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Schwerdtfeger KA, Glaesmer H, Bahramsoltani M. High overcommitment and low reward as potential predictors for increased depressive symptoms, suicidal ideation, and suicide risk in German veterinarians. PLoS One 2024; 19:e0310819. [PMID: 39316557 PMCID: PMC11421818 DOI: 10.1371/journal.pone.0310819] [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: 03/12/2024] [Accepted: 09/07/2024] [Indexed: 09/26/2024] Open
Abstract
Higher rates of depression, suicidal ideation and suicide risk have been reported for veterinarians in Germany. In this study, several demographic and job-related factors were examined to determine whether they could be considered possible predictors of depression, suicidal ideation, and suicide risk. For this purpose, a survey was conducted among veterinarians in Germany. The demographic factors surveyed were gender, age, working status (employed/self-employed), income, field of work (practicing/non-practicing veterinarian), weekly working hours and community size. For assessing job-related factors, the Effort-Reward-Imbalance questionnaire (effort, reward, overcommitment), several subscales of the Copenhagen Psychosocial Questionnaire (quantitative demands, emotional demands, demands for hiding emotions, meaning of work, work-privacy-conflict, thoughts of leaving the job) and the Copenhagen Burnout Inventory were used. A hierarchical logistic regression analysis was performed with the demographic and job-related factors as independent variables and depressive symptoms, suicidal ideation, and suicide risk as dependent variables, respectively. A total of 3.118 veterinarians (78.8% female) between 22 and 69 years (mean age 41.3 years) were included in the study. The factors used resulted in the highest variance explanation for depressive symptoms (57%), followed by suicidal ideation (34%) and suicide risk (23%). Low reward and high overcommitment were found to be the most important predictors of depressive symptoms, suicidal ideation, and suicide risk. Significant relationships with depressive symptoms, suicidal ideation, and suicide risk were also found for burnout, demands for hiding emotions, and thoughts of leaving the job. The results of this study point to opportunities for changes in the veterinary working environment, for the development of prevention and intervention programs for veterinarians, and for the further development of the veterinary curriculum to strengthen the mental health of veterinarians in Germany.
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Affiliation(s)
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, University Medical Center Leipzig, Leipzig, Germany
| | - Mahtab Bahramsoltani
- School of Veterinary Medicine, Institute of Veterinary Anatomy, Freie Universität Berlin, Berlin, Germany
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2
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Meda N, Zammarrelli J, Sambataro F, De Leo D. Late-life suicide: machine learning predictors from a large European longitudinal cohort. Front Psychiatry 2024; 15:1455247. [PMID: 39355379 PMCID: PMC11442232 DOI: 10.3389/fpsyt.2024.1455247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/23/2024] [Indexed: 10/03/2024] Open
Abstract
Background People in late adulthood die by suicide at the highest rate worldwide. However, there are still no tools to help predict the risk of death from suicide in old age. Here, we leveraged the Survey of Health, Ageing, and Retirement in Europe (SHARE) prospective dataset to train and test a machine learning model to identify predictors for suicide in late life. Methods Of more than 16,000 deaths recorded, 74 were suicides. We matched 73 individuals who died by suicide with people who died by accident, according to sex (28.8% female in the total sample), age at death (67 ± 16.4 years), suicidal ideation (measured with the EURO-D scale), and the number of chronic illnesses. A random forest algorithm was trained on demographic data, physical health, depression, and cognitive functioning to extract essential variables for predicting death from suicide and then tested on the test set. Results The random forest algorithm had an accuracy of 79% (95% CI 0.60-0.92, p = 0.002), a sensitivity of.80, and a specificity of.78. Among the variables contributing to the model performance, the three most important factors were how long the participant was ill before death, the frequency of contact with the next of kin and the number of offspring still alive. Conclusions Prospective clinical and social information can predict death from suicide with good accuracy in late adulthood. Most of the variables that surfaced as risk factors can be attributed to the construct of social connectedness, which has been shown to play a decisive role in suicide in late life.
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Affiliation(s)
- Nicola Meda
- Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Fabio Sambataro
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova University Hospital, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Diego De Leo
- De Leo Fund, Research Division, Padova, Italy
- Italian Psychogeriatric Association, Padova, Italy
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt Campus, Brisbane, QLD, Australia
- Slovene Centre for Suicide Research, Primorska University, Koper, Slovenia
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3
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Hong M, Kim H, Park CHK, Lee H, Rhee SJ, Min S, Kim MJ, Yang JH, Song Y, Son K, Ahn YM. Effect of community attitudes on suicide mortality in South Korea: a nationwide ecological study. Front Psychiatry 2024; 15:1423609. [PMID: 39351329 PMCID: PMC11439762 DOI: 10.3389/fpsyt.2024.1423609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/26/2024] [Indexed: 10/04/2024] Open
Abstract
Background Attitudes toward suicide are essential in suicide prevention, as suicide is socio-culturally nuanced. Although the relationship between individual attitudes and suicidal behavior has been extensively studied, the effect of community attitudes-aggregated by region-on suicide mortality remains ambiguous. This study explored the association between community attitudes and real-world suicide mortality. Methods Data on attitudes toward suicide from the 2018 Korea National Suicide Survey (N = 1500) and individual mortality data from the MicroData Integrated System were obtained. Confirmatory factor analysis supported a factor structure with three factors: "Permissiveness," "Unjustified behavior," and "Readiness to help/Preventability." Thirty regional units in South Korea aggregated the data for ecological analysis. We used negative binomial models to examine the association at the regional level, and stratified analysis by gender and age group was conducted. Results "Permissiveness" was associated with reduced suicide rates in a univariate model (P < 0.001). Adjusting for gender, age, and additional sociodemographics did not alter the association. Additionally, this relationship was observed in males and individuals under 60 years of age after stratification. However, "Unjustified Behavior" and "Readiness to help/Preventability" exhibited no significant association with suicide in any model or stratum. Conclusion The observed inverse association between permissive community attitudes and suicide contradicts the findings of previous research that links permissive individual attitudes to increased suicidal behavior. Our findings suggest that attitudes may operate differently at the individual and group levels. Although the cross-sectional design and single-country focus of this study warrant further investigation, our findings indicate that attitudes are significant contextual factors in the process of suicide, which could lead to novel approaches in suicide prevention.
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Affiliation(s)
- Minseok Hong
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyesoo Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Hyunju Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sooyeon Min
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Ji Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hun Yang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoojin Song
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyunghoon Son
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University Medical Research Center, Institute of Human Behavioral Medicine, Seoul, Republic of Korea
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Sessa F, Polito R, Li Rosi G, Salerno M, Esposito M, Pisanelli D, Ministeri F, Messina A, Carotenuto M, Chieffi S, Messina G, Monda M. Neurobiology and medico-legal aspects of suicides among older adults: a narrative review. Front Psychiatry 2024; 15:1449526. [PMID: 39290301 PMCID: PMC11405742 DOI: 10.3389/fpsyt.2024.1449526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
The task of preventing suicide in older adults is an important social burden as older adults aged above 65 are exposed to singular psychological aspects that increase suicide risks. Moreover, when an older adult corpse is found, the medico-legal inspection represents a fundamental tool to identify the exact cause of death, classifying or excluding it as suicide. In this scenario, this review aims to explore the neurobiological factors that could be related to suicidal behavior in older adults. A further goal of this review is the exploration of the medico-legal aspects surrounding older adult suicides, clarifying the importance of forensic investigation. Particularly, this review examines issues such as neurotransmitter imbalances, cognitive impairment, neuroinflammation, psychosocial factors related to geriatric suicide, and neurodegenerative diseases. Additionally, medico-legal aspects such as policy considerations, legal frameworks, mental health assessments, ethical implications and forensic investigation were explored. Considering the importance of this phenomenon, especially in western countries, a need has emerged for focused screening tools on suicidal behavior among older adults, in order to contain it. Therefore, this review makes an exhaustive appraisal of the literature giving insights into the delicate interplay between neurobiology as well as mental health in relation to older adult suicide within a medico-legal context. The comprehension of different aspects about this complex phenomenon is fundamental to propose new and more effective interventions, supporting tailored initiatives such as family support and improving healthcare, specifically towards vulnerable ageing societies to reduce older adult suicide risks.
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Affiliation(s)
- Francesco Sessa
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Li Rosi
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | | | - Daniela Pisanelli
- Microbiology and Virology Unit, Ospedali Riuniti, Viale Luigi Pinto, Foggia, Italy
| | - Federica Ministeri
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Antonietta Messina
- Department of Precision Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sergio Chieffi
- Department of Clinical Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Giovanni Messina
- Department of Clinical Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Marcellino Monda
- Department of Clinical Medicine, University of Campania, Luigi Vanvitelli, Napoli, Italy
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Nieuwenhuijs B, Gorus E, Portzky G, De Witte N. Risk and protective factors of a wish to die and suicidal ideation in community-dwelling, older, Flemish adults: results of the Belgian ageing studies. Aging Ment Health 2024; 28:1262-1269. [PMID: 38708865 DOI: 10.1080/13607863.2024.2345779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES This study aims to increase the understanding of suicidality in older adults by investigating the prevalence, characteristics, risk and protective factors of suicidal phenomena in community-dwelling older adults (60+) in Flanders, specifically of a current wish to die (WTD) and lifetime suicidal ideation and behaviour (LSIB). METHOD Cross-sectional data from the Belgian Ageing Studies (BAS) is used (N = 3050). The BAS aims to monitor the needs and quality of life of community-dwelling older adults through a standardised survey. Statistical methods used are bivariate analyses and binary logistic regression. RESULTS Prevalence rates of 4.8% for WTD and 8.2% for LSIB are found. LSIB is the biggest predictor of a current WTD, followed by requiring support on three domains, elder abuse, depression and subjective cognitive complaints, and elder abuse were significant risk factors for both WTD and LSIB. Limited effects of protective factors were found. CONCLUSION Previous research regarding risk factors to be confirmed in this study, and new insights on the effect of elder abuse, subjective indicators of cognitive complaints and requiring support are added. Further research into protective factors and underlying mechanisms is required.
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Affiliation(s)
- Beau Nieuwenhuijs
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Gorus
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Geriatrics Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gwendolyn Portzky
- Unit for Suicide Research, Department Head and Skin, Ghent University, Gent, Belgium
| | - Nico De Witte
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
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Sugita S, Hata K, Kodaiarasu K, Takamatsu N, Kimura K, Miller C, Gonzalez L, Umemoto I, Murayama K, Nakao T, Kito S, Ito M, Kuga H. Psychological treatments for mental health symptoms associated with COVID-19 infection: A scoping review. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e223. [PMID: 38962000 PMCID: PMC11216928 DOI: 10.1002/pcn5.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.
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Affiliation(s)
- So Sugita
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
| | - Kotone Hata
- Faculty of Human SciencesWaseda UniversityTokyoJapan
| | - Krandhasi Kodaiarasu
- McLean Hospital, Simches Division of Child and Adolescent PsychiatryBelmontMassachusettsUSA
| | - Naoki Takamatsu
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Kentaro Kimura
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
| | | | | | - Ikue Umemoto
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
| | - Keitaro Murayama
- Department of NeuropsychiatryKyushu University HospitalFukuokaJapan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shinsuke Kito
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
- Department of Psychiatry, National Center HospitalNational Center of Neurology and PsychiatryTokyoJapan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
| | - Hironori Kuga
- National Center for Cognitive Behavior Therapy and ResearchNational Center of Neurology and PsychiatryTokyoJapan
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Ward M, Briggs R, Kenny RA. Social disconnection correlates of a "Wish to Die" among a large community-dwelling cohort of older adults. Front Public Health 2024; 12:1436218. [PMID: 39234069 PMCID: PMC11371793 DOI: 10.3389/fpubh.2024.1436218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/24/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Social disconnection and deaths by suicide among older adults are both important public health concerns, particularly in the context of ageing populations. The association between death ideation and behaviours, and social disconnection is well established and both functional and structural social relationships have been identified as predictive of suicide-related thoughts and behaviours. The "Wish to Die" (WTD) involves thoughts of or wishes for one's own death or that one would be better off dead is a commonly used indicator to capture death ideation. It has been shown to be as predictive as active ideation of future suicide attempt. Methods Data were from a large cohort of community-dwelling older adults aged 50+, The Irish Longitudinal Study on Ageing (TILDA). Cross-sectional analyses of the association between numerous markers of social disconnection (loneliness, social isolation, living alone, marital status, social participation, volunteering, and attending religious service) and WTD were conducted. Results Multiple markers of social disconnection were associated with a "wish to die". However, loneliness was the strongest risk factor while attendance of religious services was an important protective behaviour. Discussion There is a strong association between social disconnection and a WTD among older adults. There is also a strong association between depression and a WTD, while attending religious services or similarly prosocial settings may protect older adults from experiencing negative thoughts about dying.
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Affiliation(s)
- Mark Ward
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- Mercers Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- Mercers Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Gysin-Maillart A, Bettschen D, Annaheim P, Brogna S, Walther S, Waern M, Müller M, Exadaktylos AK, Klukowska-Rötzler J. Sociodemographic and Clinical Characteristics of Older Adults With Suicide-Related Emergency Department Presentations. J Aging Health 2024:8982643241261094. [PMID: 39030841 DOI: 10.1177/08982643241261094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVES To identify characteristics of older adult emergency department (ED) patients aged ≥65 with suicidal ideation and/or behavior. METHODS A single center retrospective chart review analyzed 392 patients (≥65) with suicidal ideation and/or behavior (2013-2019). Comprehensive full-text searches were used. Subgroup analyses for age and gender were conducted. RESULTS Depressive disorder was documented in 50% of cases. Notably, 54% of all women were prescribed antidepressants, compared to only 31% of men. Most patients had general medical conditions (74.5%) and chronic multimorbidity (71.2%). Social stress affected 40.1%; 35.7% were intoxicated upon presentation. Alcohol abuse was more common in the 65-74 age group, while dementia impacted 20% of those ≥75. Men had a six-fold higher 30-day post-discharge mortality. DISCUSSION Older ED patients with suicidal ideation and/or behavior exhibit typical characteristics. The dementia prevalence suggests tailored care for those ≥75, and the heightened post-discharge mortality rate in older men requires further research.
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Affiliation(s)
- Anja Gysin-Maillart
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
- Unit for Clinical Suicide Research, Department of Clinical Sciences, Psychiatry, Faculty of Medicine, University of Lund, Lund, Sweden
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - David Bettschen
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascale Annaheim
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stella Brogna
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Margda Waern
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Sullivan JL, Burns B, O'Malley K, Mlinac M. An Environmental Scan of Suicide Prevention Resources for Older Veterans in Primary Care. Clin Gerontol 2024; 47:607-615. [PMID: 37433058 DOI: 10.1080/07317115.2023.2234901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Previous research has identified the critical role of primary care for suicide prevention. Although several suicide prevention resources for primary care already exist, it is unclear how many have been created specifically for older veterans. This environmental scan sought to assemble a compendium of suicide prevention resources to be utilized in primary care. METHODS We searched four academic databases, Google Scholar, and Google to identify available suicide prevention resources. Data from 64 resources was extracted and summarized; 15 were general resources and did not meet inclusion criteria. RESULTS Our scan identified 49 resources with three resources specifically developed for older veterans in primary care. Identified resources shared overlapping content, including implementing a safety plan and lethal means reduction. CONCLUSION Although only 10 of the identified resources were exclusively primary care focused, many of the resources had content applicable to suicide prevention in primary care. CLINICAL IMPLICATIONS Primary care providers can use this compendium of resources to strengthen suicide prevention work within their clinics including: safety planning, lethal means reduction, assessing for risk factors that place older veteran at increased risk of suicide, and mitigating risk factors through referral to programs designed to support older adult health and well-being.
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Affiliation(s)
- Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System, Capt. Jonathan H. Harwood Jr. Center for Research, Rhode Island, USA
- School of Public Health, Department of Health Service, Policy and Practice, Research Track, Brown University, Rhode Island, USA
| | - Benjamin Burns
- College of Arts and Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Kelly O'Malley
- VA Boston Healthcare System, Harvard Medical School, Brockton, Massachusetts, USA
| | - Michelle Mlinac
- VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
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Grande E, Alicandro G, Vichi M, Pompili M, Frova L. Suicide After Partner's Death in the Elderly Population: Results From a Nationwide Cohort Study in Italy. Am J Geriatr Psychiatry 2024; 32:825-831. [PMID: 38342662 DOI: 10.1016/j.jagp.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE This study aims to investigate the effect of partner loss on suicide mortality for surviving partners in the elderly Italian population and to explore differences according to sex and time elapsed since the loss. DESIGN This was a historical cohort study. SETTING All Italian residents registered by the 15th Italian Population Census (9 October 2011) were linked to emigration records and death certificates for 2012-2017 to track migration, vital status, and cause of death. PARTICIPANTS 5,068,414 individuals living as a couple, as registered in the census, and aged ≥69 years on January 1, 2012. MEASUREMENTS Mortality rate ratios (MRR) estimated through Poisson regression models were used to compare suicide mortality at age ≥75 years between subjects who experienced partner loss and those who did not. RESULTS Among people who experienced partner loss, there were 383 suicide deaths in men and 90 in women. Suicide mortality was higher in older men and women who experienced the loss compared to those who did not, and the impact of the spouse loss on mortality was stronger in men (age-adjusted MRR=2.83) than in women (1.41). Among men the excess risk was particularly high during the first year following the loss; in women, no substantial differences in the excess risk were observed over the follow-up period. CONCLUSION Study findings provide evidence of the sex differences in the impact of spouse loss based on data from a large national cohort and reinforce the need for monitoring suicide risk in recently widowed older people.
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Affiliation(s)
- Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics (EG, LF), Rome, Italy.
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano (GA), Milano, Italy; Department of Paediatrics, Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (GA), Milano, Italy
| | - Monica Vichi
- Statistical Service, Istituto Superiore di Sanità (MV), Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome (MP), Italy
| | - Luisa Frova
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics (EG, LF), Rome, Italy
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Palanbek Yavaş S, Baysan C. A scientometric analysis and visualisation of elderly suicide research from 1951 to 2022. Psychogeriatrics 2024; 24:811-821. [PMID: 38627605 DOI: 10.1111/psyg.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND There are still many gaps in both national and international literature on elderly suicide. This study aimed to identify the most influential journals in elderly suicide, the countries and authors that contribute the most to the field, and the trends in the field. MATERIAL AND METHODS Studies published on elderly suicide between 1951 and 2022 were retrieved utilising the Web of Science Core Collection. Co-authorship analysis of countries and authors, as well as co-occurrence analysis of keywords, were conducted using VOSviewer 1.6.18. RESULTS There were 2864 articles retrieved, including 95 countries, 889 academic journals, 9162 authors and 4160 keywords. The number of publications in this field has significantly increased after the 2000s, and the United States is the most productive country (996). The most prolific author is Yeates Conwell, while the journal with the highest number of publications in this field is the International Journal of Geriatric Psychiatry. Other than 'suicide' and 'elderly', the most trending keywords are 'depression', 'primary care', 'treatment', 'antidepressant', 'loneliness', 'quality of life' and 'COVID-19'. CONCLUSION There has been an increase in both the thematic diversity and quantity of studies on elderly suicide over time. However, these publications predominantly originate from socioeconomically affluent countries with relatively low suicide rates. While the increasing numbers of publications from developing countries in recent years are promising, there is a greater need for publications from countries with lower socioeconomic status for the prevention or intervention of elderly suicides.
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Affiliation(s)
- Seher Palanbek Yavaş
- Faculty of Medicine, Department of Public Health, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Caner Baysan
- Faculty of Medicine, Department of Public Health, Izmir Democracy University, Izmir, Turkey
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12
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Owsiany MT, Fiske A. Control in relation to suicidal ideation and nonfatal suicidal behavior among older adults: a systematic review. Aging Ment Health 2024:1-12. [PMID: 38884617 DOI: 10.1080/13607863.2024.2365885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES This review aims to evaluate and synthesize quantitative and qualitative findings on perceived control and value placed on control within the context of suicidal ideation or nonfatal suicidal behaviors in older adults. METHOD A comprehensive literature search was completed in June 2022, October 2022, and November 2023. Included studies focused on perceived control or value placed on control and on suicidal ideation or nonfatal suicidal behavior. Studies were published in English and included older adults (≥ 60 years) in separate analyses. Studies focusing on self-efficacy were excluded. RESULTS Twelve studies with 10 unique samples of 1487 total participants from eight countries were assessed. Quantitative studies indicated that perceived control and value placed on control are significant correlates of suicidal ideation and nonfatal suicidal behaviors, while qualitative studies highlighted that individuals who survive suicide attempts often specify decreased perceived control as a reason for their attempts. CONCLUSION Results of this review indicate that perceived control and value placed on control are relevant variables when studying suicidal ideation and nonfatal suicidal behavior. This conclusion should be considered preliminary. Future research should examine heterogeneous samples, adopt gold standard assessments, and assess covariates in the associations.
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Affiliation(s)
| | - Amy Fiske
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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13
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Uwiringiyimana A, Niyonsenga J, Lisette KG, Bugenimana A, Mutabaruka J, Nshimiyimana A. Depression symptoms and suicidal ideation among HIV infected Rwandans: the mediating and moderating effects of complicated grief and substance abuse. AIDS Res Ther 2024; 21:38. [PMID: 38844952 PMCID: PMC11157700 DOI: 10.1186/s12981-024-00628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND People with HIV/AIDS (PWHA) have 7-36 times greater risk for completed suicide associated with depression symptoms compared to general population. However, no study has sufficiently analyzed the mediating or moderating variables of the relationship between depression and suicidal ideation in Rwanda. OBJECTIVES This study aimed to examine how complicated grief mediates and substance abuse moderates the effects of depression symptoms on suicidal ideation. METHODS Data were collected from a convenient sample of 140 participants (M-age = 38.79 years, SD = 10.218) receiving antiretroviral therapy (ART) at Remera Health Center in a cross-sectional study. Multiple linear regression and Sobel test were used to examine the relationships between depression symptoms, complicated grief, suicidal ideation, and substance abuse. RESULTS The results indicated that 29% of the sample had clinically significant symptoms of depression and 18% had suicidal ideation. The interaction between substance abuse and depression symptoms (β = .468, t = 8.02, p = 0.000) was a significant predictor, explaining the 55.7% of variance in suicidal ideation. Furthermore, the Sobel test demonstrated that complicated grief mediated the effects of depression symptoms (t = 4.67, SE = 0.0101, p ≤ 0.001) on suicidal ideation. CONCLUSION The results suggest that depression symptoms are associated with an increased risk of suicidal ideation, and this risk significantly amplified in the presence of complicated grief and substance abuse. These findings highlight the importance of integrating mental health services, particularly those addressing depression, complicated grief, and substance abuse, into HIV care programs to mitigate the risk of suicidal ideation among PWHA.
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Affiliation(s)
- Anualitha Uwiringiyimana
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Japhet Niyonsenga
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Mental Health and Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Kethina Gaju Lisette
- Mental Health and Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Global Mental Health, London Kings College, London, UK
| | - Athanasie Bugenimana
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Augustin Nshimiyimana
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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14
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Gannu L, Devine F, Popadic L, Lal S, Witte M, Potter M, Hass S. Characterizing the treatment patterns, medication burden, and patient demographics of older adults with major depressive disorder treated with antidepressants with or without selected comorbidities. Curr Med Res Opin 2024:1-12. [PMID: 38693906 DOI: 10.1080/03007995.2024.2348603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Evaluate clinical characteristics, comorbidity burden, major depressive disorder (MDD)-related healthcare resource utilization (HCRU), medication burden, and antidepressant treatment (ADT) patterns among older adults with MDD with and without selected comorbidities. METHODS Using Komodo's Healthcare Map claims data (1/1/2016-9/30/2022), patients with MDD (≥65 years) treated with ADTs were assessed 24 months preceding (baseline) and 12 months following (follow-up) first observed ADT prescription fill (index). Patients were separated into cohorts of those with ≥1 of 5 selected comorbidities and those without. Clinical characteristics, comorbidities, and MDD-related HCRU were assessed during baseline; treatment patterns were assessed during follow-up. Baseline and follow-up all-cause and comorbidity-specific medication burdens (mean prescription claims/month) were determined. RESULTS Among the total cohort (N = 417,643), 97.1% had ≥1 of 5 selected comorbidities: hypertension (80.3%), hyperlipidemia (75.4%), diabetes (54.2%), anxiety disorder (39.0%), and chronic obstructive pulmonary disorder (19.5%). Baseline and follow-up all-cause medication burdens per month were 3.8 and 4.5 for patients with selected comorbidities and 1.7 and 2.3 for those without. During baseline, most patients (96.0% with selected comorbidities, 96.2% without) had ≥1 outpatient visit, and a numerically higher percentage of those with vs. without selected comorbidities had MDD-related emergency room (13.9% vs. 6.0%) and inpatient (13.5% vs. 4.1%) visits. The majority of both cohorts (61.0% with selected comorbidities, 59.5% without) underwent treatment pattern changes. CONCLUSION This study highlights the medication burden and ADT patterns in older adults with MDD, assessing these outcomes among patients with and without comorbidities. Numerically higher medication burdens among those with selected comorbidities suggests future studies could investigate the impact of comorbidities on MDD-related care.
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Affiliation(s)
- Laxmi Gannu
- HEOR Real-World Evidence (RWE), Sage Therapeutics, Inc., Cambridge, MA, USA
| | | | | | - Sagar Lal
- HEOR, Komodo Health, Inc., San Francisco, CA, USA
| | - Michael Witte
- Global Medical Affairs, Sage Therapeutics, Inc., Cambridge, MA, USA
| | - Marci Potter
- Neuropsychiatry, US Medical, Biogen Inc, Cambridge, MA, USA
| | - Steve Hass
- HEOR Real-World Evidence (RWE), Sage Therapeutics, Inc., Cambridge, MA, USA
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15
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Ramm M, Jedamzik J, Lenz P, Jürgens L, Heuft G, Conrad R. Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood. Front Psychiatry 2024; 15:1389021. [PMID: 38800056 PMCID: PMC11116776 DOI: 10.3389/fpsyt.2024.1389021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear. Methods Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults. Results The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals. Discussion This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.
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Affiliation(s)
- Markus Ramm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Philipp Lenz
- West German Cancer Center, University Hospital Münster, Münster, Germany
- Institute of Palliative Care, University Hospital Münster, Münster, Germany
| | - Lara Jürgens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
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16
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Bolstad CJ, Cui R, Fiske A, Nadorff MR. Age Moderates the Relation between Sleep Problems and Suicide Risk. Clin Gerontol 2024; 47:408-415. [PMID: 35209805 DOI: 10.1080/07317115.2022.2044951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This cross-sectional study examined whether age moderates the relation between sleep problems and suicide risk and investigated whether sleep problems are differentially associated with suicide risk in younger (18-40) and older (60+) adults. METHODS MTurk workers (N = 733) completed the Pittsburgh Sleep Quality Index, Suicidal Behavior Questionnaire-Revised, Patient Health Questionnaire, and demographic questions. Analysis of variance and linear regressions were utilized. RESULTS Older adults scored lower on four PSQI components, symptoms of depression, and suicide risk than younger adults. Age significantly moderated the relation between sleep problems and suicide risk after controlling for gender and depressive symptoms, F(5, 635) = 72.38, p < .001. Sleep problems significantly related to suicide risk in younger adults (t = 6.47, p < .001) but not in older adults (t = 0.57, p = .57). Sleep medication use was related to suicide risk in both groups, whereas daytime dysfunction was related to suicide risk in older adults and sleep disturbances were related to suicide risk in younger adults. CONCLUSIONS The relation between sleep problems and suicide risk differs between younger and older adults. This study adds to the literature suggesting that sleep medications may not be appropriate for older adults. CLINICAL IMPLICATIONS Sleep problems are significantly related to suicide risk in younger adults but not older adults. Sleep medication use is associated with suicide risk regardless of age.
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Affiliation(s)
- Courtney J Bolstad
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
| | - Ruifeng Cui
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Amy Fiske
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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17
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Hedna K, Jonson M, Sigström R, Levinsson A, Nordenskjöld A, Waern M. Suicidal behavior and all-cause mortality in depressed older adults aged 75+ treated with electroconvulsive therapy: A Swedish register-based comparison study. Int J Geriatr Psychiatry 2024; 39:e6102. [PMID: 38767969 DOI: 10.1002/gps.6102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is effective in treating late-life depression. There is limited research on suicidal behavior and all-cause mortality in the oldest old after ECT. METHODS Older adults aged 75 years and above who had been inpatients for moderate to severe depression between January 1, 2011, and December 31, 2017, were included in the study. We used exact and propensity score matching to balance groups. We compared suicidal behavior (fatal and non-fatal) and all-cause mortality in those who had received ECT and those with other depression treatments. RESULTS Of the study population, 1802 persons who received ECT were matched to 4457 persons with other treatments. There were no significant differences in the risk of suicidal behavior between groups, (within 3 months: odds ratio 0.73; 95% confidence intervals (CI), 0.44-1.23, within 4 months to 1 year: aOR 1.34; 95% CI, 0.84-2.13). All-cause mortality was lower among ECT recipients compared to those who had received other treatments, both within 3 months (aOR, 0.35; 95% CI, 0.23-0.52), and within 4 months to 1 year (aOR 0.65; 95% CI, 0.50-0.83). CONCLUSIONS Compared to other depression treatments, ECT is not associated with a higher risk of suicidal behavior in patients aged 75 and above. ECT is associated with lower all-cause mortality in this age group, but we advise caution regarding causal inferences.
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Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna Väst AB, Gothenburg, Sweden
| | - Mattias Jonson
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Sigström
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cognition and Old Age Psychiatry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Levinsson
- Department of Social Medicine and Public Health, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal-CRCHUM, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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18
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Szanto K, Szücs A, Kenneally LB, Galfalvy HC. Is Late-Onset Suicidal Behavior a Distinct Subtype? Am J Geriatr Psychiatry 2024; 32:622-629. [PMID: 38182486 PMCID: PMC11016379 DOI: 10.1016/j.jagp.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/20/2023] [Accepted: 12/10/2023] [Indexed: 01/07/2024]
Abstract
This clinical viewpoint article aims to draw attention to a yet unexplored factor influencing suicidal behavior: age of onset of suicidal behavior. To tackle the substantial heterogeneity among depressed older attempters, we suggest consideration of at least two distinct pathways to suicidal behavior in late life based on when the first suicidal crisis occurred. Specifically, we discuss the current state of research and the rationale behind the suggested early-late-onset categorization of late-life suicidal behavior. We summarize available evidence so far on early-onset and late-onset attempters, and the potential heterogeneity in the interplay of risk/precipitating factors. Certain risk factors for suicide, such as impulsivity and borderline traits, decrease with age, while memory and broader cognitive impairments increase with age. Research indicates that familial/social exposure to suicidal behavior, childhood trauma, impulsivity, maladaptive personality traits, longstanding interpersonal difficulties, and legal problems are found predominantly in attempters experiencing their first suicidal crisis between youth and early midlife. In contrast, dementia prodrome is one of the most promising but understudied candidates for late-onset suicide risk, especially in the context of other risk factors. Moreover, personality traits conferring increased vulnerability to late-onset suicidal behavior (such as high conscientiousness) are not the same as ones classically identified in younger attempters and in older suicide attempters who have early-onset suicidal behavior (such as neuroticism and Cluster B traits). We discuss methodological points about studying age of onset of suicidal behavior, outline clinical implications, share ideas for future directions, and call for research on this understudied topic.
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Affiliation(s)
- Katalin Szanto
- Department of Psychiatry (KS), University of Pittsburgh, PA.
| | - Anna Szücs
- Department of Medicine (AS), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Faculty of Behavioural and Movement Sciences (AZ), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Hanga C Galfalvy
- Department of Psychiatry (HCG), Vagelos College of Physicians and Surgeons, Columbia University, NY; Department of Biostatistics (HCG), Mailman School of Public Health, Columbia University, NY
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Kim CY, Ha A, Shim SR, Hong IH, Chang IB, Kim YK. Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e247026. [PMID: 38630473 PMCID: PMC11024775 DOI: 10.1001/jamanetworkopen.2024.7026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
Importance Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. Objective To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors. Data Sources An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024. Study Selection All published studies were considered without restrictions on study design, publication date, or language. Data Extraction and Synthesis Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide. Main Outcomes and Measures The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively. Results A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation. Conclusions and Relevance The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.
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Affiliation(s)
- Chung Young Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea
- Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, Korea
| | - Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Korea
| | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Hallym University Medical Center, Hwaseong, Korea
| | | | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul, Korea
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Minaya I, Raine S, Levy A, O’Malley CB. Mental Health Effects of the COVID-19 Pandemic on Aging Lesbian, Gay, Bisexual, Transgender, and Queer Populations. Perm J 2024; 28:14-21. [PMID: 38155588 PMCID: PMC10940241 DOI: 10.7812/tpp/23.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
INTRODUCTION The COVID-19 pandemic affected numerous subpopulations of people in unique ways. This study evaluated the impact of the COVID-19 pandemic on the mental health status of Broward County's aging lesbian, gay, bisexual, transgender, and queer (LGBTQ) seniors and identified strengths, weaknesses, and opportunities for interventions to enhance positive mental health outcomes. The study was performed from April 2021 through July 2021. METHODS Online surveys measuring anxiety, depression, social support, and resilience were delivered by email to 47 residents of Wilton Manors, Florida. Study data were collected and collated using research electronic data capture tools with bivariate analysis using the Mann-Whitney test and generalized linear regression. RESULTS Bivariate analysis showed that males scored significantly higher on the social interactions subscale of the Duke Social Support Index, indicating greater social support, yet there was not a significant difference with sexual orientation or living situation. Multivariate analysis revealed differences for several dependent variables including anxiety and depression reporting being lower in LGBTQ individuals. DISCUSSION This study provides important insight into specific mental health challenges faced by Broward County's LGBTQ seniors, which can be applied to other LGBTQ populations across the globe. CONCLUSION Using the results, targeted interventions can be developed to help improve mental health outcomes during periods of isolation for all individuals.
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Affiliation(s)
- Iliza Minaya
- Department of Medical Education, Nova Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Samuel Raine
- Department of Medical Education, Nova Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Arkene Levy
- Department of Medical Education, Nova Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Chasity B O’Malley
- Department of Medical Education, Nova Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Department of Medical Education, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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21
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Tan H, Shipley J, Park FS, Donnelly MR, Kong AP, Barrios C, Grigorian A, Nahmias J. Firearm Violence Involving Adults 65 and Older During the Novel Coronavirus Disease Pandemic. Am Surg 2024; 90:345-349. [PMID: 37669124 DOI: 10.1177/00031348231200672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Rates of firearm violence (FV) surged during the COVID-19 pandemic. However, there is a paucity of data regarding older adults (OAs) (≥65 years old). This study aimed to evaluate patterns of FV against OAs before and after the COVID-19 pandemic, hypothesizing decreased firearm incidents, injuries, and deaths for OAs due to restricted social movement. METHODS Retrospective (2016-2021) data for OAs were obtained from the Gun Violence Archive. The rate of FV was weighted per 10,000 OAs using annual population data from the United States Census Bureau. Mann-Whitney U tests were performed to compare annual firearm incidence rates, number of OAs killed, and number of OAs injured from 2016-2020 to 2021. RESULTS From 944 OA-involved shootings, 842 died in 2021. The median total firearm incidents per month per 10,000 OAs decreased in 2021 vs 2016 (.65 vs .38, P < .001), 2017 (.63 vs .38, P < .001), 2018 (.61 vs .38, P < .001), 2019 (.39 vs .38, P = .003), and 2020 (.43 vs .38, P = .012). However, there was an increased median number of OAs killed in 2021 vs 2020 (.38 vs .38, P = .009), but no difference from 2016-2019 vs 2021 (all P > .05). The median number of firearm injuries decreased from 2017 to 2021 (.21 vs .19, P = .001) and 2020 to 2021 (.19 vs .19 P < .001). DISCUSSION Firearm incidents involving OAs decreased in 2021 compared to pre-pandemic years; however, there was a slight increase in deaths compared to 2020. This may reflect increased social isolation; however, future research is needed to understand why this occurred.
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Affiliation(s)
- Heidi Tan
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jonathan Shipley
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Flora S Park
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Megan R Donnelly
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Allen P Kong
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Cristobal Barrios
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
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22
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Martin CL, Richey M, Richardson DB, Nocera M, Cantrell J, McClure ES, Martin AT, Marshall SW, Ranapurwala SI. 25-Year fatal workplace suicide trends in North Carolina: 1992-2017. Am J Ind Med 2024; 67:214-223. [PMID: 38197263 DOI: 10.1002/ajim.23563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Suicide is a serious public health problem in the United States, but limited evidence is available investigating fatal suicides at work. There is a substantial need to characterize workplace suicides to inform suicide prevention interventions and target high-risk settings. This study aims to examine workplace suicide rates in North Carolina (NC) by worker characteristics, means of suicide used, and industry between 1992 and 2017. METHODS Fatal workplace suicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificate. Sex, age, race, ethnicity, class of worker, manner of death, and industry were abstracted. Crude and age-standardized homicide rates were calculated as the number of suicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% confidence intervals (CIs) were calculated, and trends over calendar time for fatal workplace suicides were examined overall and by industry. RESULTS 81 suicides over 109,464,430 w-y were observed. Increased rates were observed in workers who were male, self-employed, and 65+ years old. Firearms were the most common means of death (63%) followed by hanging (16%). Gas service station workers experienced the highest fatal occupational suicide rate, 11.5 times (95% CI: 3.62-36.33) the overall fatal workplace suicide rate, followed by Justice, Public Order, and Safety workers at 3.23 times the overall rate (95% CI: 1.31-7.97). CONCLUSION Our findings identify industries and worker demographics that were vulnerable to workplace suicides. Targeted and tailored mitigation strategies for vulnerable industries and workers are recommended.
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Affiliation(s)
- Chelsea L Martin
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, Chapel Hill, North Carolina, USA
| | - Morgan Richey
- Department of Population Sciences, Duke University, Durham, North Carolina, USA
| | - David B Richardson
- Susan and Henry Samueli College of Health Sciences, Irvine, California, USA
| | - Maryalice Nocera
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - John Cantrell
- Injury Prevention Research Center, Chapel Hill, North Carolina, USA
| | - Elizabeth S McClure
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, Chapel Hill, North Carolina, USA
| | - Amelia T Martin
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, Chapel Hill, North Carolina, USA
| | - Stephen W Marshall
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, Chapel Hill, North Carolina, USA
| | - Shabbar I Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, Chapel Hill, North Carolina, USA
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23
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Morin RT, Li Y, Karel MJ, Consolino T, Hwong A, Clark R, Byers AL. Comorbidity profiles in older patients last seen by mental health prior to suicide attempt. Aging Ment Health 2024; 28:551-556. [PMID: 37545400 DOI: 10.1080/13607863.2023.2228228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/11/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide. METHODS Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012-2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository. RESULTS 2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion. CONCLUSIONS Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression.
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Affiliation(s)
- Ruth T Morin
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Yixia Li
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Michele J Karel
- VA Central Office, Office of Mental Health and Suicide Prevention, Washington, D.C., USA
| | | | - Alison Hwong
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences and Medicine, University of California, San Francisco, CA, USA
- UCSF National Clinician Scholars Program, San Francisco, CA, USA
| | - Ryan Clark
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Amy L Byers
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences and Medicine, University of California, San Francisco, CA, USA
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Olgiati P, Pecorino B, Serretti A. Suicide ideation and male-female differences in major depressive disorder. Int J Psychiatry Clin Pract 2024; 28:53-62. [PMID: 38587055 DOI: 10.1080/13651501.2024.2335950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This study aimed to explore male-female differences in suicide ideation (SI) and suicide risk factors in major depressive disorder (MDD). METHODS We analysed 482 adults (sample 1) and 438 elderly outpatients (sample 2) with MDD. Sample 1 was treated with different antidepressant combinations (escitalopram; bupropion plus escitalopram; venlafaxine plus mirtazapine) and assessed by means of the Concise Health Risk Tracking (SI), Quick Inventory of Depressive Symptomatology, Altman Mania Rating Scale and Psychiatric Diagnostic Screening Questionnaire. Sample 2 was treated with venlafaxine and assessed using the Hamilton scale for depression, Anxiety Sensitivity Index and Penn State Worry Questionnaire for anxiety, Beck Scale for Suicide Ideation and Repeatable Battery for the Assessment of Neuropsychological Status. RESULTS In sample 1, females had greater depression severity (O.R 0.961 99%CI: 0.929 - 0.995), males reported more alcohol abuse (O.R 1.299 99%CI: 1.118 - 1.509) and active SI (O.R 1.109 99%CI: 1.005 - 1.255). In sample 2 men showed more severe SI (O.R 1.067; 99%CI: 1.014 - 1.122) and weight loss (OR = 5.89 99%CI: 1.01 - 34.19), women more gastrointestinal symptoms. CONCLUSIONS In these selected samples, although women had more severe depression, men had more suicide risk factors. Such differences might contribute to men's increased suicide risk.
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Affiliation(s)
- Paolo Olgiati
- Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy
- Mental Health Department, Azienda Sanitaria Locale TO4, Turin, Italy
| | - Basilio Pecorino
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Kore University of Enna, Enna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Kore University of Enna, Enna, Italy
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25
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Reid HE, Edge D, Pratt D, Wittkowski A. Working with suicidal mothers during the perinatal period: a reflexive thematic analysis study with mental health professionals. BMC Psychiatry 2024; 24:106. [PMID: 38326817 PMCID: PMC10848420 DOI: 10.1186/s12888-024-05537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Suicide is the leading cause of death in mothers postpartum and one of the most common causes of death during pregnancy. Mental health professionals who work in perinatal services can offer insights into the factors they perceive as being linked to mothers' suicidal ideation and behaviour, support offered to mothers and improvements to current practices. We aimed to explore the experiences and perceptions of perinatal mental health professionals who have worked with suicidal mothers during the perinatal period. METHOD Semi-structured interviews were conducted face-to-face or via telephone with mental health professionals working in perinatal mental health inpatient or community services across England. Data were analysed using reflexive thematic analysis. RESULTS From the professionals' (n = 15) accounts three main themes were developed from their interview data. The first, factors linked to suicidal ideation and behaviour, overarched two sub-themes: (1.1) the mother's context and (1.2) what the baby represents and what this means for the mother. These sub-themes described factors that professionals assessed or deemed contributory in relation to suicidal ideation and behaviour when a mother was under their care. The second main theme, communicating about and identifying suicidal ideation and behaviour, which outlined how professionals enquired about, and perceived, different suicidal experiences, encapsulated two sub-themes: (2.1) how to talk about suicide and (2.2) types of suicidal ideation and attempts. The third main theme, reducing suicidal ideation through changing how a mother views her baby and herself, focused on how professionals supported mothers to reframe the ways in which they viewed their babies and in turn themselves to reduce suicidal ideation. CONCLUSION Professionals highlighted many factors that should be considered when responding to a mother's risk of suicide during the perinatal period, such as the support around her, whether the pregnancy was planned and what the baby represented for the mother. Professionals' narratives stressed the importance of adopting a tailored approach to discussing suicidal experiences with mothers to encourage disclosure. Our findings also identified psychological factors that professionals perceived as being linked to suicidal outcomes for mothers, such as self-efficacy; these factors should be investigated further.
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Affiliation(s)
- Holly E Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
- Manchester Academic Health Sciences Centre, Manchester, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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26
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Fu D, Wang F, Gao B, Bai Q, Liu G, Zhu J. The influence of different sources of anticipated instrumental support on depressive symptoms in older adults. Front Public Health 2024; 12:1278901. [PMID: 38351956 PMCID: PMC10861699 DOI: 10.3389/fpubh.2024.1278901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Objective This study investigated how anticipated instrumental support sources and intergenerational support influence depressive symptoms in older Chinese adults. Methods We employed binary logistic regression on data from 7,117 adults aged ≥60 in the 2018 China Health and Retirement Longitudinal Study, controlling for gender, marital status, and self-rated health. Results 38.89% of respondents exhibited depressive symptoms. Anticipated support from spouse and children, spouse only, children only, or other sources showed 52, 25, 46, and 40% lower odds of depression, respectively, compared with no anticipated support. Those providing financial support had 36% higher odds of depression than those without exchanges. However, those receiving financial support, receiving instrumental support, and receiving and providing financial and emotional support had 19, 14, 23, and 24% lower odds of depression. Conclusion Different anticipated instrumental support sources and intergenerational support influenced depression odds in older adults, suggesting potential benefits in promoting such support systems.
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Affiliation(s)
| | | | | | | | - Guilin Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Jinghui Zhu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
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27
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Ahmed A, Patil PS. Navigating the Shadows: A Comprehensive Review of Suicide in the Geriatric Population. Cureus 2024; 16:e53352. [PMID: 38435868 PMCID: PMC10907885 DOI: 10.7759/cureus.53352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This review critically examines the complex landscape of suicide within the geriatric population, defined as individuals aged 65 and older. By synthesizing existing research, we elucidate critical findings related to the prevalence, risk factors, and challenges associated with suicide in this demographic. Social isolation, mental health issues, and the intricate psychosocial dimensions of ageing emerge as pivotal factors contributing to the vulnerability of older individuals. The conclusion underscores a compelling call to action, urging collaborative efforts from healthcare professionals, policymakers, and communities to implement targeted prevention strategies. Our vision for the future involves building a supportive and resilient community for the geriatric population, emphasizing age-friendly policies, robust social support networks, and destigmatizing mental health discussions. Through this comprehensive exploration, we aim to contribute to a deeper understanding of suicide in the geriatric population and inspire effective interventions that prioritize the well-being and dignity of older individuals.
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Affiliation(s)
- Ateeba Ahmed
- Psychiatry, Jawaharlal Nehru Medical College, Wardha, IND
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28
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Wilson JD, Gerlach AR, Karim HT, Aizenstein HJ, Andreescu C. Sex matters: acute functional connectivity changes as markers of remission in late-life depression differ by sex. Mol Psychiatry 2023; 28:5228-5236. [PMID: 37414928 PMCID: PMC10919097 DOI: 10.1038/s41380-023-02158-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
The efficacy of antidepressant treatment in late-life is modest, a problem magnified by an aging population and increased prevalence of depression. Understanding the neurobiological mechanisms of treatment response in late-life depression (LLD) is imperative. Despite established sex differences in depression and neural circuits, sex differences associated with fMRI markers of antidepressant treatment response are underexplored. In this analysis, we assess the role of sex on the relationship of acute functional connectivity changes with treatment response in LLD. Resting state fMRI scans were collected at baseline and day one of SSRI/SNRI treatment for 80 LLD participants. One-day changes in functional connectivity (differential connectivity) were related to remission status after 12 weeks. Sex differences in differential connectivity profiles that distinguished remitters from non-remitters were assessed. A random forest classifier was used to predict the remission status with models containing various combinations of demographic, clinical, symptomatological, and connectivity measures. Model performance was assessed with area under the curve, and variable importance was assessed with permutation importance. The differential connectivity profile associated with remission status differed significantly by sex. We observed evidence for a difference in one-day connectivity changes between remitters and non-remitters in males but not females. Additionally, prediction of remission was significantly improved in male-only and female-only models over pooled models. Predictions of treatment outcome based on early changes in functional connectivity show marked differences between sexes and should be considered in future MR-based treatment decision-making algorithms.
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Affiliation(s)
- James D Wilson
- Department of Mathematics and Statistics, University of San Francisco, San Francisco, CA, USA
| | - Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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29
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Choi NG, Marti CN, Choi BY. Firearm use risk factors and access restriction among suicide decedents age 75 and older who disclosed their suicidal intent. Front Public Health 2023; 11:1255519. [PMID: 38026395 PMCID: PMC10654963 DOI: 10.3389/fpubh.2023.1255519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background and aims A majority of older adult suicide decedents used firearms. In this study, we focused on suicide decedents age 75+ who disclosed their suicidal intent within a month of their injury/death to examine demographic and clinical characteristics associated with firearm use and firearm access restriction attempts by their family members. Methods The 2017-2019 U.S. National Violent Death Reporting System provided data (N = 1,734 suicidal intent disclosers; 1,476 males and 258 females; 21.4% of decedents age 75+). Generalized linear model (GLM) for a Poisson distribution with a log link was used to examine firearm use risk factors. Firearm access restriction attempts by decedents' family members were examined based on coroner/medical examiner and law enforcement (CME/LE) reports. Results Nearly three quarters of disclosers disclosed their intent to family members, and 82.9% of males and 27.5% of females used firearms. GLM results showed males, non-Hispanic white people, and residents in the South and West regions had higher likelihood of firearm use. CME/LE reports of 140 out of 1,294 firearm decedents included narratives related to firearm restriction attempts or lack thereof. Firearm access restrictions were not attempted in 65 cases because family members did not take suicidal intent disclosure seriously or because decedents promised no self-harm. Partial or complete removal of firearms in 75 cases were not effective as decedents had hidden a firearm or purchased a new one. Others used different lethal methods. Implications The findings indicate a need for: (a) training family members of older adults who are at risk of suicide in effective means safety/access restriction and strategies to prevent means substitution; (b) more comprehensive legislative reforms reducing access to firearms by those at risk of suicide; and (c) more comfort and palliative care and counseling for psychosocial risk factors.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, United States
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30
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Han N, Jeong S, Lee SY, Kong SY. Gender and Age Bias in the Evaluation of Suicide Attempt Behavior in an Emergency Department. Community Ment Health J 2023; 59:1521-1531. [PMID: 37280375 DOI: 10.1007/s10597-023-01139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/13/2023] [Indexed: 06/08/2023]
Abstract
We aimed to investigate whether demographic characteristics such as age and gender of attempted suicide patients are associated with bias in the post-Emergency Department (ED) discharge program manager's evaluation of genuineness of the patients' suicide attempts. In the ED-Based Post-Suicide Attempt Case Management (ED-PSACM) program, the manager interviews patients with suicide attempts and makes subjective judgement on the patient's genuineness of the suicide attempt. After patients' discharge, the manager provides follow-up post-discharge care management services. Compared to ≥ 65 years old male patients as a reference group, 18-39 years old female patients showed significantly lower judgment for a genuine suicide attempt (OR = 0.34; 95% CI 0.12-0.81). Other groups did not show significant differences from the reference group. Our study result suggests the possibility of the effects of bias on young females on the judgment of the suicide attempt genuineness. Medical staff and interventions managers in the ED should be concerned to avoid knowledge-mediated bias, especially by gender and age.
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Affiliation(s)
- Nahee Han
- Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Seungmin Jeong
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon, South Korea.
- Gangwon Center for Infectious Diseases, Chuncheon, South Korea.
| | - Seo-Young Lee
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, South Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, South Korea
| | - So Yeon Kong
- Strategic Research, Laerdal Medical, Stavanger, Norway
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31
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Jeong H, Noh H. Resilience as a Protective Factor in Older Adult Suicide: A Rapid Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1005-1018. [PMID: 37129535 DOI: 10.1080/01634372.2023.2202729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
Nearly 700,000 suicide deaths occur each year. One in every five suicide death occurs among adults over 60 years of age or older. As the aging population increases rapidly, there is a need to understand protective factors to prevent older adult suicide. This study used the rapid review methodology to search literature from 1997 to 2022, examining whether resilience was a protective factor. The literature search was conducted over the following six databases for peer-reviewed journals and gray literature including Abstracts in Social Gerontology, Academic Search Premier, APA PsycInfo, CINAHL Complete, MEDLINE, and SocINDEX with Full Text. A total of six peer-reviewed journal articles met the inclusion criteria. The conclusion of the articles suggested resilience may be a protective factor in older adult suicide. Despite its underpinning, resilience in suicide prevention literature is lacking. More studies should examine resilience and its constructs as part of the effort to prevent older adult suicide.
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Affiliation(s)
- Haelim Jeong
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
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32
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Bress JN, Arslanoglou E, Banerjee S, Alexopoulos GS, Kiosses DN. Positive valence system function and anhedonia in middle-aged and older adults at high suicide risk. Biol Psychol 2023; 182:108647. [PMID: 37499781 PMCID: PMC10529097 DOI: 10.1016/j.biopsycho.2023.108647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Positive valence systems are disrupted in late-life depression and in individuals at risk for suicide. The reward positivity (RewP) is an event-related potential measure of positive valence system function that relates to depression and anhedonia in children and young adults. However, it is unclear whether a reliable RewP signal can be elicited in middle-aged and older adults at high risk for suicide and, if so, whether this signal is similarly associated with clinical symptoms. In the current study, a RewP was elicited with a standard gambling task in middle-aged and older adults (N = 31) at discharge from a hospitalization for suicidal thought or behaviors. The resulting electrocortical response differed significantly for monetary wins compared to losses. Internal reliability of the RewP and the feedback negativity (FN) to monetary loss was good to excellent. Internal reliability of difference measures was lower but still largely acceptable, with residualized differences scores demonstrating stronger reliability than subtraction-based scores. A smaller residualized RewP, after accounting for the influence of the FN, was associated with greater severity of lassitude, an index of appetitive anhedonia. These findings set the groundwork for future studies of positive valence system function and depression in middle-aged and older adults at high risk for suicide.
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Affiliation(s)
- Jennifer N Bress
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York.
| | - Elizabeth Arslanoglou
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Dimitris N Kiosses
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
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Ichiki T, Koyama A, Imai M, Nishi Y, Abe Y, Fukunaga R, Murakami R, Nagaoka M, Takebayashi M, Fujise N. The trajectory of non-depressed suicidal ideation in community-dwelling older people in a rural area in Japan: a prospective longitudinal study with a 3-year follow-up. Psychogeriatrics 2023; 23:831-837. [PMID: 37448176 DOI: 10.1111/psyg.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post-baseline in a rural area of Japan, and to examine the subsequent course of depression among non-depressed older people with suicidal ideation. METHODS In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non-depression group using 15-item Geriatric Depression Scale scores 3 years post-baseline. Logistic regression analysis was used to identify predictive factors of late-life depression 3 years post-baseline. RESULTS We received 597 valid responses, with a 3-year follow-up rate of 78.8%. Regarding suicidal ideation, 6.7% of non-depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post-baseline. Logistic regression analysis indicated that development of late-life depression is significantly associated with suicidal ideation, being female, and poor health-related quality of life (HRQOL). CONCLUSIONS The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late-life depression 3 years post-baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community-dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people.
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Affiliation(s)
- Takahiro Ichiki
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
- Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Asuka Koyama
- Faculty of Social Welfare, Kumamoto Gakuen University, Kumamoto, Japan
| | - Masaki Imai
- Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
- Kumamoto Mental Health Hospital, Kumamoto, Japan
| | | | | | | | | | - Maiko Nagaoka
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
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Leleu E, Sánchez-Rico M, Abellán M, Blanco C, Yeim S, Chaugne E, Limosin F, Hoertel N. Impact of lithium on mortality among older adults with major psychiatric disorders: A 5-year prospective multicenter study. Aging Ment Health 2023; 27:1752-1761. [PMID: 36905630 DOI: 10.1080/13607863.2023.2188172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Prior studies report conflicting results about the association between lithium use and all-cause mortality. In addition, data are scarce on this association among older adults with psychiatric disorders. In this report, we sought to examine the associations of lithium use with all-cause mortality and specific causes of death (i.e., due to cardiovascular disorder, non-cardiovascular disease, accident, or suicide) among older adults with psychiatric disorders during a 5-year follow-up period. METHODS In this observational epidemiological study, we used data from 561 patients belonging to a Cohort of individuals with Schizophrenia or Affective disorders aged 55-years or more (CSA). Patients taking lithium at baseline were first compared to patients not taking lithium, and then to patients taking (i) antiepileptics and (ii) atypical antipsychotics in sensitivity analyses. Analyses were adjusted for socio-demographic (e.g., age, gender), clinical characteristics (e.g., psychiatric diagnosis, cognitive functioning), and other psychotropic medications (e.g. benzodiazepines). RESULTS There was no significant association between lithium use and all-cause mortality [AOR=1.12; 95%CI=0.45-2.79; p=0.810] or disease-related mortality [AOR=1.37; 95%CI=0.51-3.65; p=0.530]. None of the 44 patients taking lithium died from suicide, whereas 4.0% (N=16) of patients not receiving lithium did. CONCLUSION These findings suggest that lithium may not be associated with all-cause or disease-related mortality and might be associated with reduced risk of suicide in this population. They argue against the underuse of lithium as compared with antiepileptics and atypical antipsychotics among older adults with mood disorders.
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Affiliation(s)
- Emmanuel Leleu
- DMU Psychiatrie et Addictologie, AP-HP Centre, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, Paris, France
- Faculté de médecine Sorbonne, Université, Sorbonne Université, Paris, France
| | - Marina Sánchez-Rico
- DMU Psychiatrie et Addictologie, AP-HP Centre, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, Paris, France
| | - Miriam Abellán
- DMU Psychiatrie et Addictologie, AP-HP Centre, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Sunthavy Yeim
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Esther Chaugne
- Service de psychiatrie adulte sectorisée, Hôpital Henri Ey secteur 75G19, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Limosin
- DMU Psychiatrie et Addictologie, AP-HP Centre, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- DMU Psychiatrie et Addictologie, AP-HP Centre, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Jordan JT, Chick CF, Rolle CE, Hantke N, Gould CE, Lutz J, Kawai M, Cotto I, Karna R, Pirog S, Berk M, Sudheimer K, O'Hara R, Beaudreau SA. Neurocognitive markers of passive suicidal ideation in late-life depression. Int Psychogeriatr 2023; 35:421-431. [PMID: 33118918 DOI: 10.1017/s1041610220003610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES (1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression. DESIGN Cross-sectional study. SETTING University medical school. PARTICIPANTS Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O'Hara). MEASUREMENTS Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains. RESULTS The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume. CONCLUSIONS Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.
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Affiliation(s)
- Joshua T Jordan
- Department of Psychology, Dominican University of California, San Rafael, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina F Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Camarin E Rolle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan Hantke
- Mental Health and Clinical Neuroscience Division, VA Portland Health Care System, Portland, OR, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Geriatric Research, Education, and Clinical Centers (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Julie Lutz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Isabelle Cotto
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosy Karna
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sophia Pirog
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Berk
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Keith Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
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Crowther G, Ninan S. Managing depression in frail older people; too little too late or pathologising loss? Future Healthc J 2023; 10:107-111. [PMID: 37786635 PMCID: PMC10540808 DOI: 10.7861/fhj.2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
It is testament to the advances of modern medicine that we have a population with more older people than ever before. While we are increasingly adept at managing their physical comorbidities, we have made relatively little progress in addressing the psychological impact of ageing. In this article we consider the prevalence and complex aetiology of depression in older people who often have to deal with profound loss, while simultaneously managing multiple comorbidities. We consider the challenges of diagnosing depression faced by healthcare professionals including access to resources and training, and what differentiates depression from socially appropriate low mood. Finally, we discuss treatment options and the difficulties that clinicians face when they have only limited resources and skills available, but a desire to help. We consider the role for antidepressants, and when not to prescribe, before addressing the challenges of providing talking therapies and social interventions.
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Affiliation(s)
- George Crowther
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK; consultant geriatrician, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sean Ninan
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK; consultant geriatrician, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Bareeqa SB, Samar SS, Masood Y, Husain MM. Prevalence of Suicidal Behaviors in Residents of Long-Term Care Facilities: A Systematic Review and Meta-Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231176309. [PMID: 37247610 DOI: 10.1177/00302228231176309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Long-term care facilities (LTC) plays a pivotal role in caring for geriatric population. However, the risk of suicide in long-term care institutions among older individuals is little understood (e.g., nursing homes, assisted living facilities). OBJECTIVE The purpose of this systematic review is to pool and meta-analyze the data on prevalence of suicidal behaviors in geriatric population residing in long-term care facilities. METHODS We have conducted the systematic review in accordance with the PRISMA guidelines. The utilized databases are Pubmed, Medline, Google scholar and Scopus. The Meta-analysis was done using OpenMeta [analyst] software. Subgroup analysis was also performed. RESULTS After running an analysis on pooled data from twenty cross-sectional studies with 3,023,224 participants, the prevalence of suicidal behavior is 6.4% (95% CI = 5.7-7) in LTC. CONCLUSION This meta-analysis shows pooled prevalence of suicidal behavior among geriatric residents of LTC was found to be moderately high all over the world.
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Affiliation(s)
| | | | - Yasir Masood
- Department of Social Sciences, Washington University in St. Louis, St Louis, MO, USA
| | - Mustafa M Husain
- Department of Psychiatry, Neurology and Medicine, UT Southwestern Medical Centre, Dallas, TX, USA
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Möller J, Lindholm E, Fredlund P, Vaez M, Liang Y, Laflamme L. Trends in intentional and unintentional poisonings among older adults - A national register-based study in Sweden. BMC Geriatr 2023; 23:296. [PMID: 37189030 DOI: 10.1186/s12877-023-03973-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Among older people intentional poisoning outnumber unintentional ones. While there are indications that time trends differ by poisoning intent, studies are scarce. We assessed how the annual prevalence of intentional and unintentional poisoning changed over time, overall and by demographic groups. METHODS We conducted a national open cohort study of individuals aged 50-100 years, resident in Sweden during 2005-2016. Individuals were followed up in population-based registers for their demographic and health attributes from 2006-2016. Annual prevalence of hospitalization and death by poisoning intent (unintentional vs. intentional or undetermined; ICD-10 definitions) were compiled for the categories of four demographic attributes (age, sex, marital status, and birth cohort "baby boomers"). The time trends were assessed by multinomial logistic regression with year as an independent variable. RESULTS The annual overall prevalence of hospitalization and death by intentional poisonings consistently exceeded that of unintentional poisonings. There was a significant downward trend in intentional poisonings but not in unintentional ones. This difference in trends also applied when considering men and women separately, married and unmarried people, the young-old individuals (but not the older- or oldest-old ones), and the baby boomers and non-baby boomers. The largest demographic differences within intent were found between married and unmarried people, and the smallest one between men and women. CONCLUSION As expected, the annual prevalence of intentional poisonings considerably exceed that of unintentional ones among Swedish older people. The recent trends reveal a significant reduction of intentional poisonings, consistent across a range of demographic attributes. The scope for action regarding this preventable cause of mortality and morbidity remains considerable.
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Affiliation(s)
- J Möller
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
| | - E Lindholm
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden.
| | - P Fredlund
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
| | - M Vaez
- Department of Living Conditions and Lifestyles, The Public Health Agency of Sweden, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Y Liang
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
| | - L Laflamme
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
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Kuffel RL, Morin RT, Covinsky KE, Boscardin WJ, Lohman MC, Li Y, Byers AL. Association of Frailty With Risk of Suicide Attempt in a National Cohort of US Veterans Aged 65 Years or Older. JAMA Psychiatry 2023; 80:287-295. [PMID: 36811913 PMCID: PMC9947807 DOI: 10.1001/jamapsychiatry.2022.5144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/11/2022] [Indexed: 02/24/2023]
Abstract
Importance Frailty is associated with reduced physiological reserve, lack of independence, and depression and may be salient for identifying older adults at increased risk of suicide attempt. Objectives To examine the association between frailty and risk of suicide attempt and how risk differs based on components of frailty. Design, Setting, and Participants This nationwide cohort study integrated databases from the US Department of Veterans Affairs (VA) inpatient and outpatient health care services, Centers for Medicare & Medicaid Services data, and national suicide data. Participants included all US veterans aged 65 years or older who received care at VA medical centers from October 1, 2011, to September 30, 2013. Data were analyzed from April 20, 2021, to May 31, 2022. Exposures Frailty, defined based on a validated cumulative-deficit frailty index measured using electronic health data and categorized into 5 levels: nonfrailty, prefrailty, mild frailty, moderate frailty, and severe frailty. Main Outcomes and Measures The main outcome was suicide attempts through December 31, 2017, provided by the national Suicide Prevention Applications Network (nonfatal attempts) and Mortality Data Repository (fatal attempts). Frailty level and components of the frailty index (morbidity, function, sensory loss, cognition and mood, and other) were assessed as potential factors associated with suicide attempt. Results The study population of 2 858 876 participants included 8955 (0.3%) who attempted suicide over 6 years. Among all participants, the mean (SD) age was 75.4 (8.1) years; 97.7% were men, 2.3% were women, 0.6% were Hispanic, 9.0% were non-Hispanic Black, 87.8% were non-Hispanic White, and 2.6% had other or unknown race and ethnicity. Compared with patients without frailty, risk of suicide attempt was uniformly higher among patients with prefrailty to severe frailty, with adjusted hazard ratios (aHRs) of 1.34 (95% CI, 1.27-1.42; P < .001) for prefrailty, 1.44 (95% CI, 1.35-1.54; P < .001) for mild frailty, 1.48 (95% CI, 1.36-1.60; P < .001) for moderate frailty, and 1.42 (95% CI, 1.29-1.56; P < .001) for severe frailty. Lower levels of frailty were associated with greater risk of lethal suicide attempt (aHR, 1.20 [95% CI, 1.12-1.28] for prefrail veterans). Bipolar disorder (aHR, 2.69; 95% CI, 2.54-2.86), depression (aHR, 1.78; 95% CI, 1.67-1.87), anxiety (aHR, 1.36; 95% CI, 1.28-1.45), chronic pain (aHR, 1.22; 95% CI, 1.15-1.29), use of durable medical equipment (aHR, 1.14; 95% CI, 1.03-1.25), and lung disease (aHR, 1.11; 95% CI, 1.06-1.17) were independently associated with increased risk of suicide attempt. Conclusions and Relevance This cohort study found that among US veterans aged 65 years or older, frailty was associated with increased risk of suicide attempts and lower levels of frailty were associated with greater risk of suicide death. Screening and involvement of supportive services across the spectrum of frailty appear to be needed to help reduce risk of suicide attempts.
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Affiliation(s)
- Randall L. Kuffel
- San Francisco VA Health Care System, San Francisco, California
- Northern California Institute for Research and Education, San Francisco
| | - Ruth T. Morin
- San Francisco VA Health Care System, San Francisco, California
- Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Yixia Li
- San Francisco VA Health Care System, San Francisco, California
- Northern California Institute for Research and Education, San Francisco
| | - Amy L. Byers
- San Francisco VA Health Care System, San Francisco, California
- Department of Psychiatry and Medicine, University of California, San Francisco
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Kandula S, Martinez-Alés G, Rutherford C, Gimbrone C, Olfson M, Gould MS, Keyes KM, Shaman J. County-level estimates of suicide mortality in the USA: a modelling study. Lancet Public Health 2023; 8:e184-e193. [PMID: 36702142 PMCID: PMC9990589 DOI: 10.1016/s2468-2667(22)00290-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide is one of the leading causes of death in the USA and population risk prediction models can inform decisions on the type, location, and timing of public health interventions. We aimed to develop a prediction model to estimate county-level suicide risk in the USA using population characteristics. METHODS We obtained data on all deaths by suicide reported to the National Vital Statistics System between Jan 1, 2005, and Dec 31, 2019, and age, sex, race, and county of residence of the decedents were extracted to calculate baseline risk. We also obtained county-level annual measures of socioeconomic predictors of suicide risk (unemployment, weekly wage, poverty prevalence, median household income, and population density) and state-level prevalence of major depressive disorder and firearm ownership from US public sources. We applied conditional autoregressive models, which account for spatiotemporal autocorrelation in response and predictors, to estimate county-level suicide risk. FINDINGS Estimates derived from conditional autoregressive models were more accurate than from models not adjusted for spatiotemporal autocorrelation. Inclusion of suicide risk and protective covariates further reduced errors. Suicide risk was estimated to increase with each SD increase in firearm ownership (2·8% [95% credible interval (CrI) 1·8 to 3·9]), prevalence of major depressive episode (1·0% [0·4 to 1·5]), and unemployment rate (2·8% [1·9 to 3·8]). Conversely, risk was estimated to decrease by 4·3% (-5·1 to -3·2) for each SD increase in median household income and by 4·3% (-5·8 to -2·5) for each SD increase in population density. An increase in the heterogeneity in county-specific suicide risk was also observed during the study period. INTERPRETATION Area-level characteristics and the conditional autoregressive models can estimate population-level suicide risk. Availability of near real-time situational data are necessary for the translation of these models into a surveillance setting. Monitoring changes in population-level risk of suicide could help public health agencies select and deploy targeted interventions quickly. FUNDING US National Institute of Mental Health.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA.
| | - Gonzalo Martinez-Alés
- Department of Epidemiology, Columbia University, New York, NY, USA; CAUSALab, Harvard T H Chan School of Public Health, Boston, MA, USA; Mental Health Network Biomedical Research Center, Madrid, Spain; Mental Health Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | | | | | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
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Thaysa Bier de Sousa N, Vedana KGG, Zanetti ACG, de Souza J, da Silva AHS, Miasso AI. Intentional self-poisoning with medications: Occurrence, recurrence and suicide deaths. DEATH STUDIES 2023:1-9. [PMID: 36794403 DOI: 10.1080/07481187.2023.2175390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study aimed to identify the sociodemographic and clinical factors associated with the occurrence and recurrence of intentional self-poisoning with medications (ISP-M), and suicide deaths by ISP-M in the state of Mato Grosso, Brazil. In this cross-sectional analytical study, we used logistic regression models to analyze data obtained through health information systems. Factors associated with use of ISP-M as a method were female gender, white skin color, occurrence in urban areas and at home. The ISP-M as a method was less reported in people presumed under the influence of alcohol. Lower chance of death by suicide using ISP-M was found among young people and adults (under 60 years old).
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Affiliation(s)
- Nágella Thaysa Bier de Sousa
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | - Kelly Graziani Giacchero Vedana
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | - Jacqueline de Souza
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | - Amanda Heloisa Santana da Silva
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | - Adriana Inocenti Miasso
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
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Wang X, Beltran S, Burns R, Hamel M, Gray S, Gryglewicz K. Suicide Risk Help-Seeking Among Middle- to Old-Age Adults: A Systematic Review. Innov Aging 2023; 7:igac079. [PMID: 36815014 PMCID: PMC9940623 DOI: 10.1093/geroni/igac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background and Objectives Suicide has become a major public health concern worldwide and in the United States. Rates of suicide increase during the life course and are highest among middle- to old-age adults. Help-seeking represents a crucial coping mechanism that can mitigate suicide risk. Yet, less is known about suicide risk help-seeking, especially among these age groups. To address this knowledge gap, a systematic review of existing literature was performed to obtain a refined understanding of help-seeking for suicide risk among middle- to old-age adults. Research Design and Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic databases and key journals with suicide and/or gerontology focuses were searched to identify peer-reviewed publications in English between 2010 and 2020. A total of 4 732 unduplicated publications were screened for relevance based on titles and abstracts, of which 52 were reviewed in full text. Results Twenty-four articles met inclusion criteria and were included in the qualitative synthesis. These articles discussed a range of topics, including the prevalence of service utilization, service use prior to a suicide death, and correlates of help-seeking. In general, the prevalence of service utilization was low and varied by suicidal history (eg, higher prevalence among individuals with a history of suicide attempts than those with suicide ideation only). Key facilitators (eg, current or history of suicidal thoughts, plans, or attempts) and barriers (eg, stigma) for service use and help-seeking were also identified. Discussion and Implications Findings highlight the need for future studies and tailored services to improve age-appropriate and culturally responsive suicide prevention and intervention strategies for middle- to old-age adults.
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Affiliation(s)
- Xiaochuan Wang
- Address correspondence to: Xiaochuan Wang, PhD, School of Social Work, University of Central Florida, Orlando, FL 32816, USA. E-mail:
| | - Susanny Beltran
- School of Social Work, University of Central Florida, Orlando, Florida, USA
| | - Rachael Burns
- School of Social Work, University of Central Florida, Orlando, Florida, USA
| | - Marie Hamel
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA
| | - Sydney Gray
- School of Social Work, University of Central Florida, Orlando, Florida, USA
| | - Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, Florida, USA
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Wang X, Bergren S, Dong X. Association Between Social Support and Depression Help-Seeking Behaviors Among U.S. Chinese Older Adults. J Aging Health 2023; 35:83-93. [PMID: 35694797 DOI: 10.1177/08982643221106870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: Depression has become one major mental health concern among Asian older adults. Yet, less is known about the role of social support on depression help-seeking among this population. This study examined the association between positive (i.e., open up to, rely on) and negative (i.e., too many demands, criticism) social support and depression help-seeking among U.S. Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Study sample consisted of 994 U.S. Chinese older adults with depressive symptoms. Results: Stepwise logistic regression results indicated that greater positive social support was associated with increased likelihood of both formal and informal help-seeking behaviors, whereas negative support was not a significant predictor. Discussion: Findings highlight the key role of positive social support in influencing U.S. Chinese older adults' depression help-seeking behaviors. Tailored strategies are recommended to better meet the mental health needs of this vulnerable population.
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Affiliation(s)
- Xiaochuan Wang
- School of Social Work, 6243University of Central Florida, Orlando, FL, USA
| | - Stephanie Bergren
- 242612Rutgers University, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - XinQi Dong
- 242612Rutgers University, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
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Crisan RM, Băcilă CI, Toboltoc PC, Morar S. Completed Suicide Linked to the COVID-19 Pandemic by Using the Psychological Autopsy Method in Sibiu County, Romania: Case Series and Literature Review. Healthcare (Basel) 2022; 10:healthcare10122377. [PMID: 36553902 PMCID: PMC9777587 DOI: 10.3390/healthcare10122377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic is associated with suicide, as some data suggests. Our study aims to investigate the emergence of eleven completed suicide cases suspected to be linked to the COVID-19 pandemic during the restrictive measures imposed by the Romanian government, and to identify the consequences of mental health, suicidal motivation, and behavioral changes. To this end, we analyzed the deceased's medical records and applied the psychological autopsy method to the relatives/caregivers of the deceased for a suicidal investigation history, within conducted free-flow discussions. To highlight behavioral changes that occurred in the distant antecedents as well as immediately before the suicidal act, we used two sets of closed questions comprised of fifteen alarm signs, including depressive and/or anxiety symptoms. Our results showed that a deterioration of the mental status, especially concerning depressive and anxiety symptoms, was evident in people without or with pre-existing psychiatric pathology. The suicidal motivation proved to be complex including, in addition to the SARS-CoV-2 infection, social and economic consequences of the COVID-19 pandemic. We noted an intensification of the investigated alarm signs and even the emergence of new warning signs in the recent antecedents. Based on our findings, we reaffirmed the important role of the psychological autopsy method in suicide investigation, proving that it can detect the specific impact of the COVID-19 pandemic on people prone to suicide. This impact can be psycho-emotional, social, and/or economical, and thus we can state that the COVID-19 pandemic and its consequences can be, at least, a triggering factor that enhances completed suicide risk. Further studies are needed in this particular area because correlations between the COVID-19 pandemic and completed suicide do not appear to be accidental.
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Affiliation(s)
- Roxana-Mihaela Crisan
- Doctoral Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
- Forensic Department, County Clinical Emergency Hospital of Sibiu, Corneliu Coposu Boulevard 2-4, 550245 Sibiu, Romania
| | - Ciprian Ionuț Băcilă
- 'Dr. Gheorghe Preda' Clinical Psychiatry Hospital, 550082 Sibiu, Romania
- Dental Medicine and Nursing Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
| | - Paul-Cătălin Toboltoc
- Doctoral Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
- Department of Anatomical Pathology, County Clinical Emergency Hospital of Sibiu, Corneliu Coposu Boulevard 2-4, 550245 Sibiu, Romania
| | - Silviu Morar
- Forensic Department, County Clinical Emergency Hospital of Sibiu, Corneliu Coposu Boulevard 2-4, 550245 Sibiu, Romania
- Preclinical Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
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45
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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46
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Liu Q, Leng P, Gu Y, Shang X, Zhou Y, Zhang H, Zuo L, Mei G, Xiong C, Wu T, Li H. The dose-effect relationships of cigarette and alcohol consumption with depressive symptoms: a multiple-center, cross-sectional study in 5965 Chinese middle-aged and elderly men. BMC Psychiatry 2022; 22:657. [PMID: 36284280 PMCID: PMC9594935 DOI: 10.1186/s12888-022-04316-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although association of depressive symptoms with cigarette or alcohol is well documented, the dose-response relationship between them is rarely studied. This study aims to evaluate dose-response relationships of cigarette and alcohol consumption with depressive symptoms in Chinese middle-aged and elderly men, providing evidence to guide cigarette and alcohol control. METHODS This multiple-center, cross-sectional study including 5965 Chinese men aged 40-79 years was conducted in 2013-2016 in China. Depressive symptoms were evaluated by Beck Depression Inventory-Short Form. History of cigarette smoking and alcohol drinking were collected with a structured questionnaire. Prevalence of depressive symptoms was compared depending on cigarette and alcohol consumption. Adjusted odds ratios (OR) and 95% confidence interval (CI) were estimated by binary logistic regression. Interpolation analysis was applied to test dose-effect relationships. RESULTS A parabolic-shaped relationship was observed between cigarette consumption and depressive symptoms. Compared to never smokers, 59.0% (OR = 1.59, 95% CI 1.30-1.94) and 29.0% (OR = 1.29, 95% CI 1.08-1.54) higher odds of depressive symptoms were observed in men smoking < 10 cigarettes/day and 10-20 cigarettes/day, whereas, similar odds of depressive symptoms among men smoking > 20 cigarettes/day (P = 0.092). An inverted J-shaped relationship was observed between alcohol consumption and depressive symptoms. Compared to never drinkers, a tendency of higher prevalence of depressive symptoms (OR = 1.16, 95% CI 0.99-1.36) was observed in men drinking < 140 g/week, and similar prevalence was observed in those drinking 140-280 g/week (P = 0.920), whereas, 29.4% (OR = 0.71, 95% CI 0.57-0.88) lower odds in men drinking > 280 g/week. CONCLUSIONS Associations of cigarette smoking and alcohol drinking with depressive symptoms differ with consumption in middle-aged and elderly men. Health-care providers should exercise great caution on depressive symptoms in conducting cigarette and alcohol control.
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Affiliation(s)
- Qian Liu
- grid.33199.310000 0004 0368 7223Center for Reproductive Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000 China ,grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Pei Leng
- grid.33199.310000 0004 0368 7223Center for Reproductive Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000 China
| | - Yiqun Gu
- grid.453135.50000 0004 1769 3691National Health and Family Planning Key Laboratory of Male Reproductive Health, National Research Institute for Family Planning, Beijing, 100000 China
| | - Xuejun Shang
- Department of Andrology, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, 210093 China
| | - Yuanzhong Zhou
- grid.417409.f0000 0001 0240 6969School of Public Health, Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Huiping Zhang
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China ,Wuhan Tongji Reproductive Medicine Hospital, Wuhan, 563000 China
| | - Liandong Zuo
- grid.413428.80000 0004 1757 8466Guangzhou Women and Children’s Medical Center, Guangzhou, 510000 China
| | - Guangan Mei
- Technical Guidance Institute of Shanxi Province Family Planning Commission, Xi’an, 710000 China
| | - Chengliang Xiong
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China ,Wuhan Tongji Reproductive Medicine Hospital, Wuhan, 563000 China
| | - Tianpeng Wu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Honggang Li
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Wuhan Tongji Reproductive Medicine Hospital, Wuhan, 563000, China.
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Malek Rivan NF, Shahar S, Singh DKA, Ibrahim N, Mat Ludin AF, Yahya HM, Mohamed Sakian NI, Mahadzir H, Subramaniam P, Kamaruddin MZA. Mediation effect of coping strategies on general psychological health among middle-aged and older adults during the COVID-19 pandemic. Aging Ment Health 2022; 26:2039-2047. [PMID: 34486885 DOI: 10.1080/13607863.2021.1972281] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE In this study, we aim to assess general psychological health, associated factors, and the potential of coping strategies as a mediator for middle-aged and older Malaysian adults during the COVID-19 pandemic. METHODS A total of 535 individuals aged 52 years and above from the previous cohort and interventional studies in Peninsular Malaysia were contacted during the Movement Control Order (MCO) issued during the COVID-19 pandemic. Telephonic interviews were conducted to obtain participant information concerning socio-demography, physical activity, subjective well-being (SWB) as assessed using flourishing scale, coping strategies, and general psychological health (GHQ-12). Simple linear regression (SLR) and multiple linear regression (MLR) analyses were performed to identify the factors associated with GHQ-12. The associated factors were further analysed using mediation analysis to determine the potential of coping strategies as a mediator. RESULTS It was observed that participants had a low mean GHQ-12 score (M = 0.80, SD = 2.19), indicating good psychological health. Living arrangement, physical activity, and flourishing scale were associated with psychological health (R2 = 0.412, p < 0.05) in MLR. Positive reinterpretation, emotional support, instrumental support, humour, denial, and self-blame appear to partially mediate the relationship between socio-demography, physical activity, flourishing scale and GHQ-12, with lower coefficient values. CONCLUSION Middle-aged and older adults in Malaysia had good psychological health during the COVID-19 pandemic, especially when living with family, physically active, and having good subjective well-being. These findings provide the initial evidence to help promote the ageing population's general well-being and mental health and enable them to cope with change during the COVID-19 pandemic.
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Affiliation(s)
- Nurul Fatin Malek Rivan
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme and Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Clinical Psychology Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Biomedical Science Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanis Mastura Yahya
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noor Ibrahim Mohamed Sakian
- Occupational Therapy Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hazlina Mahadzir
- Internal Medicine and Geriatric Department, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Clinical Psychology Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Zul Amin Kamaruddin
- Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Parkhurst KA, Daks JS, Conwell Y, Podgorski CA, Van Orden KA. Social network subtypes among socially disconnected older adults at risk for suicide: A latent class analysis. Suicide Life Threat Behav 2022; 52:963-974. [PMID: 35735167 DOI: 10.1111/sltb.12893] [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] [Received: 10/23/2021] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to characterize the social networks of older adults who report feeling lonely or like a burden on others, psychological states that are associated with risk for suicide according to the Interpersonal Theory of Suicide. METHODS We used a latent class analysis to identify distinct groups of older adults based on social network characteristics and perceptions of their networks within a sample of older adults endorsing loneliness and/or feeling like a burden. We examined associations between class membership and mental health outcomes. RESULTS Four network types were identified: small, cohabitating networks with daily contact; moderate-sized family-oriented networks with multiple contacts weekly; moderate-sized friend-oriented networks with weekly contact; and average-sized mixed networks with weekly contact. The friend-oriented class reported the greatest loneliness, perceived burden, and lifetime prevalence of suicidal ideation and attempts. CONCLUSIONS Social network composition may be more explanatory of loneliness and perceived burden than number of members alone. Profile differences in outcomes suggest utilizing tailored social connectedness interventions. Individuals with small-to-moderate networks may benefit most from interventions designed to build friendships. Individuals with many close confidants may benefit most from psychotherapy. Individuals reporting moderately frequent contact with moderately-sized networks may benefit from both intervention types.
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Affiliation(s)
| | - Jennifer S Daks
- Department of Psychology, University of Rochester, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol A Podgorski
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Kimberly A Van Orden
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Zhu XM, Xu YM, Wang ZQ, Zhong BL. Prevalence and correlates of suicidal ideation among older adults attending primary care clinics in Wuhan, China: A multicenter cross-sectional study. Front Psychiatry 2022; 13:1003810. [PMID: 36159910 PMCID: PMC9500179 DOI: 10.3389/fpsyt.2022.1003810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary care represents an ideal setting for screening for and managing suicidal older adults but the clinical epidemiology of suicidal ideation in Chinese older primary care patients remains unclear. This study investigated the prevalence and correlates of suicidal ideation in older Chinese adults receiving primary care. Methods This multicenter cross-sectional survey included a total of 769 older adults (≥65 years) from seven urban and six rural primary care clinics in Wuhan, China. The presence of depressive symptoms and suicidal ideation was assessed with the Geriatric Depression Scale and a single-item question "In the past 12 months, did you think about ending your life?," respectively. Results The 12-month prevalence of suicidal ideation in older primary care patients was 16.6%. Significant correlates of suicidal ideation were poor economic status (vs. good, OR = 2.80, P = 0.008), heart disease (OR = 2.48, P = 0.005), chronic gastric ulcer (OR = 3.55, P = 0.012), arthritis (OR = 2.10, P = 0.042), and depressive symptoms (OR = 11.29, P < 0.001). Conclusions Suicidal ideation is common among older adults attending Chinese primary care clinics. It is necessary to integrate psychological crisis intervention into primary care to prevent late-life suicide.
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Affiliation(s)
- Xiao-Min Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Zong-Qin Wang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
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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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