suicide ideation. RESULTS Our analyses support a four-factor model of responses to the GSIS (ideation, death ideation, loss of personal and social worth, and perceived meaning in life) measuring a higher order latent construct. Older adults with BD reporting low satisfaction with life and current depressive symptoms, and who misuse alcohol, report significantly higher levels of suicide ideation. Sleep quality and cognitive failures are also correlated with GSIS responses. CONCLUSIONS Results support the factorial validity of the GSIS with older adults with BD. Similar to other populations, the GSIS measures a four-factor structure of suicide ideation. Across BD subtypes, the GSIS appears to reliably measure suicide ideation among older adults with BD.
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Affiliation(s)
- Norm O'Rourke
- a Department of Public Health and Center for Multidisciplinary Research in Aging , Ben-Gurion University of the Negev , Be'er Sheva , Israel
| | - Marnin J Heisel
- b Department of Psychiatry , University of Western Ontario and Lawson Health Research Institute , London , Canada
| | - Sarah L Canham
- c Gerontology Research Centre , Simon Fraser University , Vancouver (BC) , Canada
| | - Andrew Sixsmith
- d STAR Institute, Simon Fraser University , Vancouver (BC) , Canada
| | | | - David B King
- e IRMACS Centre , Simon Fraser University , Burnaby (BC) , Canada
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Kiosses DN, Alexopoulos GS, Hajcak G, Apfeldorf W, Duberstein PR, Putrino D, Gross JJ. Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) for Middle-Aged and Older Adults Hospitalized for Suicidality. Am J Geriatr Psychiatry 2018; 26:494-503. [PMID: 29395858 PMCID: PMC5860974 DOI: 10.1016/j.jagp.2017.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/31/2017] [Accepted: 11/12/2017] [Indexed: 11/25/2022]
Abstract
Middle-aged and older adults constitute a high suicide-risk group. Among adults aged 50 years old and older, suicide rates increased and suicide deaths almost doubled during the period from 2000 to 2015. Suicide rates are elevated for patients hospitalized for suicidality (i.e., active suicidal ideation or suicide attempt) and the 3 months post-hospitalization is the time of the highest suicide risk. Psychosocial interventions for middle-aged and older adults hospitalized for suicidality are sparse. In this article, we present the main aspects, stages, techniques and a clinical case study of Cognitive Reappraisal Intervention for Suicide Prevention (CRISP), a psychosocial intervention targeting cognitive reappraisal to reduce suicide risk in middle-aged and older adults who have been recently hospitalized for suicidal ideation or a suicide attempt. CRISP is based on the theory that hospitalization for suicidality is preceded by an emotional crisis ("perfect storm"); this emotional crisis is related to personalized (patient- and situation-specific) triggers; and identifying these personalized triggers and the associated negative emotions and providing strategies for an adaptive response to these triggers and negative emotions will reduce suicidal ideation and improve suicide prevention. CRISP therapists identify these triggers of negative emotions and use cognitive reappraisal techniques to reduce these negative emotions. The cognitive reappraisal techniques have been selected from different psychosocial interventions and the affective neuroscience literature and have been simplified for use with middle-aged and older adults. CRISP may fill a treatment need for the post-discharge high-risk period for middle-aged and older adults hospitalized for suicidality.
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Affiliation(s)
- Dimitris N. Kiosses
- Psychology in Clinical Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College
| | | | - Greg Hajcak
- Biomedical Sciences and Psychology, Florida State University
| | - William Apfeldorf
- Clinical Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine
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O’Rourke N, Heisel MJ, Canham SL, Sixsmith A. Predictors of suicide ideation among older adults with bipolar disorder. PLoS One 2017; 12:e0187632. [PMID: 29145409 PMCID: PMC5690620 DOI: 10.1371/journal.pone.0187632] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions as 25%-50% of those with BD will make one or more suicide attempt, and about 15% will intentionally end their lives. Among young adults with BD, substance misuse, medication non-adherence, age at onset, and comorbid psychiatric conditions each predict self-harm. It is currently unclear if these same factors or others predict suicide ideation among older adults with BD. METHODS We recruited a global sample of 220 older adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection (Mean = 58.50, SD = 5.42; range 50 to 81 years). Path analyses allowed us to identify direct and indirect predictors of suicide ideation among older adults with BD. RESULTS Cognitive failures (perception, memory, and motor function), depressive symptoms, alcohol misuse, and dissatisfaction with life as direct predictors of suicide ideation; duration of BD symptoms and medication non-adherence emerged as indirect predictors. Of note, the significant impact of sleep on suicide ideation is indirect via depressive symptoms, cognitive failures, medication non-adherence and life dissatisfaction. CONCLUSIONS As with young adults with BD, alcohol misuse and medication non-adherence emerged as significant predictors of suicide ideation. In addition, cognitive failures directly and indirectly predict suicide ideation in this sample of older adults with BD. Population aging and treatment efficacy are leading to ever growing numbers of older adults with BD. Both direct and indirect predictors of suicide ideation need to be considered in future BD research and treatment planning.
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Affiliation(s)
- Norm O’Rourke
- Department of Public Health and Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- * E-mail:
| | - Marnin J. Heisel
- Department of Psychiatry University of Western Ontario and Lawson Health Research Institute, London, Ontario, Canada
| | - Sarah L. Canham
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Andrew Sixsmith
- STAR Institute, Simon Fraser University, Surrey, British Columbia, Canada
| | - BADAS Study Team
- IRMACS Centre, Simon Fraser University, Burnaby, British Columbia, Canada
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Fry M, Kay S, Elliott RM. Emergency department presentations by older people for mental health or drug and alcohol conditions: A multicentre retrospective audit. ACTA ACUST UNITED AC 2017; 20:169-173. [PMID: 29054575 DOI: 10.1016/j.aenj.2017.09.001] [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] [Received: 07/07/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Emergency department presentations by older people associated with mental health and drug and alcohol related conditions are increasing. However, the characteristics of presentations by older people in Australia are largely unknown. The aim of this research was to explore the characteristics of older people presenting with mental health and drug and alcohol conditions. PROCEDURES We used a retrospective electronic medical record audit to explore all emergency department presentations by older people 65 years and over for mental health and drug and alcohol related conditions over a 12 month period. Data were described using descriptive statistics. FINIDNGS There were 40,093 presentations; 2% (n=900) were related to mental health or drug and alcohol related conditions. Presentations were mainly associated with primary mental or medical symptoms. The majority were female (n=471; 53%). Predominate conditions were cognitive impairment (n=234; 26%) and affective disorders (n=233; 26.0%). Sixty-three percent of patients were admitted to a hospital ward. Over the study period 106 patients (242 episodes of care) represented. PRINCIPLE CONCLUSIONS Given the ageing population and increasing prevalence for mental health and drug and alcohol conditions, strategies are required to better recognise these conditions to reduce the burden on the health care system and improve health for older people.
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Affiliation(s)
- Margaret Fry
- Research and Practice Development, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia; University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Steve Kay
- Specialist Mental Health for Older People, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia
| | - Rosalind M Elliott
- Research and Practice Development, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia; University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
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Rehm IC, Stargatt J, Willison AT, Reser MP, Bhar SS. Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study. J Cogn Psychother 2017; 31:72-88. [PMID: 32755919 DOI: 10.1891/0889-8391.31.1.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.
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Affiliation(s)
- Imogen C Rehm
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jennifer Stargatt
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Aaron T Willison
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Maree P Reser
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil S Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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Van Orden KA, Smith PN, Chen T, Conwell Y. A Case Controlled Examination of the Interpersonal Theory of Suicide in the Second Half of Life. Arch Suicide Res 2016. [PMID: 26219512 PMCID: PMC4899307 DOI: 10.1080/13811118.2015.1025121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The interpersonal theory of suicide proposes that the most proximal cause of suicide is the combination of thwarted belongingness and perceived burdensomeness coupled with a pre-existing vulnerability of reduced fear of death and increased pain tolerance. This pre-existing vulnerability develops in response to painful and provocative life events. According to the theory, empirically demonstrated risk factors for suicide operate by increasing the likelihood of one or more of the theory's constructs. The current study examined the relations of the major constructs of the interpersonal theory with suicide case status compared to living controls in the second half of life. The current study used a pre-existing psychological autopsy database to compare suicide decedents to living controls 50 years and older. Theory constructs were measured by composite scores of thwarted belongingness, perceived burdensomeness, and painful and provocative experiences using an a priori selection of items comprising each construct. Suicide decedents experienced greater levels of all three of the theory's constructs when examined independently compared to living controls. When examined simultaneously while also controlling for Major Depression, greater perceived burdensomeness and painful and provocative experiences were associated with suicide case status (vs. control). The interpersonal theory is a comprehensive framework that may be useful in understanding risk for death by suicide in the second half of life. Clinical management of suicide risk for adults in the second half of life could include a focus on perceived burdensomeness, as the IPTS proposes that this psychological state is amenable to change via therapeutic intervention.
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Rehm IC, Musić S, Carlsson A, Scanlan F, Silver M, Bhar SS. Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion. J Clin Psychol Med Settings 2016; 23:285-97. [PMID: 27073103 DOI: 10.1007/s10880-016-9457-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.
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Affiliation(s)
- Imogen C Rehm
- Faculty of Health, Arts and Design, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia.
| | - Selma Musić
- Faculty of Health, Arts and Design, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
| | - Anthony Carlsson
- Faculty of Health, Arts and Design, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
| | - Faye Scanlan
- Faculty of Health, Arts and Design, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
| | | | - Sunil S Bhar
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, VIC, Australia
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Villatte JL, O'Connor SS, Leitner R, Kerbrat AH, Johnson LL, Gutierrez PM. Suicide Attempt Characteristics Among Veterans and Active-Duty Service Members Receiving Mental Health Services: A Pooled Data Analysis. MILITARY BEHAVIORAL HEALTH 2015; 3:316-327. [PMID: 26740909 PMCID: PMC4699574 DOI: 10.1080/21635781.2015.1093981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Past suicidal behaviors are among the strongest and most consistent predictors of eventual suicide and may be particularly salient in military suicide. The current study compared characteristics of suicide attempts in veterans (N = 746) and active-duty service members (N = 1,013) receiving treatment for acute suicide risk. Baseline data from six randomized controlled trials were pooled and analyzed using robust regression. Service members had greater odds of having attempted suicide relative to veterans, though there were no differences in number of attempts made. Service members also had higher rates of premilitary suicide attempts and nonsuicidal self-injury (NSSI). Veterans disproportionately attempted suicide by means of overdose. In veterans, combat deployment was associated with lower odds of lifetime suicide attempt, while history of NSSI was associated with greater attempt odds. Neither was significantly associated with lifetime suicide attempt in service members. Implications for suicide assessment and treatment are discussed.
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Affiliation(s)
| | | | - Rebecca Leitner
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver VA Medical Center, Denver, Colorado
| | | | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver VA Medical Center, and University of Colorado School of Medicine, Denver, Colorado
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Bhar SS, Silver M. Introduction of a university-based counselling service for older adults. Australas J Ageing 2014; 33:36-42. [PMID: 24795944 DOI: 10.1111/ajag.12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sunil S. Bhar
- Brain and Psychological Sciences Research Centre; Swinburne University of Technology; Hawthorn Victoria Australia
| | - Mark Silver
- Uniting Aged Care; Elgin Street Centre; Hawthorn Victoria Australia
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Klinedinst NJ, Resnick B. Volunteering and depressive symptoms among residents in a continuing care retirement community. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 57:52-71. [PMID: 24313849 DOI: 10.1080/01634372.2013.867294] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This descriptive study examined the relationship between volunteer activities, depressive symptoms, and feelings of usefulness among older adults using path analysis. Survey data was collected via interview from residents of a continuing care retirement community. Neither feelings of usefulness nor volunteering were directly associated with depressive symptoms. Volunteering was directly associated with feelings of usefulness and indirectly associated with depressive symptoms through total physical activity. Age, fear of falling, pain, physical activity, and physical resilience explained 31% of the variance in depressive symptoms. Engaging in volunteer work may be beneficial for increasing feelings of usefulness and indirectly improving depressive symptoms among older adults.
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Bhar SS, Wiltsey-Stirman S, Zembroski D, McCray L, Oslin DW, Brown GK, Beck AT. Recruiting older men for geriatric suicide research. Int Psychogeriatr 2013; 25:88-95. [PMID: 22929086 PMCID: PMC4583196 DOI: 10.1017/s104161021200138x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical research is required to develop and evaluate suicide prevention interventions in the elderly. However, there is insufficient information available about how to best recruit suicidal older adults for such research. This study evaluated the success and efficiency of five recruitment strategies for a clinical trial on the efficacy of cognitive therapy for suicidal older men. METHODS For each strategy, the numbers of individuals approached, screened, and enrolled were calculated, and the expenses and time associated with each enrollment estimated. Men who were 60 years or older and who had a desire for suicide over the past month were eligible for the trial. RESULTS Of 955 individuals considered for trial, 33 were enrolled. Most enrollments were sourced from the Veterans Affairs Behavioral Health Laboratory. Recruiting form this source was also the most time and cost efficient recruitment strategy in the study. CONCLUSIONS Recruitment strategies are effective when they are based on collaborative relationships between researchers and providers, and utilize an existing infrastructure for involving patients in ongoing research opportunities.
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Affiliation(s)
- Sunil S Bhar
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Translating Research for Professional Development and Effective Clinical Practice With Older Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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