Associations between anxiety disorders, suicide ideation, and age in nationally representative samples of Canadian and American adults

Pain, functional disability and mental disorders as potential mediators of the association between chronic physical conditions and suicidal ideation in community living older adults

OBJECTIVES

To examine the associations between chronic physical conditions and suicidal ideation and to assess whether associations are mediated by pain, anxiety, depression, post-traumatic stress syndrome (PTSS), and functional disability.

METHODS

The study sample includes 1533 older adults aged 65+ recruited in primary care clinics between 2011-2013 and participating in Quebec's Health Survey on Services "Étude sur la Santé des Aînés-Services" (ESA-S) study. Path analysis was used to assess the associations. The presence of suicidal behaviour was ascertained using 4 questions. PTSS was based on a validated scale for primary care older adults. Anxiety and depression were assessed according to DSM-IV criteria. Pain was self-reported on an ordinal scale and functional disability was based on the presence of disability in 8 dimensions of activities of daily living. The main predictors included a list of 13 physical disorders identified by diagnostic codes. Suicidal ideation was also controlled by a number of socio-demographic and psychosocial factors.

RESULTS

PTSS, depression, and functional disability mediate the association between various chronic conditions and suicidal ideation. Although pain and anxiety are associated with many physical disorders, they did not mediate the association with suicidal ideation.

CONCLUSIONS

Chronic physical disorders are associated with suicidal ideation, either directly or indirectly through PTSS, depression, and functional disability. The findings underscore the importance of early identification and management of older patients with specific chronic disorders in primary care as they may be most at risk for suicidal ideation.

National origins, social context, timing of migration and the physical and mental health of Caribbeans living in and outside of Canada

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes.Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses.Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants.Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth.

Motivation Research on the Content Creation Behaviour of Young Adults in Anxiety Disorder Online Communities

With the advancements in science and technology and the improvement of medical care, mental health problems are receiving increasing attention. Increasing numbers of children, adolescents, and young adults are susceptible to anxiety. This paper assesses young adults based on self-determination theory and the theory of planned behaviour to determine the intrinsic and extrinsic motivations and mediating variables behind young adults' content creation behaviour within anxiety disorder online communities (ADOCs). In addition, the paper introduces empathy as a moderating variable, builds a model of the content creation behavioural motivation of young adults, studies the motivation behind young adults' content creation behaviour in ADOCs, and determines the moderating effect of empathy on young adults' content creation behaviour. The research data were obtained using a questionnaire survey, and the SmartPLS structural equation model was used for empirical analysis. The study found that expressing one's anxiety was the most obvious motivation, the content creation intention of young adults significantly positively affected their content creation behaviour, perceived enjoyment motivation had a significant negative influence on young adults' intention to create content, reward motivation had no significant influence on the content creation intention of young adults, other motivations had significant positive influences on young adults' content creation intention, and empathy only had a significant negative moderating effect on the relationship between self-efficacy and young adults' content creation intention. This study not only enriches and expands research on motivation theory but also has practical significance for the improvement and active development of ADOCs.

Differences in Suicide Risk Severity Among Suicidal Youth With Anxiety Disorders

Background: Adolescent suicidality is a growing public health concern. Although evidence supports a link between anxiety and suicidality, little is known about risk associated with specific anxiety disorders. Aims: This study examined the prevalence of anxiety disorders in a sample of adolescents with depression and suicidal ideation and the associations between specific anxiety disorders and suicide ideation severity and attempt history. Method: The sample consisted of 115 adolescents (M_age = 14.96 years; 55.8% African American) entering a clinical trial for suicidal ideation and depressive symptoms. Prior to treatment, adolescents completed self-report and interview measures. Results: In all, 48% of the sample met criteria for an anxiety disorder, 22% met criteria for social anxiety disorder (SAD), and 40% met criteria for major depressive disorder (MDD). SAD was uniquely associated with more severe suicidal ideation. Limitations: Findings may not generalize to all suicidal adolescents, and non-measured variables may account for the observed relationships. Conclusion: Future research should examine whether targeting social anxiety would improve treatment response for suicidal adolescents.

Age Differences in Death and Suicidal Ideation in Anxious Primary Care Patients

OBJECTIVES

The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders.

METHOD

Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and/or social anxiety disorder (SAD).

RESULTS

Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared with younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared with older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association.

CONCLUSIONS

Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults. Findings speak to the importance of physical health, social functioning, and MDD in this association.

CLINICAL IMPLICATIONS

When working with anxious older adults it is important to conduct a thorough suicide risk assessment and teach skills to cope with death and suicidal ideation-related thoughts.

Air pollution, aeroallergens and suicidality: a review of the effects of air pollution and aeroallergens on suicidal behavior and an exploration of possible mechanisms

OBJECTIVE

Risk factors for suicide can be broadly categorized as sociodemographic, clinical and treatment. There is interest in environmental risk and protection factors for suicide. Emerging evidence suggests a link between environmental factors in the form of air pollution and aeroallergens in relation to suicidality.

METHODS

Herein, we conducted a systematic review of 15 articles which have met inclusion criteria on the aforementioned effects.

RESULTS

The majority of the reviewed articles reported an increased suicide risk alongside increased air pollutants or aeroallergens (i.e. pollen) increase; however, not all environmental factors were explored equally. In specific, studies that were delimited to evaluating particulate matter (PM) reported a consistent association with suicidality. We also provide a brief description of putative mechanisms (e.g. inflammation and neurotransmitter dysregulation) that may mediate the association between air pollution, aeroallergens and suicidality.

CONCLUSION

Available evidence suggests that exposure to harmful air quality may be associated with suicidality. There are significant public health implications which are amplified in regions and countries with greater levels of air pollution and aeroallergens. In addition, those with atopic sensitivity may represent a specific subgroup that is at risk.

Anxiety Disorders and General Medical Conditions: Current Research and Future Directions

Evidence that anxiety disorders are associated with general medical conditions is growing. While it is known that medical and mental conditions are often comorbid, research demonstrates that there may be underlying causal mechanisms. Furthermore, comorbid anxiety and general medical conditions are associated with poorer patient outcomes than either condition alone. Comorbid general medical and mental disorders not only affect individual patient health but also strain existing medical systems. Growing health care expenditures and increasing time pressures on clinicians create a challenging environment for intensive therapy in traditional settings. Effective screening, diagnosis, and treatment of individuals with comorbid conditions require health systems that are based on interprofessional collaboration, including integrative and collaborative care services. These models encourage the provision of patient care within a network of health care professionals, working together and sharing expertise for more efficient and holistic care. Research on the design and implementation of these systems within the context of anxiety disorders and comorbid general medical conditions is in its infancy. Given the staggeringly high rates of anxiety disorders within the general population and the continued rise of many chronic medical conditions coinciding with the increasing lifespan, mental health and primary care providers should consider how they might implement integrative care methods within their own practice.

Epidemiology and temporal trend of suicide mortality in the elderly in Jiading, Shanghai, 2003-2013: a descriptive, observational study

OBJECTIVES

To investigate and describe the epidemiological characteristics of suicide in the elderly in Jiading, Shanghai, for the period 2003-2013.

DESIGN

Retrospective, observational, epidemiological study using routinely collected data.

SETTING

Jiading District, Shanghai.

METHODS

Suicide data were retrieved from the Shanghai Vital Registry database for the period 2003-2013. Crude and age-standardised mortality rates were calculated for various groups according to sex and age. Joinpoint regression was performed to estimate the percentage change (PC) and annual percentage change (APC) for suicide mortality.

RESULT

A total of 956 deaths due to suicide occurred among people aged ≥65 years during the study period, accounting for 76.7% (956/1247) of all suicide decedents. Among the 956 people with suicide deaths, 88.7% (848/956) had a history of a psychiatric condition. The age-standardised mortality rates for suicide without and with a psychotic history in people aged ≥65 years were much higher than those for people aged <65 years in both genders. Suicide mortality in the elderly showed a declining trend, with a PC of -51.5% for men and -47.5% for women. The APC was -29.1 in 2003-2005, 4.6 in 2005-2008 and -9.7 in 2008-2013 for aged men, and -12.2 in 2003-2006 and -5.2 in 2006-2013 for aged women, respectively. Women living in Jiading had a higher risk of suicide death than men, especially among the elderly. The mortality rate for suicide increased with age in the elderly, and was more marked for those with a psychiatric history than for those without.

CONCLUSIONS

Suicide mortality declined in Jiading during the study period 2003-2013 overall, but remained high in the elderly, especially those with a psychiatric history.

Determinants of chronic physical health conditions in Canadian Veterans

Introduction: Limited information is available about the determinants of chronic health conditions of Veterans despite the increasingly perilous nature of military engagements in recent decades. Methods: Econometric analysis, using probit and negative binomial models, was conducted on the basis of data from a cross-sectional self-reported health survey of Canadian Veterans to investigate the determinants of musculoskeletal, respiratory, gastrointestinal, and cardiovascular health conditions; pain; and diabetes. Results: The results stress the role of military service–related factors in the increased likelihood of chronic physical health conditions in Canadian Veterans. Army Veterans had an increased probability of musculoskeletal (0.08, p ≤ 0.001) and gastrointestinal (0.05, p ≤ 0.001) conditions and pain (0.07, p ≤ 0.01). Veterans who were deployed had an increased risk of musculoskeletal conditions (0.08, p ≤ 0.001) and pain (0.06, p ≤ 0.001). In terms of non–service-related factors, the results confirm the role of obesity as a statistically significant determinant of chronic musculoskeletal, respiratory, and cardiovascular conditions; pain; and diabetes. Female Veterans were also at higher risk of respiratory and gastrointestinal conditions. Low-income Veterans have increased probability of musculoskeletal, gastrointestinal, pain, and cardiovascular conditions, and the risk decreased with rising income level. Finally, Veterans with mental health conditions had increased odds of musculoskeletal (OR = 2.79, p ≤ 0.001), respiratory (OR = 2.40, p ≤ 0.001), gastrointestinal (3.66, p ≤ 0.001), pain (OR = 2.61, p ≤ 0.001), and cardiovascular (OR = 1.45, p ≤ 0.01) conditions and diabetes (OR = 1.37, p ≤ 0.05). Discussion: The findings have important clinical and health resource use implications as Veterans seek treatment in community settings once they transition from military to civilian life. They also serve to advance the research agenda on the health of Veterans, an understudied population in Canada.

Intra-personal and extra-personal predictors of suicide attempts of South Korean adolescents

The purpose of this study was to explore significant variables predicting adolescent suicidal attempts. Socio-environmental variables such as gender, school record, school grade, school adaptation, and family intimacy together with intra-individual variables including depression, anxiety, delinquency, stress, and self-esteem were considered as candidates. Data from 1481 adolescents were collected from Korea National Youth Policy Institute. For statistical analyses, hierarchical logistic regression analysis was performed. Results of hierarchical logistic regression analysis showed that gender, school grade, depression, delinquent, stress, and family intimacy were significant predictors of suicidal attempts of adolescents. Among those, the most powerful predictor was depression, and the second was delinquency. Classification accuracy by the model of our study was 87.6%. Implications and limitations of present study and suggestions for future study were discussed.