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Jung HW, Jang JS. Constructing prediction models and analyzing factors in suicidal ideation using machine learning, focusing on the older population. PLoS One 2024; 19:e0305777. [PMID: 39038039 PMCID: PMC11262681 DOI: 10.1371/journal.pone.0305777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/04/2024] [Indexed: 07/24/2024] Open
Abstract
Suicide among the older population is a significant public health concern in South Korea. As the older individuals have long considered suicide before committing suicide trials, it is important to analyze the suicidal ideation that precedes the suicide attempt for intervention. In this study, six machine learning algorithms were employed to construct a predictive model for suicidal thinking and identify key variables. A traditional logistic regression analysis was supplementarily conducted to test the robustness of the results of machine learning. All analyses were conducted using a hierarchical approach to compare the model fit of each model in both machine learning and logistic regression. Three models were established for analysis. In Model 1, socioeconomic, residential, and health behavioral factors were incorporated. Model 2 expanded upon Model 1 by integrating physical health status, and Model 3 further incorporated mental health conditions. The results indicated that the gradient boosting algorithm outperformed the other machine learning techniques. Furthermore, the household income quintile was the most important feature in Model 1, followed by subjective health status, oral health, and exercise ability in Model 2, and anxiety and depression in Model 3. These results correspond to those of the hierarchical logistic regression. Notably, economic and residential vulnerabilities are significant factors in the mental health of the older population with higher instances of suicidal thoughts. This hierarchical approach could reveal the potential target population for suicide interventions.
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Affiliation(s)
- Hyun Woo Jung
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Republic of Korea
- Yonsei Institute of Health and Welfare, Yonsei University Mirae Campus, Wonju, Republic of Korea
| | - Jin Su Jang
- Human Behavior & Genetic Institute, Associate Research Center, Korea University, Seoul, Republic of Korea
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2
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Çekiç Y, Yüksel R. Psychometric properties of the Turkish version of the Geriatric Feelings of Burdensomeness Scale (T-GFBS) in Turkish community-dwelling older adults. Geriatr Nurs 2024; 58:69-75. [PMID: 38776719 DOI: 10.1016/j.gerinurse.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES The study aimed to evaluate the psychometric properties of the Turkish version of the Geriatric Feelings of Burdensomeness Scale (T-GFBS) in Turkish community-dwelling older adults. METHODS This study included 300 community-dwelling older adults. Data were collected face-to-face between October 2023 and January 2024. The psychometric properties of the T-GFBS were evaluated using internal consistency, factor analysis, and test-retest reliability. RESULTS The confirmatory factor analysis indicated a good model fit (χ2/df = 2.360, RMSEA = 0.06, CFI = 0.93, GFI = 0.87, IFI = 0.93, TLI = 0.92). The scale revealed good internal consistency (Cronbach's alpha = 0.953) and acceptable test-retest reliability (ICC = 0.998). The single-factor structure of the T-GFBS with 25 items was consistent with the original version. CONCLUSIONS The T-GFBS is an easy-to-understand, comprehensive, reliable, and valid tool for assessing the feelings of burdensomeness in Turkish older adults.
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Affiliation(s)
- Yasemin Çekiç
- Ankara University, Faculty of Nursing, Psychiatric Nursing Department, Ankara, Türkiye.
| | - Rüveyda Yüksel
- Aydın Adnan Menderes University, Faculty of Nursing, Mental Health and Diseases Nursing Department, Aydın, Türkiye
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3
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Bean M, McLaren S, Kinkead R. Thwarted Belongingness and Depressive Symptoms Among Older Adults: The Moderating Roles of Self-Warmth, Self-Coldness, and Place of Residence. Clin Gerontol 2024:1-13. [PMID: 38703110 DOI: 10.1080/07317115.2024.2349678] [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] [Indexed: 05/06/2024]
Abstract
OBJECTIVES This study investigated whether the relationship between thwarted belongingness and depressive symptoms was moderated by self-warmth and self-coldness and whether the moderating effects were conditional on place of residence (urban versus rural). METHODS A sample of 236 Australian adults aged 65 to 97 years (M = 73.63, SD = 6.53) completed the Geriatric Depression Scale, Interpersonal Needs Questionnaire, and Self-Compassion Scale. RESULTS The interaction between thwarted belongingness and self-warmth was significant for urban but not rural older adults. For urban older adults, the relationship between thwarted belongingness and depressive symptoms weakened as levels of self-warmth increased. The association between thwarted belongingness and depressive symptoms was significantly stronger for older adults living in rural areas than in urban areas. The relationship between thwarted belongingness and depressive symptoms strengthened as self-coldness levels increased. CONCLUSIONS Self-warmth is a protective factor for older adults living in urban areas and experiencing thwarted belongingness. Self-coldness is an additional risk factor for older adults experiencing thwarted belongingness. CLINICAL IMPLICATIONS Interventions focusing on increasing self-warmth among urban older adults and decreasing self-coldness among older adults might weaken the relationship between thwarted belongingness and depressive symptoms.
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Affiliation(s)
- Montanna Bean
- School of Psychology, Charles Sturt University, Australia
| | | | - Robyn Kinkead
- School of Psychology, Charles Sturt University, Australia
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4
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Ki M, Lapierre S, Gim B, Hwang M, Kang M, Dargis L, Jung M, Koh EJ, Mishara B. A systematic review of psychosocial protective factors against suicide and suicidality among older adults. Int Psychogeriatr 2024; 36:346-370. [PMID: 38305360 DOI: 10.1017/s104161022300443x] [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: 02/03/2024]
Abstract
BACKGROUND Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. METHOD First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. RESULTS A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. CONCLUSION Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.
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Affiliation(s)
- Myung Ki
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Brain Korea 21 Four Research and Education Center, Korea University, Seoul, South Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montréal, Canada
| | - Boeun Gim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Minji Hwang
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Brain Korea 21 Four Research and Education Center, Korea University, Seoul, South Korea
| | - Minku Kang
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Luc Dargis
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montréal, Canada
| | - Myoungjee Jung
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Emily Jiali Koh
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
| | - Brian Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montréal, Canada
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Kim S, Cha J, Kim D, Park E. Understanding Mental Health Issues in Different Subdomains of Social Networking Services: Computational Analysis of Text-Based Reddit Posts. J Med Internet Res 2023; 25:e49074. [PMID: 38032730 PMCID: PMC10722371 DOI: 10.2196/49074] [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: 05/16/2023] [Revised: 08/10/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Users increasingly use social networking services (SNSs) to share their feelings and emotions. For those with mental disorders, SNSs can also be used to seek advice on mental health issues. One available SNS is Reddit, in which users can freely discuss such matters on relevant health diagnostic subreddits. OBJECTIVE In this study, we analyzed the distinctive linguistic characteristics in users' posts on specific mental disorder subreddits (depression, anxiety, bipolar disorder, borderline personality disorder, schizophrenia, autism, and mental health) and further validated their distinctiveness externally by comparing them with posts of subreddits not related to mental illness. We also confirmed that these differences in linguistic formulations can be learned through a machine learning process. METHODS Reddit posts uploaded by users were collected for our research. We used various statistical analysis methods in Linguistic Inquiry and Word Count (LIWC) software, including 1-way ANOVA and subsequent post hoc tests, to see sentiment differences in various lexical features within mental health-related subreddits and against unrelated ones. We also applied 3 supervised and unsupervised clustering methods for both cases after extracting textual features from posts on each subreddit using bidirectional encoder representations from transformers (BERT) to ensure that our data set is suitable for further machine learning or deep learning tasks. RESULTS We collected 3,133,509 posts of 919,722 Reddit users. The results using the data indicated that there are notable linguistic differences among the subreddits, consistent with the findings of prior research. The findings from LIWC analyses revealed that patients with each mental health issue show significantly different lexical and semantic patterns, such as word count or emotion, throughout their online social networking activities, with P<.001 for all cases. Furthermore, distinctive features of each subreddit group were successfully identified through supervised and unsupervised clustering methods, using the BERT embeddings extracted from textual posts. This distinctiveness was reflected in the Davies-Bouldin scores ranging from 0.222 to 0.397 and the silhouette scores ranging from 0.639 to 0.803 in the former case, with scores of 1.638 and 0.729, respectively, in the latter case. CONCLUSIONS By taking a multifaceted approach, analyzing textual posts related to mental health issues using statistical, natural language processing, and machine learning techniques, our approach provides insights into aspects of recent lexical usage and information about the linguistic characteristics of patients with specific mental health issues, which can inform clinicians about patients' mental health in diagnostic terms to aid online intervention. Our findings can further promote research areas involving linguistic analysis and machine learning approaches for patients with mental health issues by identifying and detecting mentally vulnerable groups of people online.
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Affiliation(s)
- Seoyun Kim
- Department of Applied Artificial Intelligence, Sungkyunkwan University, Seoul, Republic of Korea
| | - Junyeop Cha
- Department of Applied Artificial Intelligence, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dongjae Kim
- Department of Applied Artificial Intelligence, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eunil Park
- Department of Applied Artificial Intelligence, Sungkyunkwan University, Seoul, Republic of Korea
- Teach Company, Seoul, Republic of Korea
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Alfaro AJ, Carlson C, Segal DL, Gould CE. Distinctions between depression and anxiety with fear of being a burden in late life. Aging Ment Health 2022; 26:2366-2371. [PMID: 34713761 DOI: 10.1080/13607863.2021.1993131] [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] [Indexed: 01/25/2023]
Abstract
Objectives: The perception of being a burden is a well-known risk factor for dying by suicide. Research on factors that precede the state of perceived burdensomeness, such as fearing being a burden, is necessary. We investigated the extent to which health status, elevated depressive symptoms, and elevated anxiety symptoms are associated with fear of being a burden in late life.Method: Older adult participants (N = 155) completed the Geriatric Anxiety Scale (GAS), Patient Health Questionnaire (PHQ-8), and demographic and health questions. Fear of being a burden, assessed with a supplemental item on the GAS, was categorically grouped as 'no fear' or 'some fear'. Using logistic regression, we examined predictors of fear of being a burden.Results: In the first step, elevated depression was associated with fear of being a burden (OR = 2.30, 95% CI: 1.09, 4.89, p = .03), but health status was not significant. In the second step, elevated anxiety was significant (OR = 2.63, 95% CI: 1.15, 5.99, p = .02); depression was no longer significant.Conclusion: Contrary to expectations, anxiety more strongly predicted fear of being a burden than depression. Future research should further investigate the role of anxiety in fear of being a burden and ways of intervening.
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Affiliation(s)
- Ana Jessica Alfaro
- GRECC, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Daniel L Segal
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
| | - Christine E Gould
- GRECC, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Okan C, Bilson L, Zhong D, Weidemann G, Bailey PE. Validating the interpersonal theory of suicide among older adultspre- and peri-COVID-19 pandemic. Aging Ment Health 2022:1-7. [PMID: 36052977 DOI: 10.1080/13607863.2022.2116402] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Global suicide rates are highest among older adults, and especially older men, yet proximal predictors of suicidal ideation in older age remain poorly understood. This study tested the Interpersonal Theory of Suicide in older men and women by investigating whether perceived burdensomeness and thwarted belongingness and/or their interaction are proximal predictors of suicidal ideation before versus during the global COVID-19 pandemic. METHODS The sample (N = 208) included healthy community-dwelling older Australian persons surveyed face-to-face pre-pandemic (n = 102), or online peri-pandemic (n = 106). Depression, social interaction, social satisfaction, thwarted belongingness, and perceived burdensomeness were assessed as predictors of suicidal ideation. RESULTS Perceived burdensomeness was a more proximal predictor of suicidal ideation among older adults than depression or thwarted belongingness. Suicidal ideation and perceived burdensomeness were higher in men than women, but sex did not moderate the influence of perceived burdensomeness, thwarted belongingness or social satisfaction on suicidal desire. The interaction between perceived burdensomeness and thwarted belongingness predicted more additional variance in suicidal ideation in the older persons surveyed during the COVID-19 pandemic relative to those surveyed before the pandemic. CONCLUSION Suicidal ideation among older persons peri-pandemic is discussed, and recommendations are made for age-specific suicide prevention strategies.
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Affiliation(s)
- Ceylan Okan
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Lily Bilson
- School of Psychology, Western Sydney University, Sydney, Australia
| | - David Zhong
- School of Psychology, Western Sydney University, Sydney, Australia
| | | | - Phoebe E Bailey
- School of Psychology, Western Sydney University, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, Australia
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8
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Liu CC, Lin YT, Cheng KC, Pan HH, Chiou CP. Predictors of Depression Level among Community-Dwelling Elderly Persons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159414. [PMID: 35954771 PMCID: PMC9367993 DOI: 10.3390/ijerph19159414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022]
Abstract
Elderly people in the community have difficulty taking care of themselves because of their inability to care for themselves in daily life as well as their poor social support system, which leads to loneliness, resulting in depression. The primary objective was to investigate the level of depression and related factors among community-dwelling elderly persons (CDEP). This was a cross-sectional study, and 150 participants were interviewed. The questionnaires included demographics, the Functional Independence Measure, the Interpersonal Support Evaluation List, the UCLA Loneliness Scale, and the Geriatric Depression Scale Short Form. It was found that participants with different levels of depression accounted for 26%, and education level, living status, chronic disease, daily life function, social support, and loneliness were all significant factors influencing the depression level among the CDEP that could significantly predict 63.4% of the variation in depression level. Nursing staff must understand the level of depression and its influencing factors, encourage the elderly in the community to increase social networks, and integrate leisure into their lives, thereby enhancing the sense of value and meaning of life and reducing feelings of loneliness and depression.
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Affiliation(s)
- Chin-Chen Liu
- Department of Family Medicine, E-Da Dachang Hospital, Kaohsiung City 82445, Taiwan;
| | - Yi-Tung Lin
- Department of Nursing, E-Da Hospital, Kaohsiung City 82445, Taiwan;
| | - Kung-Chuan Cheng
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 83340, Taiwan;
| | - Hsueh-Hsing Pan
- School of Nursing, National Defense Medical Center, Taipei City 11420, Taiwan
- Correspondence: (H.-H.P.); (C.-P.C.); Tel.: +886-2-87923100 (ext. 18166) (H.-H.P.); +886-9-21299091 (C.-P.C.)
| | - Chou-Ping Chiou
- School of Nursing, I-Shou University, No. 8, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung City 84020, Taiwan
- Correspondence: (H.-H.P.); (C.-P.C.); Tel.: +886-2-87923100 (ext. 18166) (H.-H.P.); +886-9-21299091 (C.-P.C.)
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A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the body of research on suicide in later life has developed, so has its vocabulary. This has generated a high level of overlap in concepts and terminology used to articulate suicide and how it might present, as well as ‘grey area’ behavioural terms that are both specific to older adults and less well-defined (e.g. ‘hastening of death’ or ‘completed life’). A better understanding of individual experiences and pathways to suicide can help to inform assessment and interventions, and increase the potential to relate any theoretical concepts to the implementation of such. Here, we adopted a scoping review to search systematically literature on specific presentation, features, circumstances and outcomes of these grey areas of suicide in later life. Fifty-three articles (quantitative, qualitative and theoretical) were reviewed. A narrative approach was used to merge and translate this body of knowledge into a new conceptual framework based on four key themes: (a) a sense of completed life or existential loneliness; (b) death thoughts, wishes and ideation; (c) death-hastening behaviour and advanced directives; and (d) self-destructive or self-injurious behaviour. We discuss the importance of integrating this understanding into current knowledge and suicide prevention strategies for older adults. Recommendations are made for unifying research with policy themes on healthy ageing, person-centredness within service provision and citizen participation.
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10
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Beach VL, Brown SL, Cukrowicz KC. Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter? Aging Ment Health 2021; 25:1759-1767. [PMID: 33317336 DOI: 10.1080/13607863.2020.1855102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.
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Affiliation(s)
- Victoria L Beach
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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11
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Keefner TP, Stenvig T. Rethinking Suicide Risk With a New Generation of Suicide Theories. Res Theory Nurs Pract 2021; 34:389-408. [PMID: 33199410 DOI: 10.1891/rtnp-d-19-00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide is a global concern to nurses and other health-care providers. However, deaths by suicide are only part of the spectrum of suicide, as suicidal thinking and behaviors may precede a suicide attempt. Theoretical models are used infrequently in research to explain how the individual progresses from suicidal ideation to a suicide attempt. Thus, there is a critical need to advance the study of suicide with useful theoretical models to describe and explain processes whereby suicidal thoughts transition to attempts and to suicide. PURPOSE This article provides a conceptual discussion and scoping review comparing historical and contemporary ideation-to-action theories of suicide. METHOD Systematic reviews and meta-analyses from three databases (CINAHL, JSTOR, and PsychINFO) were reviewed to find literature describing suicide theories. RESULTS Historically, theory applications have limited capacity to differentiate between those individuals with suicidal ideations and those who attempt suicide. Newer theories, grounded in the ideation-to-action framework, propose distinct processes explaining what moves an individual from suicidal ideations toward suicidal behaviors. IMPLICATIONS FOR PRACTICE The ideation-to-action theories can guide health-care providers' assessment of at-risk individuals beyond merely asking about suicidal thinking. CONCLUSION The new generation of suicide theories suggest that suicidal ideations are only one component of risk. The common factor in ideation-to-action theories that distinguishes ideators from attempters is the acquired capability for suicide.
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Affiliation(s)
- Tamara P Keefner
- College of Nursing, South Dakota State University, Brookings, South Dakota
| | - Thomas Stenvig
- College of Nursing, South Dakota State University, Brookings, South Dakota
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12
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Stensland M. "If You Don't Keep Going, You're Gonna Die": Helplessness and Perseverance Among Older Adults Living With Chronic Low Back Pain. THE GERONTOLOGIST 2021; 61:907-916. [PMID: 33033826 DOI: 10.1093/geront/gnaa150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP. RESEARCH DESIGN AND METHODS Using van Manen's phenomenological method, semistructured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66-83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding. RESULTS Findings dually illustrate how participants were living a battle between helplessness and perseverance; the final thematic structure revealed 5 subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going. DISCUSSION AND IMPLICATIONS This study contributes a vivid illustration of older adults' CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio
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13
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Makara-Studzińska M, Somasundaram SG, Halicka J, Madej A, Leszek J, Rehan M, Ashraf GM, Gavryushova LV, Nikolenko VN, Mikhaleva LM, Muresanu C, Kirkland CE, Avila-Rodriguez M, Aliev G. Suicide and Suicide Attempts in Elderly Patients: An Epidemiological Analysis of Risk Factors and Prevention. Curr Pharm Des 2021; 27:2231-2236. [PMID: 33243131 DOI: 10.2174/1381612826999201126202008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
A number of elderly patients commit suicide due to the interaction of various factors, including, for example, feelings of loneliness, financial distress, alcohol abuse, chronic pain, progressive diseases, and personality disorders. The data from the EU countries with the highest rates of suicide and suicide attempts among people over 55 years of age warrant the consideration of new approaches to address this social problem. METHODS PubMed and other databases, including Polish National data, were used for the analyses. RESULTS The average European suicide-attempt rate is 18 per 100 thousand inhabitants. More cases of suicides were reported among those over 55 years of age. Suicide attempts from the year 2012 to 2014 and deaths in 2012 have been reviewed. The risk factors involved in these events, such as depression and social situations including loneliness, health condition, etc., have been discussed to suggest a plausible preventative approach for this important elderly problem. CONCLUSION The psychophysiology of elderly persons affected by retirement, socio-economic changes, limited personal autonomy, loneliness, lack of support by the family, and diseases ultimately may lead elderly patients to commit suicide. Thus, financial freedom, family support (respect, love, and care), proper medications, psychological and psychiatric interventions may help the elderly avoid suicidal thoughts and prevent attempts.
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Affiliation(s)
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem WV 26426, United States
| | - Joanna Halicka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Agata Madej
- Department of Applied Psychology, Medical University of Lublin, Lublin, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Mohd Rehan
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghulam M Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Liliya V Gavryushova
- Saratov State Medical University named after V.I. Razumovsky, 410012, Saratov, Russian Federation
| | - Vladimir N Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
| | - Liudmila M Mikhaleva
- Federal State Budgetary Institution «Research Institute of Human Morphology», 3, Tsyurupy Str., Moscow, 117418, Russian Federation
| | - Cristian Muresanu
- Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem WV 26426, United States
| | - Marco Avila-Rodriguez
- Health Sciences Faculty, Clinic Sciences Department, University of Tolima, 730006 Ibague, Colombia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, 142432, Russian Federation
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14
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Shim Y, Choe K, Kim KS, Kim JS, Ha J. The applicability of the interpersonal-psychological theory of suicide among community-dwelling older persons. Suicide Life Threat Behav 2021; 51:816-823. [PMID: 33870547 DOI: 10.1111/sltb.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/03/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study examined the application of the interpersonal-psychological theory of suicide to community-dwelling older persons in South Korea. METHODS A cross-sectional study design was used. The data were collected by surveying 200 older persons (117 female, 83 male) aged over 65 years at welfare centers for older persons. The Interpersonal Needs Questionnaire, the Suicidal Ideation Scale, and the Acquired Capability for Suicide Scale were used to assess participants' thwarted belongingness, perceived burdensomeness, suicidal ideation, attempts, and the capability for suicide. Structural equation modeling was used to examine the fitness of a model based on the interpersonal-psychological theory of suicide. This theory described that perceived burdensomeness and thwarted belongingness lead to suicidal ideation, which is transformed into suicide attempts through an acquired capability for suicide. RESULTS Perceived burdensomeness was significantly associated with suicidal ideation among older persons, whereas thwarted belongingness was not. Furthermore, suicidal ideation influenced suicide attempts. The acquired capability for suicide moderated the relationship between suicidal ideation and suicide attempts. CONCLUSIONS To prevent suicidal ideation and suicide attempts among older persons, it is important to prevent them from feeling that they are a burden.
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Affiliation(s)
- Yuhwa Shim
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Kwisoon Choe
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Ki-Sook Kim
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Jeongmin Ha
- Department of Nursing, Chung-Ang University, Seoul, Korea
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15
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Park E, Lee HY. Urban and rural differences in suicidal ideation and associated factors among older Koreans: Results from the Korean National Survey 2012–2013. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01962-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Stensland M. Managing the Incurable: Older Pain Clinic Patients' Experiences of Managing Treatment-Resistant Chronic Low Back Pain. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:405-422. [PMID: 33719939 DOI: 10.1080/01634372.2021.1898073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is a highly prevalent disabling condition among older adults, and treatment remains a challenge. Limited research has qualitatively examined late-life CLBP and its management. Study objective was to examine how older adults experience pain management approaches for CLBP. Guided by van Manen's phenomenological method, 21 pain clinic patients (66-83) completed semi-structured interviews. Under the main theme "Managing the incurable," four subthemes emerged: (a) A quest for relief; (b) Spinal procedures offer temporary relief yet ongoing disappointment; (c) The apprehension of medication (d) Making things work for me. Social work practice implications are discussed.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio, San Antonio, Texas, USA
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17
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Van Den Noortgate N, Van Humbeeck L. Medical assistance in dying and older persons in Belgium: trends, emerging issues and challenges. Age Ageing 2021; 50:68-71. [PMID: 32574355 DOI: 10.1093/ageing/afaa116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
In 2002, the Belgian Act on euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. Subsequently, the number of reported euthanasia deaths increased every year. Specifically, the proportion of euthanasia deaths in older persons has risen significantly in the last few years. Since the conception of the Euthanasia Act, Belgian physicians have been confronted with challenges concerning euthanasia requests in older persons with polypathology, tiredness of life or dementia. By exploring these issues, this commentary highlights the importance of a meticulous and team-based assessment of the (i) seriousness of the underlying condition, (ii) voluntariness of the request and (iii) decisional capacity of the older person requesting euthanasia.
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18
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The Cost of Being Apart: The Contribution of Perceived Burdensomeness and Thwarted Belongingness to Suicide Ideation Among Israeli Older Adults. J Nerv Ment Dis 2020; 208:663-670. [PMID: 32520851 DOI: 10.1097/nmd.0000000000001198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Older adults have the highest suicide rates of all age groups in most industrialized countries. However, research concerning psychological risk factors for suicide among older adults is sparse. Thus, our study aimed to examine the contribution of perceived burdensomeness (PB) and thwarted belongingness (TB) to suicide ideation (SI) among older adults. Participants included 160 Israeli older adults (aged 65-91 years), who completed measures of suicide risk, PB, and TB as well as hopelessness and depression. Using hierarchical regression, we found that PB and TB accounted for 9.8% of the variance in SI and that the interaction of PB and TB had a significant unique contribution to SI among the participants, beyond the effect of hopelessness and depression. The study's findings highlight the contribution of interpersonal variables to SI among older adults and suggest that mental health professionals should be aware of PB and TB levels when assessing suicide risk among older adults.
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19
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Liu RT, Bettis AH, Burke TA. Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychol Med 2020; 50:367-383. [PMID: 31907085 PMCID: PMC7024002 DOI: 10.1017/s003329171900391x] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear. METHODS We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO. RESULTS A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons. CONCLUSIONS Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
| | - Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
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20
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McLaren S. The Relationship between living alone, sense of belonging, and depressive symptoms among older men: the moderating role of sexual orientation. Aging Ment Health 2020; 24:103-109. [PMID: 30588832 DOI: 10.1080/13607863.2018.1531373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Living alone is a risk factor for depressive symptoms among older men, and is likely to occur due to belongingness needs being unmet. It is proposed the living alone-sense of belonging and living alone-depressive symptoms relations are stronger for gay men than heterosexual men, due to different family circumstances. This research tested a moderated mediation model, specifically whether the relationship between living alone and depressive symptoms is mediated by sense of belonging, and whether the living alone-sense of belonging and living alone-depressive symptoms relationships are moderated by sexual orientation.Method: A community sample of 169 Australian gay men aged 65 to 93 years and 187 Australian heterosexual men aged 65 to 94 years completed the Psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale.Results: Results supported the simple mediation model, with living alone being associated directly and indirectly with depressive symptoms via sense of belonging. The conditional indirect effect of living alone on depressive symptoms via sense of belonging was not significant, and therefore the moderated mediation model was not supported.Conclusion: Results imply that older men who live alone are at increased risk of depressive symptoms directly and indirectly via lower levels of sense of belonging.
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Affiliation(s)
- Suzanne McLaren
- School of Health and Life Sciences, Federation University Australia, Australia
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21
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Chu C, Buchman-Schmitt JM, Stanley IH, Hom MA, Tucker RP, Hagan CR, Rogers ML, Podlogar MC, Chiurliza B, Ringer-Moberg FB, Michaels MS, Patros C, Joiner TE. The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychol Bull 2017; 143:1313-1345. [PMID: 29072480 PMCID: PMC5730496 DOI: 10.1037/bul0000123] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, Tallahassee, FL
- McLean Hospital, Belmont, MA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA
| | | | - Ian H. Stanley
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Raymond P. Tucker
- Louisiana State University, Department of Psychology, Baton Rouge, LA
| | | | - Megan L. Rogers
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | - Bruno Chiurliza
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | | | - Connor Patros
- Temple University, Department of Psychology, Philadelphia, PA
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL
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22
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Interpersonal Needs, Depressive Symptoms, and Suicide Ideation in a Sample of Portuguese Elderly Patients Recovering from Acute Medical Conditions. J Clin Psychol Med Settings 2017; 25:1-10. [DOI: 10.1007/s10880-017-9520-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Lohman PhD MC, Raue PhD PJ, Greenberg RL, Bruce ML. Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial. Int J Geriatr Psychiatry 2016; 31:708-15. [PMID: 26552852 PMCID: PMC4861681 DOI: 10.1002/gps.4381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. METHODS Data come from the cluster-randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12-month follow-up. SI was measured using the Hamilton Rating Scale for Depression item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed-effects models. RESULTS A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (odds ratio = 0.51, 95% CI; 0.24-1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. CONCLUSION SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long-term reduction in SI among high-risk patients. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Matthew C. Lohman PhD
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Patrick J. Raue PhD
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Rebecca L. Greenberg
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Martha L. Bruce
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
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