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Thapa S, Sharma S, Shrestha S, Ghimire BR, Dahal S, Maharjan R, Thapa S, Koirala R. Distress Thermometer Score Is Useful For Predicting Suicidal Ideation in Patients With Cancer. JCO Glob Oncol 2023; 9:e2300071. [PMID: 37625105 PMCID: PMC10581637 DOI: 10.1200/go.23.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE Suicidal ideation (SI) and depressive symptoms are common in patients with cancer. A Distress Thermometer (DT) is an effective tool to screen depression and anxiety in such cohorts. We investigated the value of the DT for predicting SI and the prevalence and associated risk factors of SI in the study population. METHODS This cross-sectional study enrolled a total of 162 heterogeneous patients with cancer. Information regarding sociodemographic and clinical characteristics, the Hospital Anxiety and Depression Scale, DT score, and the past month SI were collected. Receiver operating characteristic (ROC) analysis was performed to find accuracy and the optimal cutoff score for predicting risk of SI. The significance of difference between DT scores was obtained using the median independence test. Likelihood of risk was analyzed through odds ratio. RESULTS DT possesses good overall accuracy (area under the ROC curve = 0.797) for predicting SI in patients with cancer. The DT had a sensitivity of 0.929 and a specificity of 0.522 with a cutoff score of ≥4. The patients with SI had significantly higher DT scores than the patients without SI (7 [5,8] v 3 [1,6]; P < .001). The 1-month prevalence of SI was 17.3%. Depression, anxiety, and psychological distress were the predictive factors of SI. CONCLUSION SI is a global issue in patients with cancer. The DT scores may be a rapid predicting tool for identifying SI in patients with cancer. Higher DT scores and patients with psychosocial problems need to be routinely screened for SI, which may help to prevent suicidal risk.
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Affiliation(s)
- Sudip Thapa
- Department Medical Oncology, B&B Hospital Pvt. Ltd, Lalitpur, Nepal
| | - Susmita Sharma
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Sudip Shrestha
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Bijesh Raj Ghimire
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Sanuja Dahal
- Vinayak College of Health Science, Kathmandu, Nepal
| | - Rubina Maharjan
- PGY-1, Pediatrics, New York Health and Hospitals, Woodhull Medical Center, Brooklyn, NY
| | - Sadiksha Thapa
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Rishav Koirala
- Department of Psycho-oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
- Brain and Neuroscience Center, Kathmandu, Nepal
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Jonson M, Sigström R, Van Orden KA, Fässberg MM, Skoog I, Waern M. Life-Weariness, Wish to Die, Active Suicidal Ideation, and All-Cause Mortality in Population-Based Samples of Older Adults. Am J Geriatr Psychiatry 2023; 31:267-276. [PMID: 36369206 DOI: 10.1016/j.jagp.2022.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To investigate potential differences in the strength of associations between different levels of passive and active suicidal ideation and all-cause mortality in older adults. DESIGN Prospective cohort study. SETTING Population-based samples of older adults in Gothenburg, Sweden. PARTICIPANTS Older adults aged 79 and above who participated in any wave of the Gothenburg H70 Birth Cohort Studies or the Prospective Population Study of Women between 1986 and 2015 (n = 2,438; 1,737 women, 701 men; mean age 86.6). MEASUREMENTS Most intense level of passive or active suicidal ideation during the past month: life-weariness, wish to die, or active suicidal ideation. The outcome was all-cause mortality over 3 years. RESULTS During follow-up, 672 participants (27.6%) died. After adjustments for sex, age, and year of examination, participants who reported a wish to die (HR 2.01; 95% CI 1.55-2.60) as the most intense level of ideation, but not participants who reported life-weariness (HR 1.40; 95% CI 0.88-2.21) or active suicidal ideation (HR 1.10; 95% CI 0.69-1.76) were at increased risk of all-cause mortality. Reporting a wish to die remained associated with mortality in a fully adjusted model, including somatic conditions, dementia, depression, and loneliness (HR 1.70; 95% CI 1.27-2.26). CONCLUSION In older adults, reporting a wish to die appears to be more strongly associated with all-cause mortality than either life-weariness or active suicidal ideation.
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Affiliation(s)
- Mattias Jonson
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry (MJ, RS, MMF, IS,MW), Gothenburg University, Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, (MJ, RS, MMF,MW), University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Affective Psychiatry, (MJ) Gothenburg, Sweden.
| | - Robert Sigström
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry (MJ, RS, MMF, IS,MW), Gothenburg University, Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, (MJ, RS, MMF,MW), University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cognition and Old Age Psychiatry, (RS, IS), Gothenburg, Sweden
| | - Kimberly A Van Orden
- School of Medicine and Dentistry, (KAVO), University of Rochester Medical Center
| | - Madeleine Mellqvist Fässberg
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry (MJ, RS, MMF, IS,MW), Gothenburg University, Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, (MJ, RS, MMF,MW), University of Gothenburg, Sweden
| | - Ingmar Skoog
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry (MJ, RS, MMF, IS,MW), Gothenburg University, Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, (MJ, RS, MMF,MW), University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cognition and Old Age Psychiatry, (RS, IS), Gothenburg, Sweden
| | - Margda Waern
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry (MJ, RS, MMF, IS,MW), Gothenburg University, Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, (MJ, RS, MMF,MW), University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Department, (MW), Gothenburg, Sweden
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3
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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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A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the body of research on suicide in later life has developed, so has its vocabulary. This has generated a high level of overlap in concepts and terminology used to articulate suicide and how it might present, as well as ‘grey area’ behavioural terms that are both specific to older adults and less well-defined (e.g. ‘hastening of death’ or ‘completed life’). A better understanding of individual experiences and pathways to suicide can help to inform assessment and interventions, and increase the potential to relate any theoretical concepts to the implementation of such. Here, we adopted a scoping review to search systematically literature on specific presentation, features, circumstances and outcomes of these grey areas of suicide in later life. Fifty-three articles (quantitative, qualitative and theoretical) were reviewed. A narrative approach was used to merge and translate this body of knowledge into a new conceptual framework based on four key themes: (a) a sense of completed life or existential loneliness; (b) death thoughts, wishes and ideation; (c) death-hastening behaviour and advanced directives; and (d) self-destructive or self-injurious behaviour. We discuss the importance of integrating this understanding into current knowledge and suicide prevention strategies for older adults. Recommendations are made for unifying research with policy themes on healthy ageing, person-centredness within service provision and citizen participation.
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Muruthi JR, Spafford SG, Osa ML, DeLouize A, Kowal P, Biritwum R, Snodgrass JJ. Suicidal ideation in older Ghanaian women: The roles of bodily pain, functional limitation, and chronic health conditions. Int J Soc Psychiatry 2022; 68:555-563. [PMID: 33541175 DOI: 10.1177/0020764021991179] [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: 11/17/2022]
Abstract
BACKGROUND Although approximately 79% of the world's suicides occur in low- and middle-income countries (LMICs), the limited research in these regions has primarily focused on the rates of suicide attempts (SA) and ideation among men and younger members of the population. AIM This study investigated the associations between bodily pain, functional limitation, chronic health conditions, and suicidal ideation among older Ghanaian women with a positive screen for depression. METHODS Data was obtained from the World Health Organization's Study on global AGEing and adult health (SAGE) Ghana Wave 1, a nationally representative sample. Based on the interpersonal theory of suicide, we used logistic regression analysis to investigate the associations between the variables. RESULTS Functional limitation, bodily pain, hopelessness, and hypertension were significantly associated with a higher risk of suicidal ideation after accounting for sociodemographic and other confounding factors. CONCLUSIONS Early interventions designed to decrease hopelessness, hypertension, and functional limitations may lead to reduced suicide ideation among older Ghanaian women who screen positive for depression.
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Affiliation(s)
- James R Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Sarah G Spafford
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Maggie L Osa
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Alicia DeLouize
- Department of Anthropology, University of Oregon, Eugene, USA
| | - Paul Kowal
- Department of Anthropology, University of Oregon, Eugene, USA
| | - Richard Biritwum
- Department of Community Health, University of Ghana, Legon, Greater Accra, Ghana
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Abstract
OBJECTIVES This pilot study aimed to describe the phenomenon of suicidal ideation among caregivers who were aged 60 and over and who provided care for a person with dementia. METHODS A qualitative study was conducted, using a descriptive method. Semi-structured interviews were administered to caregivers who had or were having suicidal thoughts whilst caring for a relative with dementia. RESULTS Six caregivers were interviewed. Four caregivers reported experiencing active suicidal ideation whilst caregiving. Two subjects mentioned wishing for the death of their care recipient. While saturation criteria were not all met themes regarding suicidal ideation types and developmental contexts emerged. Findings suggest that family conflicts, placement difficulties, exhaustion, feelings of injustice, and loneliness contributed to the development of suicidal ideation. CONCLUSIONS Suicidal distress can emerge from the dementia caregiving context and these findings highlight a complex phenomenon among caregivers. The understanding of caregivers' suicidal distress is of great importance to guide screening and intervention efforts. Research is needed to keep the implication and well-being of older caregivers. CLINICAL IMPLICATIONS Screening efforts should consider the caregiving context as a conducive environment for suicidal distress and clinicians could use this knowledge to provide specific interventions to distressed carers.
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Affiliation(s)
- Audrée Teasdale-Dubé
- Département de Psychologie, Université Du Québec À Trois-Rivières, Québec, Canada
- Quebec Network for Research on Aging, Montreal, Canada
| | - Charles Viau-Quesnel
- Quebec Network for Research on Aging, Montreal, Canada
- Département de Psychoéducation, Université Du Québec À Trois-Rivières, Québec, Canada
- Laboratoire Interdisciplinaire de Recherche En Gérontologie, Université Du Québec À Trois-Rivières, Trois-Rivières, Canada
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Predictive value of the Distress Thermometer score for risk of suicide in patients with cancer. Support Care Cancer 2022; 30:5047-5053. [PMID: 35201384 PMCID: PMC9046327 DOI: 10.1007/s00520-022-06801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/31/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to assess the association between the Distress Thermometer (DT) score and risk of suicide in patients with cancer. In addition, we aimed to determine the best cutoff score to predict patients at risk of suicide. METHODS From 2015 to 2016, we retrospectively collected data on patients with cancer. DT scores were collected, and the association between DT score and risk of suicide (suicide ideation or death ideation) was analyzed. Furthermore, receiver operating characteristic (ROC) analysis was performed to identify the appropriate cutoff score for predicting risk of suicide. RESULTS A total of 260 patients with cancer were included, and suicidal ideation was identified in 33 cases referred for psychological intervention. The DT scores of the patients with suicidal ideation were significantly higher than those of patients without suicidal ideation (6.30±2.11 vs. 4.29±1.72, p<0.05). In addition, the area under the ROC curve for predicting risk for suicide was 0.758. The cutoff DT score of 3 had the highest sensitivity of 1.00 to rule out suicidal ideation, while 9 had the highest specificity of 1.00 to rule in suicidal ideation. Moreover, the appropriate cutoff DT score to predict patients with suicidal ideation was 5, with a sensitivity of 0.52, specificity of .84, positive likelihood ratio of 3.24, and negative likelihood ratio of 0.58. CONCLUSION The DT score may be a helpful clinical tool to evaluate emotional distress and risk of suicide in patients with cancer. Clinically, for DT scores greater than 5 in patients with cancer, the risk of suicide greatly increases. In view of the DT's widespread use internationally by non-mental health clinicians in cancer to guide the need for specialist mental health interventions, its potential utility in also predicting suicide risk is of great interest.
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Lohman MC, Ko TM, Rapp A, Bennion E, Mezuk B. State Variation in Long-Term Care Availability, Regulation, and Cost and Suicide Mortality Among Older Adults in the United States: 2010-2015. J Am Med Dir Assoc 2021; 22:2337-2343.e3. [PMID: 33722567 PMCID: PMC8483567 DOI: 10.1016/j.jamda.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Residential long-term care (LTC) facilities may be key settings for the prevention of suicide among older adults; however, little is known about the relationship between statewide policies determining characteristics of LTC facilities and suicide mortality. The primary goal of this study was to evaluate the association between state policies regarding availability, regulation, and cost of LTC and suicide mortality among adults aged 55 and older in the United States over a 5-year period. DESIGN Longitudinal ecological study. SETTING AND PARTICIPANTS LTC residents from 16 states reporting mortality data to the National Violent Death Reporting System (NVDRS) from 2010 to 2015. METHODS We linked suicide data from the NVDRS and data sources on LTC services and regulations for 16 states. We applied a natural language-processing algorithm to identify suicide deaths related to LTC. We used fixed effect regression models to assess whether state variation in LTC characteristics is related to variation in the rate of suicide (both overall and related to LTC) among older adults. RESULTS There were 25,040 suicides among those aged 55 and older reported to the NVDRS during the study period; 382 suicides were determined to be associated with LTC in some manner. After adjusting for state-level characteristics, greater average nursing home capacity was significantly associated with increase in the cumulative incidence of suicide related to LTC (β = 0.087, SE = 0.026, P < .01), but not overall suicide incidence. Neither cost nor regulation measures were significantly associated with state-level LTC-related suicide incidence. CONCLUSIONS AND IMPLICATIONS State-level variations in LTC facility capacity are related to variation in LTC-related suicide incidence among older adults. Given the challenges of preventing suicide among older adults through facility- or individual-level interventions, policies governing the features and provision of LTC services may therefore serve as a means for public health suicide prevention.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA.
| | - Tomohiro M Ko
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ashley Rapp
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erica Bennion
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Beach VL, Brown SL, Cukrowicz KC. Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter? Aging Ment Health 2021; 25:1759-1767. [PMID: 33317336 DOI: 10.1080/13607863.2020.1855102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.
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Affiliation(s)
- Victoria L Beach
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Flapper M, van Melick E, van Campen J, Schutter N, Kok R. Tolerability of lithium: A naturalistic discontinuation study in older inpatients (≥60 years). Int J Geriatr Psychiatry 2021; 36:1231-1240. [PMID: 33644915 DOI: 10.1002/gps.5517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Lithium is one of the most effective treatment options in both bipolar disorder and treatment-resistant depression. The use of lithium in older patients declined during the last decades, probably resulting in undertreatment of older patients. To investigate how well lithium is tolerated in old age, we aimed to determine the frequency, reasons, and possible predictors of discontinuation due to adverse effects in a cohort of inpatients ≥60 years who had started with lithium. METHODS We performed a retrospective cohort study based on chart reviews. Participants were in treatment at Parnassia Group at The Hague, The Netherlands. After inclusion (between January 2010 and December 2016), participants were followed until April 2017, when we performed data extraction and analysis. RESULTS In our sample of 135 patients (median age 69 years, median follow-up duration 18 months), 49 (36.3%) participants discontinued lithium. Only a minority (11 [8.1%]) of the participants discontinued solely due to adverse effects. The majority discontinued lithium due to psychiatric (18, 5%) reasons (most commonly mentioned within this subgroup: lack of effectiveness and noncompliance) or a combination of reasons (7.4%). None of the factors we studied (age, gender, Charlson Comorbidity Index, polypharmacy, renal function, and neurological history) were significantly associated with discontinuation due to adverse effects. CONCLUSIONS The frequency of lithium discontinuation in our cohort was in range with frequencies reported in younger patients. Older age itself should not be a reason to withhold lithium treatment.
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Affiliation(s)
| | - Els van Melick
- Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Jos van Campen
- Department of Geriatrics, OLVG, Amsterdam, The Netherlands
| | - Natasja Schutter
- Department of Geriatric Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Rob Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Kessler EM, Grünewald L, Schäfer T. Depressed Older Patients with Death Wishes: Experimental Evidence for Psychotherapists' Age and Health Bias. Clin Gerontol 2021; 44:154-159. [PMID: 33275085 DOI: 10.1080/07317115.2020.1856265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: When psychotherapists encounter an older patient with depression and death wishes, especially when burdened by physical illness, they may be subject to judgmental biases. This study investigates how this group of patients with highest suicide risk may experience discrimination both on age and health status. Methods: Using a 2 × 2 [chronological age x physical health status] vignette design, psychotherapists (N = 147) were randomly presented with one of the four variants of a case describing a patient with depression and death wishes (i.e., 78 years old + poor physical health; 78 years old + normal physical health; 48 years old + poor physical health; 48 years old + normal physical health). Afterward, participants' attitudes toward the case were assessed. Results: In case of the hypothetical patient's old age and poor health status, participants did not underestimate the pathological significance of his death wishes, but nevertheless showed less optimistic treatment attitudes and less confidence in psychotherapeutic treatment. Conclusions: Psychotherapists' age bias and health bias may serve as two potentially fatal factors influencing the provision of mental health services. Clinical Implications: Psychotherapists may contribute to better mental health-care provision of older adults with depression and the prevention of late-life suicide by increasing awareness of their age and health bias.
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Affiliation(s)
- Eva-Marie Kessler
- MSB Medical School Berlin, Private university in Berlin , Berlin, Germany
| | - Lisa Grünewald
- MSB Medical School Berlin, Private university in Berlin , Berlin, Germany
| | - Thomas Schäfer
- MSB Medical School Berlin, Private university in Berlin , Berlin, Germany
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Lutz J, Van Orden KA. Sadness and Worry in Older Adults: Differentiating Psychiatric Illness from Normative Distress. Med Clin North Am 2020; 104:843-854. [PMID: 32773049 PMCID: PMC7417641 DOI: 10.1016/j.mcna.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Older adults experience greater emotional well-being in late life. However, older adults may be vulnerable to certain physiologic risk factors, including less physiologic resilience to prolonged stress. Depression and anxiety can be difficult to diagnose in late life owing to differences in self-reported symptoms from younger adults and unclear distinctions between normative and non-normative emotional experiences. We discuss age differences in the presentations of depression and anxiety, and normative and non-normative late life developmental trajectories around bereavement and grief, social isolation and loneliness, and thoughts of death and suicide. We provide recommendations for clinicians for assessing and diagnosing older adults.
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Affiliation(s)
- Julie Lutz
- Department of Psychiatry, University of Rochester Medical Center, Center for the Study and Prevention of Suicide, 300 Crittenden Boulevard, Box PSYCH, Rochester, NY 14642, USA
| | - Kimberly A Van Orden
- Department of Psychiatry, University of Rochester Medical Center, Center for the Study and Prevention of Suicide, 300 Crittenden Boulevard, Box PSYCH, Rochester, NY 14642, USA.
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Liu RT, Bettis AH, Burke TA. Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychol Med 2020; 50:367-383. [PMID: 31907085 PMCID: PMC7024002 DOI: 10.1017/s003329171900391x] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear. METHODS We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO. RESULTS A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons. CONCLUSIONS Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
| | - Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
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14
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Abstract
Objectives: When the need for relatedness is frustrated, some older adults feel that life is not worth living and wish for death (WD). The aim of this study was to look at the perception of social interactions among older adults who express the WD.Methods: A probabilistic sample of 2787 French-speaking community-dwelling older adults aged 65 to 96 years (M = 73.8) took part in the Seniors Health Survey, a study on the prevalence of mental disorders which also collected information on various demographic and social variables.Results: Results showed that 5% of participants expressed WD. Participants who WD felt significantly more isolated and in conflict with their children than participants without WD. When sociodemographic variables, self-rated physical health, and depression were controlled, three social variables predicted WD in a logistic regression: being distant toward others, dissatisfaction with social life, and a lack of participation in organizations.Conclusions: Results of the present study support the interpersonal theory of suicide, which suggests that self-reported thwarted belongingness can foster WD.Clinical implications: Clinicians should consider social dissatisfaction and withdrawal as risk factors for WD and design interventions that foster social skills or meaningful connections.
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Affiliation(s)
- Sylvie Bernier
- Department of psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Sylvie Lapierre
- Department of psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Sophie Desjardins
- Department of psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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15
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Barry LC. Passive Suicidal Ideation in Older Adults: Implications for Suicide Prevention. Am J Geriatr Psychiatry 2019; 27:1411-1413. [PMID: 31477456 DOI: 10.1016/j.jagp.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa C Barry
- UCONN Health, UConn Center on Aging (LCB), Farmington, CT.
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16
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Dong L, Kalesnikava VA, Gonzalez R, Mezuk B. Beyond Depression: Estimating 12-Months Prevalence of Passive Suicidal Ideation in Mid- and Late-Life in the Health and Retirement Study. Am J Geriatr Psychiatry 2019; 27:1399-1410. [PMID: 31353189 PMCID: PMC6842696 DOI: 10.1016/j.jagp.2019.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To provide valid estimates of the 12-month prevalence of passive suicidal ideation among older adults, without conditioning on depression status, using the Health and Retirement Study (HRS). METHODS Data come from the 2012 HRS (n = 17,434) and 2004/5 Baltimore Epidemiologic Catchment Area (ECA) Study (n = 755). In the HRS, passive suicidal ideation (i.e., thought a lot about death-your own, someone else's, or death in general) is only assessed on respondents who reported dysphoria/anhedonia; in the ECA, ideation is assessed on all respondents, regardless of depression. We compare two approaches to estimating the 12-month prevalence of passive suicidal ideation in the HRS without conditioning on depression symptoms: 1) a probit selection model within the HRS, and 2) a prediction model developed using appended ECA data applied to the HRS. RESULTS Using observed data alone on those who screened positive for depression, 6% of older adults reported passive suicidal ideation in the past year. Depending on the approach used, between 5.4% and 9.2% of HRS respondents who screened negative for depression would have reported passive suicidal ideation had they been assessed. Correcting for this selection bias, between 10.9% and 13.4% of U.S. adults over age 50 experienced passive suicidal ideation in 2012. CONCLUSIONS Population surveillance of suicidal ideation among older adults is biased by survey approaches that only assess ideation in the context of depression.
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Affiliation(s)
- Liming Dong
- Department of Epidemiology (LD, VK, BM), University of Michigan School of Public Health, Ann Arbor, MI
| | - Viktoryia A Kalesnikava
- Department of Epidemiology (LD, VK, BM), University of Michigan School of Public Health, Ann Arbor, MI
| | - Richard Gonzalez
- Research Center for Group Dynamics (RG, BM), Institute for Social Research, University of Michigan, Ann Arbor, MI; Department of Psychology (RG), University of Michigan, Ann Arbor, MI
| | - Briana Mezuk
- Department of Epidemiology (LD, VK, BM), University of Michigan School of Public Health, Ann Arbor, MI; Research Center for Group Dynamics (RG, BM), Institute for Social Research, University of Michigan, Ann Arbor, MI.
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17
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Abstract
AIMS Death ideation (thinking about/wishing for one's own death, thinking that one would be better off dead) is linked to an increased mortality risk. However, comparatively little is known about more general thoughts of death (GTOD) where no wish to die or life value is expressed. This study examined whether GTOD predicted mortality in a community-based cohort of older adults. METHODS Data came from the Komo-Ise cohort study in Gunma prefecture, Japan. The analytic sample comprised 8208 individuals (average age 61.3 (range 47-77)) who were asked in wave 2 of the study in 2000 if they had 'Thought about death more than usual, either your own, someone else's or death in general?' in the past 2 weeks. Death data were obtained from the municipal resident registration file. Cox proportional hazards regression analysis was used to examine associations. RESULTS During the follow-up period (2000-2008), there were 672 deaths. In a model adjusted for baseline covariates, GTOD were significantly associated with all-cause mortality (hazards ratio 1.66, 95% confidence interval 1.20-2.29). Stratified analyses showed an association between GTOD and mortality in men, older subjects (⩾70 years), married individuals and those with higher social support. CONCLUSIONS GTOD are associated with an increased mortality risk among older citizens in Japan. Research is now needed to determine the factors underlying this association and assess the clinical relevance of screening for GTOD in older individuals.
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18
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Tuvesson H, Hellström A, Sjöberg L, Sjölund BM, Nordell E, Fagerström C. Life weariness and suicidal thoughts in late life: a national study in Sweden. Aging Ment Health 2018; 22:1365-1371. [PMID: 28685600 DOI: 10.1080/13607863.2017.1348484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. METHOD Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery-Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. RESULTS Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. CONCLUSION This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.
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Affiliation(s)
- Hanna Tuvesson
- a Department of Health , Blekinge Institute of Technology , Karlskrona , Sweden
| | - A Hellström
- b Department of Health and Caring Sciences , Linnaeus University , Kalmar , Sweden
| | - L Sjöberg
- c Aging Research Center , Department of Neurobiology, Care Sciences and Society , Karolinska Institutet and Stockholm University , Stockholm , Sweden
| | - B-M Sjölund
- c Aging Research Center , Department of Neurobiology, Care Sciences and Society , Karolinska Institutet and Stockholm University , Stockholm , Sweden.,d Faculty of Health and Occupational Studies , University of Gävle , Gävle , Sweden
| | - E Nordell
- e Department of Geriatric Medicine , Skåne University Hospital , Malmö , Sweden
| | - C Fagerström
- f Blekinge Centre of Competence , Blekinge County Hospital , Karlskrona , Sweden
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19
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The Interpersonal Context of Suicide and Self-Harm in Later Life: An Invited Commentary on "Why Do the Very Old Self-Harm? A Qualitative Study". Am J Geriatr Psychiatry 2018; 26:872-873. [PMID: 30100022 DOI: 10.1016/j.jagp.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/21/2018] [Indexed: 11/23/2022]
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20
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Abstract
BACKGROUND The Behavioral Health Laboratory (BHL), a telephone-based mental health assessment, is a cost-effective approach that can improve mental illness identification and management. The individual BHL instruments, which were originally designed to be administered in-person, have not yet been validated with an in-person BHL assessment. This study therefore aims to characterize the concordance between the BHL data gathered by telephone and in-person interviews. METHODS A cross-sectional study was conducted with English-speaking aging services network (ASN) clients aged 60 years and older in Monroe County, NY who were randomized to a BHL interview either in-person (n = 55) or by telephone (n = 53). RESULTS There was strong evidence of equivalence between telephone and in-person interviews for depressive disorders, generalized anxiety, panic disorder, drug misuse, psychosis, PTSD, mental illness symptom severity, and five of the six questions assessing suicidality. There was marginal equivalence in PHQ-9 total scores and one of the six questions assessing suicidal ideation, and no evidence of equivalence between interview modalities for assessing cognitive impairment. CONCLUSIONS With a few exceptions, the BHL gathered nearly equivalent information via telephone as compared to in-person interviews. This suggests that the BHL may be a cost-effective approach appropriate for dissemination in a wide variety of settings including the ASN. Dissemination of the BHL has the potential to strengthen the linkages between primary care, mental healthcare, and social service providers and improve identification and management of those with late-life mental illness.
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21
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Stolz E, Mayerl H, Gasser-Steiner P, Freidl W. Attitudes towards assisted suicide and euthanasia among care-dependent older adults (50+) in Austria: the role of socio-demographics, religiosity, physical illness, psychological distress, and social isolation. BMC Med Ethics 2017; 18:71. [PMID: 29212490 PMCID: PMC5719645 DOI: 10.1186/s12910-017-0233-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. METHODS A nationwide cross-sectional survey among older care allowance recipients (50+) in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. RESULTS About a quarter (24.8-26.0%) of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to (hypothetically) make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. CONCLUSIONS Positive attitudes towards and will to (hypothetically) use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the (near) future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Peter Gasser-Steiner
- Department of Sociology, University of Graz, Universitätsstraße 15/IV, 8010, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria.
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22
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Kim K, Kim SW, Myung W, Han CE, Fava M, Mischoulon D, Papakostas GI, Seo SW, Cho H, Seong JK, Jeon HJ. Reduced orbitofrontal-thalamic functional connectivity related to suicidal ideation in patients with major depressive disorder. Sci Rep 2017; 7:15772. [PMID: 29150619 PMCID: PMC5693996 DOI: 10.1038/s41598-017-15926-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/04/2017] [Indexed: 11/25/2022] Open
Abstract
Despite recent developments in neuroimaging, alterations of brain functional connectivity in major depressive disorder (MDD) patients with suicidal ideation are poorly understood. This study investigated specific changes of suicidal ideation in functional connectivity of MDD patients. Whole brain functional connectivity in 46 patients with MDD (23 with suicidal ideation and 23 without) and 36 age- and gender- matched healthy controls were compared using resting-state functional Magnetic Resonance Imaging (fMRI) analyzed with network-based statistics (NBS) and graph-theoretical methods. Decreased functional connectivity in a characterized sub-network was observed in patients with MDD and suicidal ideation (FDR-adjusted p < 0.05). The sub-network included the regions of the fronto-thalamic circuits in the left hemisphere. The network measures of the left superior frontal gyrus, pars orbitalis (r = -0.40, p = 0.009), left thalamus (r = -0.41, p = 0.009), and right thalamus (r = -0.51, p = -0.002) were shown, through graph theoretical analysis, to be significantly negatively correlated with severity of suicidal ideation. The reduced functional connectivity in left orbitofrontal-both thalamic regions with suicidal ideation in MDD were inversely proportional to the severity of suicidality independent from depression severity. These findings suggest problems with decision-making and information integration in MDD patients with suicidal ideation.
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Affiliation(s)
- Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- National Institute of Dementia, Seongnam, South Korea
| | - Sung-Woo Kim
- School of Biomedical Engineering, College of Health Science, Korea University, Seoul, South Korea
| | - Woojae Myung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Cheol E Han
- Department of Electronics and Information Engineering, College of Science & Technology, Korea University, Sejong, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - George I Papakostas
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hana Cho
- Department of Physiology, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Suwon, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, College of Health Science, Korea University, Seoul, South Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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23
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Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment. Am J Geriatr Psychiatry 2017; 25:620-629. [PMID: 28223082 PMCID: PMC5429870 DOI: 10.1016/j.jagp.2017.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 12/31/2016] [Accepted: 01/12/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the relationship of negative emotions with suicidal ideation during 12 weeks of Problem Adaptation Therapy (PATH) versus Supportive Therapy of Cognitively Impaired Older Adults (ST-CI), hypothesizing that improved negative emotions are associated with reduced suicidal ideation, PATH improves negative emotions more than ST-CI, and improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation. METHODS In a randomized controlled trial of two home-delivered psychosocial interventions, 74 older participants (65-95 years old) with major depressive disorder and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions and assessments were conducted in participants' homes. PATH focuses on improving emotion regulation, whereas ST-CI focuses on nonspecific therapeutic factors, such as understanding and empathy. Improved negative emotions were measured as improvement in Montgomery Asberg's Depression Rating Scales' (MADRS) observer ratings of sadness, anxiety, guilt, hopelessness, and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item. RESULTS MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F[1,165] = 12.73, p = 0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F[1,63.2] = 7.02, p = 0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F[1, 96] = 9.95, p = 0.0022). CONCLUSION Findings thatimprovement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation (clinicaltrials.gov; NCT00368940).
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24
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Petkus AJ, Reynolds CA, Wetherell JL, Kremen WS, Gatz M. Temporal dynamics of cognitive performance and anxiety across older adulthood. Psychol Aging 2017; 32:278-292. [PMID: 28333502 PMCID: PMC5573587 DOI: 10.1037/pag0000164] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cognitive decline and anxiety symptoms commonly co-occur in later life, but the temporal order of changes on these two attributes is unclear. Specifically, it is unknown if greater anxiety leads to subsequent declines in cognitive performance or if worse cognitive performance leads to increased anxiety. In this study, we sought to elucidate the temporal dynamics between anxiety symptoms and cognitive performance across old age-that is, the extent to which level and change in one variable influence subsequent changes in a second variable. We examined data from 721 nondemented participants from the Swedish Adoption/Twin Study of Aging. Participants completed as many as eight assessments of cognitive performance and anxiety over a 26-year period. Bivariate dual-change score models were fit to examine the dynamic association between anxiety and cognitive performance. Bidirectional associations between anxiety and cognitive performance were found among measures of processing speed, attention, and memory but not visuospatial abilities. Higher anxiety was associated with greater declines in processing speed over the duration of 6 years and worsening attention over a span of 3 years. The reverse direction was also significant in that slower processing speed, worse attention, and poorer nonverbal and working memory performance were associated with larger increases in anxiety 3 years later. These findings highlight that in cognitively intact older adults, the association between anxiety and worse cognitive performance is bidirectional and complex. (PsycINFO Database Record
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Affiliation(s)
- Andrew J. Petkus
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089-1061
| | - Chandra A. Reynolds
- Department of Psychology, University of California, Riverside, Riverside, CA, 92521
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, CA, 92093
- Department of Psychiatry, University of California, San Diego, San Diego, CA, 92093
| | - William S. Kremen
- Department of Psychiatry, University of California, San Diego, San Diego, CA, 92093
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92093
| | - Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089-1061
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
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25
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Antidepressant pharmacotherapy in old-age depression—a review and clinical approach. Eur J Clin Pharmacol 2017; 73:661-667. [DOI: 10.1007/s00228-017-2219-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/13/2017] [Indexed: 12/21/2022]
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26
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Suizidgedanken, Hoffnungslosigkeit und Einsamkeit bei Älteren. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2016; 62:366-376. [DOI: 10.13109/zptm.2016.62.4.366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Stolz E, Fux B, Mayerl H, Rásky É, Freidl W. Passive Suicide Ideation Among Older Adults in Europe: A Multilevel Regression Analysis of Individual and Societal Determinants in 12 Countries (SHARE). J Gerontol B Psychol Sci Soc Sci 2016; 71:947-58. [PMID: 27048569 PMCID: PMC4982389 DOI: 10.1093/geronb/gbw041] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/16/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Passive suicide ideation (PSI) is common among older adults, but prevalences have been reported to vary considerably across European countries. The goal of this study was to assess the role of individual-level risk factors and societal contextual factors associated with PSI in old age. METHOD We analyzed longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) on 6,791 community-dwelling respondents (75+) from 12 countries. Bayesian logistic multilevel regression models were used to assess variance components, individual-level and country-level risk factors. RESULTS About 4% of the total variance of PSI was located at the country level, a third of which was attributable to compositional effects of individual-level predictors. Predictors for the development of PSI at the individual level were female gender, depression, older age, poor health, smaller social network size, loneliness, nonreligiosity, and low perceived control (R (2) = 25.8%). At the country level, cultural acceptance of suicide, religiosity, and intergenerational cohabitation were associated with the rates of PSI. DISCUSSION Cross-national variation in old-age PSI is mostly attributable to individual-level determinants and compositional differences, but there is also evidence for contextual effects of country-level characteristics. Suicide prevention programs should be intensified in high-risk countries and attitudes toward suicide should be addressed in information campaigns.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria.
| | - Beat Fux
- Department of Sociology, University of Salzburg, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
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28
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Lohman PhD MC, Raue PhD PJ, Greenberg RL, Bruce ML. Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial. Int J Geriatr Psychiatry 2016; 31:708-15. [PMID: 26552852 PMCID: PMC4861681 DOI: 10.1002/gps.4381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. METHODS Data come from the cluster-randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12-month follow-up. SI was measured using the Hamilton Rating Scale for Depression item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed-effects models. RESULTS A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (odds ratio = 0.51, 95% CI; 0.24-1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. CONCLUSION SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long-term reduction in SI among high-risk patients. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Matthew C. Lohman PhD
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Patrick J. Raue PhD
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Rebecca L. Greenberg
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Martha L. Bruce
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
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29
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Petkus AJ, Gatz M, Reynolds CA, Kremen WS, Wetherell JL. Stability of Genetic and Environmental Contributions to Anxiety Symptoms in Older Adulthood. Behav Genet 2016; 46:492-505. [PMID: 26659832 PMCID: PMC4887343 DOI: 10.1007/s10519-015-9772-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 11/22/2015] [Indexed: 01/31/2023]
Abstract
Anxiety symptoms are common in later life and are associated with diverse adverse health outcomes. Little is known about how genetic and environmental influences on anxiety symptoms might vary across older adulthood. The purpose of this study was to explore change and stability of contributions to anxiety symptoms across older adulthood. We examined data from the Swedish Adoption/Twin Study of Aging (SATSA). Between the years 1984 and 2010, 2021 participants (including 753 complete twin pairs) completed up to seven assessments containing two measures of anxiety symptoms. Longitudinal genetic simplex models were fit to examine the stability and change in genetic and environmental influences. Amplification of genetic factors at ages 75-80 suggests tentative new genetic contributions to anxiety symptoms. These findings suggest that the heritability of anxiety symptoms may increase later in life. Physiological factors associated with aging are discussed as potential factors explaining this increase.
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Affiliation(s)
- Andrew J Petkus
- Department of Psychology, University of Southern California, 3620 South McClintock Ave., SGM 522, Los Angeles, CA, 90089-1061, USA.
| | - Margaret Gatz
- Department of Psychology, University of Southern California, 3620 South McClintock Ave., SGM 522, Los Angeles, CA, 90089-1061, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Chandra A Reynolds
- Department of Psychology, University of California, Riverside, Riverside, CA, 92521, USA
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, San Diego, CA, 92093-0603, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, 92093-0603, USA
| | - Julie Loebach Wetherell
- Department of Psychiatry, University of California, San Diego, San Diego, CA, 92093-0603, USA
- VA San Diego Healthcare System, San Diego, CA, 92093-0603, USA
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Suicidal ideation and behavior assessment in dementia studies: An Internet survey. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 2:60-68. [PMID: 29067294 PMCID: PMC5644276 DOI: 10.1016/j.trci.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction The AARR task force on suicidal ideation and behavior (SI/SB) in dementia conducted an online survey on the extent of SI/SB in individuals diagnosed with mild cognitive impairment (MCI) or dementia who were participating in clinical trials. Methods Investigators with experience in conducting SI/SB assessments in clinical trial subjects with MCI or dementia were invited to complete a global 19-item online survey. Results A total of 204 evaluable responses were collected with the majority from North America and Europe (83.4%) and the remainder from Asia, Latin America, and Mideast/Africa. The mean (SD) number of subjects personally assessed by the respondents in the past year with MCI, mild-moderate dementia, or severe dementia was 12.8 (26.2), 31.2 (39.6), and 10.1 (34.7), respectively. The mean number of subjects in each diagnostic group with suicidal ideation (SI), suicidal behavior (SB), or completed suicide (CS) was on average quite low (0.3 to 1.1 for SI, 0.1 to 0.2 for SB, and 0.0 to 0.2 for CS). Confidence in subject self-reports of SI/SB over different time periods declined with increasing severity of cognitive impairment and with increasing duration of the recall time period assessed. Of respondents, 56% and 75% had low confidence in self-ratings of SI/SB from subjects with severe dementia over the past 24 hours and the past week to 1 month, respectively. Ratings of the reliability of information collected on SI/SB also decreased with increasing severity of cognitive impairment. Approximately 70% of respondents rated the reliability of the information they obtained from all sources (patient, caregiver, and others) for subjects with MCI as high, but only about half (42.0% to 55.3%) and less than a quarter (17.4% to 24.3%) rated the reliability of information obtained for subjects with mild to moderate dementia or severe dementia as high, respectively. Discussion These results support the usefulness of prospective SI/SB assessments in MCI and mild dementia, raise questions about the reliability of assessments in moderate dementia, and confirm their lack of clinical utility in severe dementia. The results highlight the need for development of validated assessment instruments adapted to the stage of cognitive decline of the patients under study and may be the most effective in the earliest stages of the disease.
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Alphs L, Brashear HR, Chappell P, Conwell Y, Dubrava S, Khin NA, Kozauer N, Hartley DM, Miller DS, Schindler RJ, Siemers ER, Stewart M, Yaffe K. Considerations for the assessment of suicidal ideation and behavior in older adults with cognitive decline and dementia. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 2:48-59. [PMID: 29067293 PMCID: PMC5644272 DOI: 10.1016/j.trci.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Better understanding of suicide risk and its management in older adults with cognitive impairment and/or dementia remain significant unmet public health needs. Urgency to address them derives from concern that CNS treatments for dementia may impact suicide risk. Regulatory guidances requiring assessment of emergent suicidal ideation and behavior (SI/SB) at every clinical trial visit emphasize the need for understanding their prevalence. Methods The literature regarding SI/SB in older persons with cognitive impairment or dementia was reviewed by an Alzheimer's Association Taskforce with emphasis on epidemiology, classification, assessment, and regulatory requirements. Results Gaps in our knowledge were identified, challenges discussed and recommendations for future work provided. Discussion Currently available SI/SB data from geriatric persons with dementia do not provide adequate understanding of its epidemiology, identification, assessment, or management. The growing public health burden of this population requires greater attention from clinicians and researchers on tactics and assessment tools to meet these needs.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - H Robert Brashear
- Janssen Alzheimer Immunotherapy & Research & Development, LLC, South San Francisco, CA, USA
| | | | | | | | - Ni A Khin
- Division of Psychiatry Products, Food and Drug Administration, Silver Spring, MD, USA.,Division of Clinical Compliance Evaluation, FDA, Silver Spring, MD, USA
| | - Nicholas Kozauer
- Division of Neurology Products, Food and Drug Administration, Silver Spring, MD, USA
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O'Hare C, O'Sullivan V, Flood S, Kenny RA. Seasonal and meteorological associations with depressive symptoms in older adults: A geo-epidemiological study. J Affect Disord 2016; 191:172-9. [PMID: 26655862 DOI: 10.1016/j.jad.2015.11.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/22/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Given increased social and physiological vulnerabilities, older adults may be particularly susceptible to environmental influences on mood. Whereas the impact of season on mood is well described for adults, studies rarely extend to elders or include objective weather data. We investigated the impact of seasonality and meteorological factors on risk of current depressive symptoms in older adults. METHODS We used data on 8027 participants from the first wave of The Irish Longitudinal Study of Ageing, a population-representative cohort of adults aged 50+. Depressive symptoms were recorded using the Centre for Epidemiological Studies Depression Scale. Season was defined according to the World Meteorological Organisation. Data on climate over the preceding thirty years, and temperature and rain over the preceding month, were provided by the Irish Meteorological Service and linked using Geographic Information Systems techniques to participant's geo-coded locations at a resolution of one kilometre. RESULTS The highest levels of depressive symptoms were reported in winter and the lowest in spring (mean 6.56 [CI95% 6.09, 7.04] vs. 5.81 [CI95%: 5.40, 6.22]). In fully adjusted linear regression models, participants living in areas with higher levels of rainfall in the preceding and/or current calendar month had greater depressive symptoms (0.04 SE 0.02; p=0.039 per 10mm additional rainfall per month) while those living in areas with sunnier climates had fewer depressive symptoms (-2.67 SE 0.88; p=0.003 for every additional hour of average annual daily sunshine). LIMITATIONS This was a cross-sectional analysis thus causality cannot be inferred; monthly rain and temperature averages were available only on a calendar month basis while monthly local levels of sunshine data were not available. CONCLUSIONS Environmental cues may influence mood in older adults and thus have relevance for the recognition and treatment of depression in this age group.
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Affiliation(s)
- Celia O'Hare
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland.
| | | | - Stephen Flood
- New Zealand Climate Change Research Institute, School of Geography Environment and Earth Sciences, Victoria University, Wellington 6012, New Zealand
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland
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Gustavson KA, Alexopoulos GS, Niu GC, McCulloch C, Meade T, Arean PA. Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction. Am J Geriatr Psychiatry 2016; 24:11-17. [PMID: 26743100 PMCID: PMC5730069 DOI: 10.1016/j.jagp.2015.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, sex, and additional cognitive impairment load (e.g., memory impairments) were related to changes in suicidal ideation over time. DESIGN Secondary data analysis using data from a randomized clinical trial allocating participants to PST or ST at 1:1 ratio. Raters were blind to patients' assignments. SETTING University medical centers. PARTICIPANTS 221 people aged 65 years old and older with major depression determined by Structured Clinical Interview for DSM-III-R diagnosis and executive dysfunction as defined by a score of 33 or less on the Initiation-Perseveration Score of the Mattis Dementia Rating Scale or a Stroop Interference Task score of 25 or less. INTERVENTIONS 12 weekly sessions of PST or ST. MAIN OUTCOME MEASURES The suicide item of the Hamilton Depression Rating Scale. RESULTS Of the 221 participants, 61% reported suicidal ideation (SI). The ST group had a lower rate of improvement in SI after 12 weeks (44.6%) than did the PST group (60.4%, Fisher's exact test p = 0.031). Logistic regression showed significantly greater reductions in SI in elders who received PST at both 12 weeks (OR: .50, Z = -2.16, p = 0.031) and 36 weeks (OR: 0.5, Z = -1.96, p = 0.05) after treatment. CONCLUSIONS PST is a promising intervention for older adults who are at risk for suicide. ClinicalTrials.gov Identifier: NCT00052091.
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Affiliation(s)
| | | | - Grace C. Niu
- University of California, San Francisco Department of Psychiatry
| | | | - Tanya Meade
- University of Western Sydney, School of Social Sciences and Psychology
| | - Patricia A. Arean
- University of Washington, Department of Psychiatry and Behavioral Sciences
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Van Orden KA, O'Riley AA, Simning A, Podgorski C, Richardson TM, Conwell Y. Passive Suicide Ideation: An Indicator of Risk Among Older Adults Seeking Aging Services? THE GERONTOLOGIST 2015; 55:972-80. [PMID: 24714844 PMCID: PMC4668765 DOI: 10.1093/geront/gnu026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/10/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines patterns of endorsements of active suicide ideation (SI), passive SI (synonymous with death ideation), and psychological distress (i.e., depressive and anxious symptomatology) in a sample of vulnerable older adults. METHODS Data were collected via in-home interviews with aging services care management clients aged 60 years and older (n = 377). The Paykel scale for suicide measured the most severe level of suicidality over the past year, and the ninth item of the Patient Health Questionnaire (PHQ-9) measured current passive/active SI. The remaining items from the PHQ (i.e., PHQ-8) and the Goldberg Anxiety scale measured distress. RESULTS Latent class analysis revealed a four-class model: a group with mild distress and no active SI, a group with high distress and no ideation, a group with mild distress and both passive and active SI, and a group with high distress and both passive and active SI. DISCUSSION Results indicate that passive SI rarely presents in vulnerable older adults in the absence of significant risk factors for suicide (i.e., psychological distress or active SI). Thus, the desire for death and the belief that life is not worth living do not appear to be normative in late life.
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Affiliation(s)
| | - Alisa A O'Riley
- Department of Psychiatry, University of Rochester Medical Center, New York
| | - Adam Simning
- Department of Psychiatry, University of Rochester Medical Center, New York
| | - Carol Podgorski
- Department of Psychiatry, University of Rochester Medical Center, New York
| | | | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, New York
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Barry LC, Wakefield DB, Trestman RL, Conwell Y. Active and Passive Suicidal Ideation in Older Prisoners. CRISIS 2015; 37:88-94. [PMID: 26572905 DOI: 10.1027/0227-5910/a000350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Older prisoners are the fastest growing incarcerated population with high suicide rates, yet limited information is available to inform best practices for their early risk detection and suicide prevention. AIMS The present study sought to determine the current prevalence of and factors associated with active suicidal ideation (ASI) and passive suicidal ideation (PSI) in older prisoners, and to determine if ASI and PSI were similarly associated with depression and lifetime suicide attempt - markers of subsequent suicide. METHOD ASI, PSI, current major depressive episode (MDE), lifetime suicide attempt, and participant characteristics were assessed during interviews with 124 prisoners aged 50 years and older. Participants were assigned to one of three mutually exclusive groups: no SI, PSI only, and ASI. RESULTS Past alcohol dependence and fair/poor self-rated health were associated with SI. Compared with those with no SI, older prisoners with PSI (10%) and ASI (11%) were more likely to have a lifetime suicide attempt and/or MDE. However, the likelihood of experiencing either MDE or a suicide attempt did not differ between those with ASI or PSI. CONCLUSIONS Among older prisoners, PSI and ASI may be similarly associated with markers of subsequent suicide. PSI should not be considered inconsequential and may distinguish older prisoners with elevated suicide risk.
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Affiliation(s)
- Lisa C Barry
- 1 University of Connecticut Health Center, UConn Center on Aging, Farmington, CT, USA
| | - Dorothy B Wakefield
- 2 University of Connecticut Health Center, Center for Public Health and Health Policy, Farmington, CT, USA
| | - Robert L Trestman
- 3 Correctional Managed Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Yeates Conwell
- 4 University of Rochester School of Medicine, Rochester, NY, USA
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Oh DJ, Park JY, Oh M, Kim K, Hong J, Kim T, Han JW, Kim TH, Kim KW. Suicidality-based prediction of suicide attempts in a community-dwelling elderly population: Results from the Osan Mental Health Survey. J Affect Disord 2015; 184:286-92. [PMID: 26120807 DOI: 10.1016/j.jad.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on outcomes of suicidality in the community-dwelling elderly are scarce. We investigated the association of suicidality with the suicide attempts in a community-dwelling elderly cohort. METHODS In the Osan Mental Health Survey, 848 randomly sampled elderly Koreans participated in the baseline evaluation, 623 completed 2-year follow-up evaluation and 32 died during the follow-up period. The survey was conducted between February 2010 and January 2013. We evaluated suicidality using the Mini-International Neuropsychiatric Interview suicidality module that includes both suicidal ideation and attempts. RESULTS The incidences of suicidality and suicide attempts were 70.7 and 13.1 per 1000 persons per year, respectively. Suicidality was associated with increased risk of suicide attempts (odds ratio (OR) = 3.84, 95% CI = 1.06-13.87). Two men with suicidality committed suicide by self-poisoning. Moderate to high intensity daily exercise decreased the risk of suicidality to become persistent or recurrent (OR = 0.32, 95% CI = 0.12-0.81). Low education level (OR = 2.41, 95% CI = 1.21-4.77) and depression (OR = 3.02, 95% CI = 1.65-5.53) were associated with risk of incident suicidality. LIMITATIONS Study sample was enrolled from a single city of Korea, and the size of the study sample was small. CONCLUSIONS We may reduce suicide attempts by screening for suicidality and implementing exercise programs in community-dwelling elderly people.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Miyoung Oh
- Osan Mental Health Center, Osan, Republic of Korea
| | - Kayoung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jongwoo Hong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Taehyun Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Won Han
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
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Abstract
OBJECTIVE Late-life suicide is a complex clinical and public health problem. METHOD In this article, some of the key complexities inherent in studying late-life suicide are discussed in the service of promoting high-quality late-life suicide prevention science. RESULTS We discuss the following research issues: the relatively greater lethality of suicidal behavior in later life (compared to younger ages); the lack of data on whether thoughts of death in later life are indicators of suicide risk; the fact that older adults do not tend to seek specialty mental health care, necessitating moving research into primary care clinics and the community; the lack of theory-based research in late-life suicide; the unclear role of cognitive impairment; and the promise of taking a 'patient centered' and 'participatory research' approach to late-life suicide research efforts. CONCLUSION We believe that these perspectives are too often not capitalized upon in research on suicide prevention with older adults and that voice of the older person could contribute much to our understanding of why older adults think about and act on suicidal thoughts, as well as the most acceptable ways to reach and intervene with those at risk.
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Affiliation(s)
- Kimberly A Van Orden
- a Department of Psychiatry , University of Rochester School of Medicine , Rochester , NY 14642 , USA
| | - Yeates Conwell
- a Department of Psychiatry , University of Rochester School of Medicine , Rochester , NY 14642 , USA
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Lytle MC, De Luca SM, Blosnich JR, Brownson C. Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals. J Affect Disord 2015; 178:39-45. [PMID: 25795534 PMCID: PMC4397160 DOI: 10.1016/j.jad.2014.07.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/22/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. METHODS Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. RESULTS Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. LIMITATIONS Cross-sectional design and self-reported data. CONCLUSIONS Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.
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Affiliation(s)
- Megan C Lytle
- University of Rochester Medical Center, Department of Psychiatry, Rochester, NY, United States.
| | - Susan M De Luca
- School of Social Work, University of Texas at Austin, The University of Texas at Austin, Austin, TX, United States
| | - John R Blosnich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Chris Brownson
- Counseling and Mental Health Center, The University of Texas at Austin, Austin, TX, United States
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Raue PJ, Ghesquiere AR, Bruce ML. Suicide risk in primary care: identification and management in older adults. Curr Psychiatry Rep 2014; 16:466. [PMID: 25030971 PMCID: PMC4137406 DOI: 10.1007/s11920-014-0466-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior.
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Affiliation(s)
- Patrick J. Raue
- Corresponding author: Patrick J. Raue, Ph.D., Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road White Plains, New York 10605, (914) 997-8684 (phone), (914) 997-6979 (fax),
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Suicide later in life: challenges and priorities for prevention. Am J Prev Med 2014; 47:S244-50. [PMID: 25145746 DOI: 10.1016/j.amepre.2014.05.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 11/22/2022]
Abstract
Suicide in later life is a major public health concern in the U.S., where more than 6,000 older adults take their own lives every year. Suicide prevention in this age group is made challenging by the high lethality of older adults' suicidal behavior; few survive their first attempt to harm themselves. Research has revealed that factors in each of five domains place older adults at increased risk for suicide-psychiatric illness, personality traits and coping styles, medical illness, life stressors and social disconnectedness, and functional impairment. Little research has examined the effectiveness of interventions to reduce the toll of suicide in older adulthood. The study of strategies to decrease suicide deaths in later life should emphasize four areas. First is approaches to early detection of older people at risk through improved understanding of multi-dimensional determinants and their interactions. Second is research on the impact of general health promotion that optimizes well-being and independent functioning for older adults on suicide outcomes. Third concerns the study of approaches to the provision of mental health care that is evidence-based, accessible, affordable, acceptable, and integrated with other aspects of care. The fourth area of high priority for research is approaches to improvement of social connectedness and its impact on suicide in older adults.
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O'Riley AA, Van Orden KA, He H, Richardson TM, Podgorski C, Conwell Y. Suicide and death ideation in older adults obtaining aging services. Am J Geriatr Psychiatry 2014; 22:614-22. [PMID: 23602307 PMCID: PMC3880390 DOI: 10.1016/j.jagp.2012.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 11/30/2012] [Accepted: 12/10/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the frequency and correlates of death and suicide ideation in older adults accessing aging services. DESIGN Cross-sectional. SETTING Data for this study were collected via in-home interviews. PARTICIPANTS Aging Services Network (ASN) care management clients aged 60 years and older (N = 377) were recruited for this study. MEASUREMENT The PHQ-9 and the Paykel Suicide Scale were used to assess death and suicide ideation. Correlates of death and suicide ideation were also examined. RESULTS Fourteen percent of subjects endorsed current death or suicide ideation, 27.9% of subjects endorsed death ideation in the past year, and 9.3% of subjects endorsed suicide ideation in the last year. Current death and suicide ideation were associated with greater depressive symptoms. As compared with individuals without ideation, individuals with death ideation demonstrated higher levels of depressive symptoms, more medical conditions, and lower social support. Individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and less perceived social support. Finally, as compared with individuals with death ideation, individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and more alcohol misuse. CONCLUSIONS Death and suicide ideation are common among ASN clients. There were both differences and similarities between correlates of death and suicide ideation. ASN providers are uniquely situated to address many of the correlates of suicide ideation identified in this study; in order to effectively manage suicide ideation in an ASN setting, however, links to primary and mental health care providers are necessary.
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Affiliation(s)
- Alisa A. O'Riley
- University of Rochester School of Medicine and Dentistry (URSMD), Department of Psychiatry
| | | | - Hua He
- Corresponding Author: Alisa A. O'Riley, PhD, University of Rochester Medical Center, 300 Crittenden Blvd, Box Psych, Rochester, NY 14607, Phone: (585) 393-7887, alisa.o'
| | | | - Carol Podgorski
- URSMD, Department of Biostatistics and Computational Biology
| | - Yeates Conwell
- URSMD, Department of Biostatistics and Computational Biology
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Mellqvist Fässberg M, Östling S, Braam AW, Bäckman K, Copeland JRM, Fichter M, Kivelä SL, Lawlor BA, Lobo A, Magnússon H, Prince MJ, Reischies FM, Turrina C, Wilson K, Skoog I, Waern M. Functional disability and death wishes in older Europeans: results from the EURODEP concerted action. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1475-82. [PMID: 24554123 PMCID: PMC4143593 DOI: 10.1007/s00127-014-0840-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/03/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Physical illness has been shown to be a risk factor for suicidal behaviour in older adults. The association between functional disability and suicidal behaviour in older adults is less clear. The aim of this study was to examine the relationship between functional disability and death wishes in late life. METHODS Data from 11 population studies on depression in persons aged 65 and above were pooled, yielding a total of 15,890 respondents. Level of functional disability was trichotomised (no, intermediate, high). A person was considered to have death wishes if the death wish/suicidal ideation item of the EURO-D scale was endorsed. Odds ratios for death wishes associated with functional disability were calculated in a multilevel logistic regression model. RESULTS In total, 5 % of the men and 7 % of the women reported death wishes. Both intermediate (OR 1.89, 95 % CI 1.42; 2.52) and high functional disability (OR 3.22, 95 % CI 2.34; 4.42) were associated with death wishes. No sex differences could be shown. Results remained after adding depressive symptoms to the model. CONCLUSIONS Functional disability was independently associated with death wishes in older adults. Results can help inform clinicians who care for older persons with functional impairment.
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Affiliation(s)
- Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Svante Östling
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arjan W. Braam
- Department of Epidemiology and Biostatistics, VU University Medical Centre, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands ,Department of Resident Training, Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Kristoffer Bäckman
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John R. M. Copeland
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Manfred Fichter
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany ,Schoen Klinik Roseneck, Prien, Germany
| | | | - Brian A. Lawlor
- Department of Psychiatry, St. James’ Hospital, Jonathan Swift Clinic, Dublin, Republic of Ireland
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) and CIBERSAM, Universidad de Zaragoza, Hospital Clínico Universitario, Zaragoza, Spain
| | - Halggrimur Magnússon
- Department of Geriatrics, Landspitali, University Hospital of Iceland, Reykjavík, Iceland
| | - Martin J. Prince
- Health Services and Population Research Department, King’s College London, Institute of Psychiatry, London, UK
| | - Friedel M. Reischies
- Arbeitsgruppe Neuropsychologie Und Experimentelle Psychopathologie, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Turrina
- University Psychiatric Unit, Department of Mental Health, Brescia University School of Medicine, Brescia Spedali Civili, Brescia, Italy
| | - Kenneth Wilson
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, Leo DD, Szanto K, Waern M. A systematic review of social factors and suicidal behavior in older adulthood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:722-45. [PMID: 22690159 PMCID: PMC3367273 DOI: 10.3390/ijerph9030722] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/16/2012] [Accepted: 02/22/2012] [Indexed: 01/21/2023]
Abstract
Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.
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Affiliation(s)
- Madeleine Mellqvist Fässberg
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Wallinsgatan 6, 43141 Mölndal, Sweden;
| | - Kimberly A. van Orden
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; (K.A.O.); (P.D.)
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; (K.A.O.); (P.D.)
| | - Annette Erlangsen
- Department of Mental Health, Johns Hopkins School of Public Health, 624 North Broadway, S850, Baltimore, MD 21205, USA;
| | - Sylvie Lapierre
- Département de Psychologie, Université du Québec à Trois-Rivières, 3351 des Forges blvd., Trois-Rivières, QC G9A 5H7, Canada;
| | - Ehud Bodner
- The Interdisciplinary Department of Social Sciences and the Music Department, Bar-Ilan University, Ramat-Gan, Israel;
| | - Silvia Sara Canetto
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA;
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, and Life Promotion Clinic, Mt Gravatt Campus, Griffith University,176 Messines Ridge Road, Mt Gravatt, QLD 4122, Australia;
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15260, USA;
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden
- Author to whom correspondence should be addressed; ; Tel.: +46-702-272-205; Fax: +46-31-828-163
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