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Huang D, Wang J, Fang H, Fu Y, Lou J. Longitudinal association of chronic diseases with depressive symptoms in middle-aged and older adults in China: Mediation by functional limitations, social interaction, and life satisfaction. J Glob Health 2023; 13:04119. [PMID: 37766663 PMCID: PMC10534192 DOI: 10.7189/jogh.13.04119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background Several previous studies have shown that the development of depression is often accompanied by chronic diseases; although closely related, the mechanism between them is not clear. Here we investigate the potential role of functional limitations, social interaction, and life satisfaction in the relationship between chronic diseases and depressive symptoms in middle-aged and older adults in China. Methods We selected 2407 respondents aged ≥45 from the China Health and Retirement Longitudinal Study conducted in 2013, 2015, and 2018. We established panel data to estimate the longitudinal impact of chronic diseases on depressive symptoms and the mediating role of functional limitations, social interaction, and life satisfaction. Results Chronic diseases were associated with more depressive symptoms. All of the mediating pathways examined passed functional limitations, and approximately 43.4% of the association between chronic diseases and depressive symptoms was explained by these three mediating variables. Conclusions The impact of chronic diseases on depressive symptoms was primarily mediated by functional limitations, and the mediating role of social interaction and life satisfaction was also confirmed. Therefore, attention should be paid to reducing the level of functional limitation in middle-aged and older adults with chronic diseases and improving life satisfaction by increasing social opportunities to alleviate depressive symptoms in middle-aged and older adults.
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Affiliation(s)
- Derong Huang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jian Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Huiling Fang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yingjie Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jiaxu Lou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, China
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Kim H, Kwak S, Yoo SY, Lee EC, Park S, Ko H, Bae M, Seo M, Nam G, Lee JY. Facial Expressions Track Depressive Symptoms in Old Age. SENSORS (BASEL, SWITZERLAND) 2023; 23:7080. [PMID: 37631616 PMCID: PMC10459725 DOI: 10.3390/s23167080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Facial expressions play a crucial role in the diagnosis of mental illnesses characterized by mood changes. The Facial Action Coding System (FACS) is a comprehensive framework that systematically categorizes and captures even subtle changes in facial appearance, enabling the examination of emotional expressions. In this study, we investigated the association between facial expressions and depressive symptoms in a sample of 59 older adults without cognitive impairment. Utilizing the FACS and the Korean version of the Beck Depression Inventory-II, we analyzed both "posed" and "spontaneous" facial expressions across six basic emotions: happiness, sadness, fear, anger, surprise, and disgust. Through principal component analysis, we summarized 17 action units across these emotion conditions. Subsequently, multiple regression analyses were performed to identify specific facial expression features that explain depressive symptoms. Our findings revealed several distinct features of posed and spontaneous facial expressions. Specifically, among older adults with higher depressive symptoms, a posed face exhibited a downward and inward pull at the corner of the mouth, indicative of sadness. In contrast, a spontaneous face displayed raised and narrowed inner brows, which was associated with more severe depressive symptoms in older adults. These findings suggest that facial expressions can provide valuable insights into assessing depressive symptoms in older adults.
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Affiliation(s)
- Hairin Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Seyul Kwak
- Department of Psychology, Pusan National University, Busan 46241, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Eui Chul Lee
- Department of Human-Centered Artificial Intelligence, Sangmyung University, Hongjimun 2-Gil 20, Jongno-Gu, Seoul 03016, Republic of Korea
| | - Soowon Park
- Division of Teacher Education, College of General Education for Truth, Sincerity and Love, Kyonggi University, Suwon 16227, Republic of Korea
| | - Hyunwoong Ko
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul 06355, Republic of Korea
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Minju Bae
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Myogyeong Seo
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Gieun Nam
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
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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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Linking chronic diseases, cognitive impairment and depressive symptoms in Chinese older adults: A three-wave population-based longitudinal study. J Affect Disord 2023; 324:496-501. [PMID: 36621673 DOI: 10.1016/j.jad.2022.12.150] [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: 12/15/2021] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Despite previous studies illustrate that chronic diseases are risk factors for older adults' psychological health, little is known about its mediating mechanism. This study aims to examine the mediating effect of cognitive impairment. Also, a particular emphasis is placed on whether the Hukou system in China contributes to the adverse effect of chronic diseases on depressive symptoms. METHODS Using the 2014, 2016 and 2018 rounds of the China Longitudinal Aging Social Survey (CLASS), this study estimates fixed-effect panel models for the effect of chronic diseases on depressive symptoms and the mediating effect of cognitive impairment. Meanwhile, the interaction effect of chronic diseases and hukou status on depressive symptoms is also examined. RESULTS The significant relationship between chronic diseases and depressive symptoms is supported in Chinese older adults and this association is found to be mediated by cognitive impairment. Moreover, no urban-rural disparities exist in the effect of chronic diseases on depressive symptoms. LIMITATION All of the measures in this study are relied on self-report, which may result in reporting biases. CONCLUSION This study contributes to our understanding of the relationship between chronic diseases and depressive symptoms and extends the previous literature by considering the Hukou status, a highly distinctive Chinese variable. Practical implications for policy development and intervention design are also provided.
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Grande E, Vichi M, Alicandro G, Marchetti S, Frova L, Pompili M. Suicide mortality among the elderly population in Italy: A nationwide cohort study on gender differences in sociodemographic risk factors, method of suicide, and associated comorbidity. Int J Geriatr Psychiatry 2022; 37. [PMID: 35524717 DOI: 10.1002/gps.5726] [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: 07/29/2021] [Accepted: 04/20/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed at investigating gender differences in the relationship between sociodemographic factors and suicide mortality, as well as in the method used for suicide and the presence of comorbidities in an older population in Italy. METHODS/DESIGN We conducted a historical cohort study based on individual record linkage across the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides among people aged 75 years or older from 2012 to 2017 were analyzed. Crude mortality rates were computed, and cause-specific mortality rate ratios were estimated using negative binomial regression models. Chi-square tests were used to evaluate significant gender differences in suicide methods and comorbidities associated with suicide. RESULTS The study included 9,686,698 individuals (41% men, 59% women). Compared to living alone, living with children or partners reduced suicide mortality, especially among men. Having high or medium educational levels was associated with lower mortality than low educational levels among men. Foreign citizens had lower mortality among men, but not among women. Living in urban areas was associated with lower suicide rates in men and higher rates in women. Methods of suicide significantly differed by gender: leading methods were hanging, strangulation, and suffocation in men, and falling from height in women. Mental comorbidity was significantly more frequent among women, especially at ages 75-84 years. CONCLUSIONS We believe that our findings might help to promote public health strategies taking gender differences in old age into account to improve social support and quality of life of older men and women.
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Affiliation(s)
- Enrico Grande
- National Institute of Statistics, Integrated System for Health, Social Assistance and Welfare, Rome, Italy
| | - Monica Vichi
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Gianfranco Alicandro
- National Institute of Statistics, Integrated System for Health, Social Assistance and Welfare, Rome, Italy.,Department of Pathophysiology and Transplantatation, Università degli Studi di Milano, Milan, Italy.,Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Marchetti
- National Institute of Statistics, Integrated System for Health, Social Assistance and Welfare, Rome, Italy
| | - Luisa Frova
- National Institute of Statistics, Integrated System for Health, Social Assistance and Welfare, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Abstract
Abstract
This paper explores the concept of the completed life outlined in recent writing in the Netherlands on euthanasia and assisted suicide and its implications for ageing studies. Central to this theme is the basic right of people to self-determine the length of their later life, linked with the subsidiary right to assistance in achieving such self-determination. Although the notion of weariness with life has a long history, the recent advocacy of a self-limited life seems shaped by the new social movements presaged upon individual rights together with what might be called a distinctly third-age habitus, giving centre stage to autonomy over the nature and extent of a desired later life, including choice over the manner and timing of a person's ending. In exploring this concept, consideration is given to the notion of a ‘right to die’, ‘rational suicide’ and the inclusion of death as a lifestyle choice. While reservations are noted over the unequivocal good attached to such self-determination, including the limits to freedom imposed by the duty to avoid hurt to society, the article concludes by seeing the notion of a completed life as a challenge to traditional ideas about later life.
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Heterogeneous association patterns of depressive subfactors in suicidality: The 2014 and 2016 Korea National Health and Nutrition Examination Surveys. J Affect Disord 2020; 272:183-190. [PMID: 32379614 DOI: 10.1016/j.jad.2020.04.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The heterogeneity of depressive symptoms in suicidality is poorly understood. This study examines the heterogeneous association between subfactors of depressive symptoms in suicidality. METHODS The data of 5742 participants aged 19 and older were taken from the 2014 and 2016 Korean National Health and Nutrition Examination Surveys and analyzed. Subfactors of depressive symptoms were identified utilizing factor analyses that yielded two groups (typical- and other-depressive factors). Multivariable logistic regression models were used to estimate the association between each factor and suicidality after adjusting for covariates. RESULTS Typical depressive factors included cardinal and somatic symptoms, whereas other depressive factors contained cognitive and other symptoms. The typical factors were associated with each suicidality in succession, however, others depressive factors were not. The heterogeneity of subfactors made the greatest impact on suicide attempts, controlling for all covariates, followed by suicide plans, with a robust coefficient of typical depressive factors. These differential patterns of subfactors existed especially in females and younger people, suggesting the importance of concerning typical depressive factors for those groups. LIMITATIONS Although a confirmatory factor analysis was performed, depressive subfactors need validation and reliability tests. CONCLUSIONS Our study findings may help to explain why an improved understanding of the typical depressive factors including cardinal and somatic symptoms is important to prevent suicidality, especially in females and younger people.
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Adriaenssens J, Benahmed N, Ricour C. Improving mental healthcare for the elderly in Belgium. Int J Health Plann Manage 2019; 34:e1948-e1960. [PMID: 31347202 DOI: 10.1002/hpm.2858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/06/2019] [Accepted: 07/09/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The organisation of mental healthcare for the elderly (MHCE) remains suboptimal. OBJECTIVE To identify specific organisational models that could address the mental healthcare needs of the elderly in community and primary care. METHOD A multi-modal approach, consisting of a literature review, an online survey of Belgian professional stakeholders, and an international comparison. The outcomes of this three-step study process were aggregated. RESULTS Two general and four operational strategies for organising MHCE were identified as well as barriers and incentives to MHCE in the community and primary care. About half of survey respondents perceived the current MHCE in Belgium not to meet quality criteria as described in the literature and proposed points of improvement. The transversal international comparison revealed interesting approaches for MHCE. Recommendations for the future were formulated. CONCLUSION MHCE requires a specific, low-threshold, holistic, and transdisciplinary approach. Specific strategies with emphasis on collaborative care should be applied to meet the needs of older adults with mental problems. General practitioners (GPs) can play a central role in community-oriented MHCE but should be supported by specialised healthcare providers (including old-age psychiatrists and geriatricians). Stigma and wrong beliefs, regarding the elderly population, should be tackled by means of campaigns.
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Affiliation(s)
| | | | - Céline Ricour
- Belgian Health Care Knowledge Centre, Brussels, Belgium
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Wei J, Ying M, Xie L, Chandrasekar EK, Lu H, Wang T, Li C. Late-life depression and cognitive function among older adults in the U.S.: The National Health and Nutrition Examination Survey, 2011-2014. J Psychiatr Res 2019; 111:30-35. [PMID: 30660811 DOI: 10.1016/j.jpsychires.2019.01.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/20/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
Discrepancies exist on the associations of late-life depression with cognition, and synergistic effect of depression and diabetes on cognition among older adults was suggested in literature. We aimed to examine the associations of late-life depression with cognitive function in a representative sample of older adults in the U.S., and to examine the associations among individuals with diabetes. A total of 3101 adults aged 60 and above of the 2011-2014 National Health and Nutrition Examination Survey who completed measurements of depressive symptoms and diabetes were included in cross-sectional analyses. The 9-item Patient Health Questionnaire (PHQ-9) was used to measure depressive symptoms (including overall, somatic and cognitive). Clinically relevant depression (CRD) and clinically significant depression (CSD) were defined by cutoffs of PHQ-9. Domain-specific cognitive function was examined using Delayed Word Recall Test, Digit Symbol Substitution Test, and Animal Fluency Test for memory, executive function/processing speed, and language, respectively. Z scores were created for overall cognition and specific domains. Multivariable linear regression models were applied to examine the association of depressive symptoms and scale-defined depression with cognition z scores. The overall, somatic and cognitive depressive symptoms were associated with lower cognitive function among older adults. Both CRD (β = -0.20, 95% CI: -0.28, -0.12) and CSD (β = -0.56, 95% CI: -0.75, -0.37) were associated with lower cognition. A synergistic relationship was found between depression and diabetes on lower cognition. These results suggested that cognition among older adults may be modified by late-life depression, and older adults with both depression and diabetes may be particularly impacted on cognition.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Meiling Ying
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Liyang Xie
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Haidong Lu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tiansheng Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Changwei Li
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
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Grover S, Sahoo S, Avasthi A, Lakdawala B, Dan A, Nebhinani N, Dutt A, Tiwari S, Gania A, Subramanyam A, Kedare J, Suthar N. Prevalence of suicidality and its correlates in geriatric depression: A multicentric study under the aegis of the Indian Association for Geriatric Mental Health. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_35_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang W, Liu L, Tang F, Dong X. Social Engagement and Sense of Loneliness and Hopelessness: Findings From the PINE Study. Gerontol Geriatr Med 2018; 4:2333721418778189. [PMID: 30035197 PMCID: PMC6050621 DOI: 10.1177/2333721418778189] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/09/2017] [Accepted: 02/05/2018] [Indexed: 11/21/2022] Open
Abstract
Among older Chinese adults in the United States, depression is a common health problem. Using data from the first population-based survey of older Chinese Americans (N = 2,929) and applying negative binomial and ordinary least squares regression models, this study examines the relationship between social engagement (including cognitive activity and social activity) and sense of loneliness and hopelessness. Findings reveal that social engagement is significantly and negatively related to both loneliness and hopelessness after controlling for sociodemographic characteristics and health status. In addition, it is found that different aspects of social engagement present differential associations with sense of loneliness and hopelessness: Social activity is significantly associated with lower rate ratios of loneliness, whereas cognitive activity is significantly related to reduced levels of hopelessness. Our findings address the importance of engaging in cognitively stimulating and socially integrating activities in promoting psychological well-being for U.S. Chinese older adults.
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Affiliation(s)
- Wei Zhang
- University of Hawai'i at Mānoa, Honolulu, USA
| | - Lin Liu
- University of Hawai'i at Mānoa, Honolulu, USA
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Zhao J, Verwer RWH, Gao SF, Qi XR, Lucassen PJ, Kessels HW, Swaab DF. Prefrontal alterations in GABAergic and glutamatergic gene expression in relation to depression and suicide. J Psychiatr Res 2018; 102:261-274. [PMID: 29753198 DOI: 10.1016/j.jpsychires.2018.04.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Abstract
People that committed suicide were reported to have enhanced levels of gene transcripts for synaptic proteins in their prefrontal cortex (PFC). Given the close association of suicide with major depressive disorder (MDD), we here assessed whether these changes are related to suicide or rather to depression per se. We used quantitative PCR to determine mRNA levels of 32 genes encoding for proteins directly involved in glutamatergic or GABAergic synaptic transmission in postmortem samples of the anterior cingulate cortex (ACC) and the dorsolateral PFC (DLPFC). Seventy-two brain samples from 3 groups of subjects were derived from the Stanley Medical Research Institute (SMRI): i) patients with MDD who committed suicide (MDD-S), ii) MDD patients who died of non-suicidal causes (MDD-NS) and iii) age-matched, non-psychiatric control subjects. In the ACC, a significantly enhanced expression of genes related to glutamatergic or GABAergic synaptic transmission was found only in MDD-S patients, whereas in MDD-NS patients, decreased levels for these transcripts were found. Moreover, in the DLPFC, expression of these genes was decreased in MDD-S, relative to MDD-NS patients, whereas both groups showed increased expression compared to control subjects. In conclusion, our findings indicate that MDD is associated with increases in GABA and glutamate related genes in the DLPFC (irrespective of suicide), while in the ACC, the increase in GABA and glutamate related genes may relate to suicide, rather than to MDD per se.
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Affiliation(s)
- J Zhao
- Neuropsychiatric Disorders Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - R W H Verwer
- Neuropsychiatric Disorders Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - S-F Gao
- Neuropsychiatric Disorders Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - X-R Qi
- Neuropsychiatric Disorders Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - P J Lucassen
- Center for Neuroscience, SILS, University of Amsterdam, Amsterdam, The Netherlands
| | - H W Kessels
- Synaptic Plasticity & Behavior Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - D F Swaab
- Neuropsychiatric Disorders Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Does Recognition of Meaning in Life Confer Resiliency to Suicide Ideation Among Community-Residing Older Adults? A Longitudinal Investigation. Am J Geriatr Psychiatry 2016; 24:455-66. [PMID: 26880611 DOI: 10.1016/j.jagp.2015.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To test a theoretical model of the onset and/or exacerbation of late-life suicide ideation, incorporating consideration of risk, resiliency, and precipitating factors. DESIGN A longitudinal study investigating whether recognition of meaning in life (MIL) at baseline confers resiliency to the onset and/or exacerbation of suicide ideation over a 6- to 22-month period of follow-up, controlling for baseline depression, self-rated health, and physical functioning, and for frequency and intensity of intervening daily hassles. SETTING Mental health research offices in an urban academic health sciences center. PARTICIPANTS 173 community-residing older adults (mean: 73.9 years, SD: 6.1 years, range: 65-93 years) recruited from health, wellness, and interest programs, and from newspaper ads and flyers posted in London, Ontario, a mid-sized Canadian city. A total of 126 (73%) completed follow-up assessments. MEASUREMENTS Participants completed a demographics form, a cognitive screen, and measures of suicide ideation and of risk (depressive symptom severity, self-rated health problems, and physical functioning) and potential resiliency (recognition of MIL) factors at baseline and follow-up assessment points, and a measure of intervening daily hassles. RESULTS MIL at baseline was negatively associated with the onset and/or exacerbation of suicide ideation over time, controlling for risk factors and intervening precipitating factors. The extent and relative significance of this finding differed with the manner in which MIL and suicide ideation were operationalized. CONCLUSIONS Study findings add to a growing body of knowledge suggesting that MIL may play an important role in promoting mental health and well-being and potentially conferring resiliency to contemplations of suicide in later life.
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Herbeck Belnap B, Schulberg HC, He F, Mazumdar S, Reynolds CF, Rollman BL. Electronic protocol for suicide risk management in research participants. J Psychosom Res 2015; 78:340-5. [PMID: 25592159 PMCID: PMC4422492 DOI: 10.1016/j.jpsychores.2014.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe an electronic, telephone-delivered, suicide risk management protocol (SRMP) that is designed to guide research staff and safely triage study participants who are at risk for self-harm. METHODS We tested the SRMP in the context of the NIH-funded randomized clinical trial "Bypassing the Blues" in which 302 patients who had undergone coronary artery bypass graft surgery (CABG) were screened for depression and assessed by telephone 2-weeks following hospital discharge and at 2-, 4-, and 8-month follow-up. We programmed the SRMP to assign different risk levels based on patients' answers from none to imminent with action items for research staff keyed to each of them. We describe frequency of suicidal thinking, SRMP use, and completion of specific steps in the SRMP management process over the 8-month follow-up period. RESULTS Suicidal ideation was expressed by 74 (25%) of the 302 study participants in 139 (13%) of the 1069 blinded telephone assessments performed by research staff. The SRMP was launched in 103 (10%) of assessments, and the suicidal risk level was classified as moderate or high in 10 (1%) of these assessments, thereby necessitating an immediate evaluation by a study psychiatrist. However, no hospitalizations, emergency room visits, or deaths ascribed to suicidal ideation were discovered during the study period. CONCLUSION The SRMP was successful in systematically and safely guiding research staff lacking specialty mental health training through the standardized risk assessment and triaging research participants at risk for self-harm. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00091962 (http://clinicaltrials.gov/ct2/show/NCT00091962?term=rollman+cabg&rank=1).
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Affiliation(s)
- Bea Herbeck Belnap
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Herbert C Schulberg
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, United States
| | - Fanyin He
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Sati Mazumdar
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Heisel MJ, Talbot NL, King DA, Tu XM, Duberstein PR. Adapting interpersonal psychotherapy for older adults at risk for suicide. Am J Geriatr Psychiatry 2015; 23:87-98. [PMID: 24840611 PMCID: PMC4211998 DOI: 10.1016/j.jagp.2014.03.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 02/28/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To pilot a psychological intervention adapted for older adults at risk for suicide. DESIGN A focused, uncontrolled, pre-to-post-treatment psychotherapy trial. All eligible participants were offered the study intervention. SETTING Outpatient mental health care provided in the psychiatry department of an academic medical center in a mid-sized Canadian city. PARTICIPANTS Seventeen English-speaking adults 60 years or older, at risk for suicide by virtue of current suicide ideation, death ideation, and/or recent self-injury. INTERVENTION A 16-session course of Interpersonal Psychotherapy (IPT) adapted for older adults at risk for suicide who were receiving medication and/or other standard psychiatric treatment for underlying mood disorders. MEASUREMENTS Participants completed a demographics form, screens for cognitive impairment and alcohol misuse, a semi-structured diagnostic interview, and measures of primary (suicide ideation and death ideation) and secondary study outcomes (depressive symptom severity, social adjustment and support, psychological well-being), and psychotherapy process measures. RESULTS Participants experienced significant reductions in suicide ideation, death ideation, and depressive symptom severity, and significant improvement in perceived meaning in life, social adjustment, perceived social support, and other psychological well-being variables. CONCLUSIONS Study participants experienced enhanced psychological well-being and reduced symptoms of depression and suicide ideation over the course of IPT adapted for older adults at risk for suicide. Larger, controlled trials are needed to further evaluate the impact of this novel intervention and to test methods for translating and integrating focused interventions into standard clinical care with at-risk older adults.
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Affiliation(s)
- Marnin J. Heisel
- Departments of Psychiatry and of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry,Corresponding author. Department of Psychiatry, The University of Western Ontario, LHSC-Victoria Hospital, 800 Commissioners Road East, Room #A2-515, London, Ontario, N6A-5W9, Canada; phone: (519) 685-8500, ext. 75981; fax: (519) 667-6707;
| | - Nancy L. Talbot
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - Deborah A. King
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Veterans Health Administration VISN 2 Center of Excellence for Suicide Prevention
| | - Xin M. Tu
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - Paul R. Duberstein
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry
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Innamorati M, Pompili M, Di Vittorio C, Baratta S, Masotti V, Badaracco A, Conwell Y, Girardi P, Amore M. Suicide in the old elderly: results from one Italian county. Am J Geriatr Psychiatry 2014; 22:1158-67. [PMID: 23890752 DOI: 10.1016/j.jagp.2013.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate factors differentiating old-old elderly (those aged 75 years and older) who died by suicide from middle-aged (those aged 50-64 years) and young-old (aged 65-74 years) adults who took their own lives, and from living psychiatric outpatients 75 years and older who had no suicidal behaviors in the last 12 months before assessment. METHODS Cases for psychological autopsy interviews were 117 old-old elderly who died by suicide between 1994 and 2009. Comparisons were 97 young-old adult and 98 middle-aged suicide victims and 117 psychiatric outpatients admitted to the Department of Psychiatry of the University of Parma (Parma, Italy) between 1994 and 2009. Information for suicide decedents was gathered through proxy-based interviews, and data regarding living comparison subjects were extracted from medical records. RESULTS A high number of old-old elderly were widowed and lived alone before death; widowhood was more prevalent in the old-old elderly than in the younger suicide groups and the psychiatric outpatients. In addition, old-old elderly were more frequently characterized by the presence of life stressors in the few months before death compared with the psychiatric outpatients. CONCLUSIONS Clinicians involved in the prevention of suicide in older adults should pay particular attention to loneliness and lack of social support, two conditions that may push the individual to feel hopeless, especially in those individuals who are facing stressful life events.
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Affiliation(s)
- Marco Innamorati
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Cristina Di Vittorio
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Stefano Baratta
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Vittoria Masotti
- Department of Anatomy, Pharmacology and Forensic Sciences, Section of Legal Medicine, University of Parma, Parma, Italy
| | - Annalisa Badaracco
- Department of Anatomy, Pharmacology and Forensic Sciences, Section of Legal Medicine, University of Parma, Parma, Italy
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology and Genetics, Section of Psychiatry, University of Genova, Genova, Italy
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Rios MA, Anjos KFD, Meira SS, Nery AA, Casotti CA. Completude do sistema de informação sobre mortalidade por suicídio em idosos no estado da Bahia. JORNAL BRASILEIRO DE PSIQUIATRIA 2013. [DOI: 10.1590/s0047-20852013000200006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar a completude dos dados do Sistema de Informação sobre Mortalidade sobre os óbitos por suicídio em idosos no estado da Bahia, no período de 1996 a 2010. MÉTODOS: Estudo epidemiológico, de desenho ecológico, com base em dados dos óbitos de idosos por suicídios, no estado da Bahia, disponibilizados no Sistema de Informação sobre Mortalidade, referentes ao período de 1996 a 2010, sendo calculada a incompletude das variáveis relacionadas aos óbitos e analisada por meio de um escore. Realizou-se análise de tendência temporal dos dados de incompletude por meio da estimação de modelos de regressão polinomial, utilizando o programa SPSS 15.0, com nível de significância de 5%. RESULTADOS: Registrou-se no período um total de 625 casos de suicídio em idosos. As taxas de não completude oscilaram de acordo com a variável e o ano, destacando-se raça/cor, escolaridade, fonte de informação e assistência médica como aquelas com os maiores índices de não preenchimento. Houve tendência decrescente para a não completude dos dados quanto a grau de instrução, raça/cor, fonte da informação e realização de necropsia para confirmação da causa básica do óbito. Para as demais variáveis não foram encontrados valores estatisticamente significantes nos modelos testados. CONCLUSÃO: Verificou-se melhoria na completude dos dados de suicídios em idosos na Bahia, sendo observadas tendências decrescentes ou não significativas estatisticamente.
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Davidson CL, Babson KA, Bonn-Miller MO, Souter T, Vannoy S. The impact of exercise on suicide risk: examining pathways through depression, PTSD, and sleep in an inpatient sample of veterans. Suicide Life Threat Behav 2013; 43:279-89. [PMID: 23901428 DOI: 10.1111/sltb.12014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 456] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Aylaz R, Aktürk Ü, Erci B, Öztürk H, Aslan H. Relationship between depression and loneliness in elderly and examination of influential factors. Arch Gerontol Geriatr 2012; 55:548-54. [PMID: 22487148 DOI: 10.1016/j.archger.2012.03.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 12/12/2022]
Abstract
This study was planned and conducted for the purpose of examining the relationship between depression and loneliness in elderly people and the influencing factors. The study was a descriptive and correlational study and its population consisted of 17,080 older individuals aged sixty and over who were registered at six Family Healthcare Centers (FHCs) located in the provisional center of Malatya. The sample of the study comprised of 913 elderly people who were chosen from the elderly people registered at the FHCs first by cluster sampling and then by simple random sampling from the clusters in proportion to the population. The data was collected between April and June 2011 using a questionnaire developed by the investigators in line with the literature, the Geriatric Depression Scale (GDS) and the UCLA Loneliness Scale (ULS). They had a mean score of 13.83 ± 7.4 from the GDS and 40.50 ± 12.1 from the ULS. A positive correlation was found between Geriatric Depression and loneliness (r=0.608, p<0.001). It was observed that there was a significant correlation between loneliness and depression in the elderly people living in a community, presence of social security and higher income, on the other hand, led to lower mean scores. In view of these results, it can be advised that a minimum income should be secured for elderly people whether they have social security or not, their families and the society should be trained not to leave elderly people alone.
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Affiliation(s)
- Rukuye Aylaz
- Department of Nursing, School of Health, Inonu University, Malatya 44280, Turkey.
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Minayo MCDS, Pinto LW, Assis SGD, Cavalcante FG, Mangas RMDN. Tendência da mortalidade por suicídio na população brasileira e idosa, 1980-2006. Rev Saude Publica 2012; 46:300-9. [DOI: 10.1590/s0034-89102012000200012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2001] [Accepted: 11/12/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever a mortalidade por suicídio no Brasil, com destaque para a população idosa. MÉTODOS: Análise temporal e estudo de tendência por regressão polinomial de suicídios na população acima de dez anos no Brasil e no Estado do Rio de Janeiro de 1980 a 2006. Os dados foram extraídos do Sistema de Informações sobre Mortalidade e as taxas, calculadas segundo sexo e faixa etária, considerando-se a população residente fornecida pelo Datasus por 100 mil habitantes. Para os anos de 1980 a 1995, utilizou-se a nona revisão da Classificação Internacional de Doenças e Problemas Relacionados à Saúde, e para 1996 a 2006, a décima revisão. RESULTADOS: Crescimento significativo foi observado nas taxas de suicídio na população brasileira e no Rio de Janeiro (5,7 e 3,1 para cada 100 mil habitantes, respectivamente) em 2006. Esse incremento ocorreu pelo aumento dos suicídios na população masculina em todas as idades. A curva crescente aconteceu principalmente entre homens maiores de 60 anos. O incremento não foi estatisticamente significativo entre homens e houve decréscimo entre mulheres no Rio de Janeiro. Os principais meios de suicídio utilizados pelos homens foram enforcamento, sufocação, estrangulamento e armas de fogo. Para as mulheres, o enforcamento também ocupou a primeira posição, seguido pela ingestão de substâncias, atiramento ao fogo e precipitação de altura. A elevada taxa de indefinição dos meios ressaltou problemas na qualidade dos dados. CONCLUSÕES: Suicídios são eventos significantes na população masculina, sobretudo entre homens idosos, ao longo do tempo. No Rio de Janeiro, as taxas entre homens idosos também são maiores, mas não estatisticamente significantes. Segundo a Organização Mundial da Saúde e o Ministério da Saúde, o suicídio é passível de prevenção e existem cuidados preconizados para cada grupo etário.
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Sun WJ, Xu L, Chan WM, Lam TH, Schooling CM. Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:505-14. [PMID: 21384121 PMCID: PMC3304054 DOI: 10.1007/s00127-011-0362-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 02/21/2011] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To examine dose-response associations between depressive symptoms and suicide and modification effects of sex, age and health status in older Chinese. METHODS We used the Chinese version of the 15-item Geriatric Depression Scale (GDS) to measure depressive symptoms (GDS score ≥ 8) and Cox regression to examine association with suicide mortality in a population-based cohort of 55,946 individuals, aged 65 years or above, enrolled from July 1998 to December 2000 at one of 18 Elderly Health Centres of Hong Kong Department of Health. The cohort was followed up for suicide mortality till 31 March 2009 (mean follow-up 8.7 years). RESULTS Depressive symptoms were associated with suicide in men [hazard ratio (HR) 2.03, 95% confidence interval (CI) 0.96-4.29] and women (HR = 2.36, 95% CI 1.31-4.24) after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. There was no threshold for GDS score and suicide in either sex. Age, sex and health status did not modify the association. CONCLUSIONS Depressive symptoms predict higher suicide risk in older Chinese in a dose-response pattern. These associations were not attenuated by adjustment for health status, suggesting that depressive symptoms in older people are likely to be an independent causal factor for suicide. The GDS score showed no threshold in predicting suicide risk, suggesting that older people with low GDS scores deserve further attention and those with very high scores need urgent intervention.
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Affiliation(s)
- Wen Jie Sun
- Department of Community Medicine, School of Public Health, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
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Dube P, Kurt K, Bair MJ, Theobald D, Williams LS. The p4 screener: evaluation of a brief measure for assessing potential suicide risk in 2 randomized effectiveness trials of primary care and oncology patients. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21494337 DOI: 10.4088/pcc.10m00978blu] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 05/27/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is the most common mental disorder, and suicide is its most serious consequence. The primary objective of this study was to evaluate preliminary evidence for the P4 screener as a brief measure to assess potential suicide risk. METHOD The P4 screener was prospectively evaluated in 2 randomized effectiveness trials of primary care (January 2005-June 2008; N = 250) and oncology patients (March 2006-August 2009; N = 309). Potential suicide ideation was assessed at 5 time points in both trials: baseline and 1, 3, 6, and 12 months. The P4 screener asks about the "4 P's": past suicide attempts, suicide plan, probability of completing suicide, and preventive factors. Patients were classified as minimal, lower, and higher risk based upon responses to these 4 items. RESULTS A suicide assessment was triggered 1 or more times by 17.6% (44 of 250) of Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) participants and 16.5% (51 of 309) of Indiana Cancer Pain and Depression (INCPAD) participants at some point in the trial. Of the patients who triggered a suicide assessment, the majority (29 of 44 in SCAMP and 27 of 51 in INCPAD) were classified as minimal risk by the algorithm. Only 1 (0.4%) of the SCAMP participants and 5 (1.6%) of the INCPAD participants were classified as higher risk. Among the latter, the most common factors preventing patients from attempting suicide were the "4 F's": faith, family, future hope, and fear of failing in their attempt. CONCLUSIONS Preliminary findings suggest that the P4 screener may be useful in assessing potential suicide risk in the clinical care of depressed patients as well as in clinical research. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00118430 (SCAMP) and NCT00313573 (INCPAD).
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Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ Open 2011; 1:e000198. [PMID: 22021884 PMCID: PMC3191598 DOI: 10.1136/bmjopen-2011-000198] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To characterise suicide-risk discussions in depressed primary-care patients. Design Secondary analysis of recordings and self reports by physicians and patients. Descriptive statistics of depression and suicide-related discussion, with qualitative extraction of disclosure, enquiry and physician response. Setting 12 primary-care clinics between July 2003 and March 2005. Participants 48 primary-care physicians and 1776 adult patients. Measures Presence of depression or suicide-related discussions during the encounter; patient and physician demographics; depression symptom severity and suicide ideation as measured by the Patient Health Questionnaire (PHQ9); physician's decision-making style as measured by the Medical Outcomes Study Participatory Decision-Making Scale; support for autonomy as measured by the Health Care Climate Questionnaire; trust in their physician as measured by the Primary Care Assessment Survey; physician response to suicide-related enquiry or disclosure. Results Of the 1776 encounters, 128 involved patients scoring >14 on the PHQ9. These patients were seen by 43 of the 48 physicians. Suicide ideation was endorsed by 59% (n=75). Depression was discussed in 52% of the encounters (n=66). Suicide-related discussion occurred in only 11% (n=13) of encounters. 92% (n=12) of the suicide discussions occurred with patients scoring <2 on PHQ9 item 9. Suicide was discussed in only one encounter with a male. Variation in elicitation and response styles demonstrated preferred and discouraged interviewing strategies. Conclusions Suicide ideation is present in a significant proportion of depressed primary care patients but rarely discussed. Men, who carry the highest risk for suicide, are unlikely to disclose their ideation or be asked about it. Patient-centred communication and positive healthcare climate do not appear to increase the likelihood of suicide related discussion. Physicians should be encouraged to ask about suicide ideation in their depressed patients and, when disclosure occurs, facilitate discussion and develop targeted treatment plans.
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Affiliation(s)
- Steven D Vannoy
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lynne S Robins
- Department of Medical Education and Bioinformatics, University of Washington, Seattle, Washington, USA
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Abstract
OBJECTIVES To examine whether there is an association between area socioeconomic status and the experience of suicidal ideation among older adults. DESIGN Secondary analyses of data from a prospective study of naturalistic outcomes of depressive symptoms. SETTING Monroe County, NY. PARTICIPANTS A cohort of older adults (≥65 years, N = 515) attending primary care settings. MEASUREMENTS Area socioeconomic status was based on the median household incomes of the census tracts (CTs) in which participants lived. At 6- and 12-month follow-up, the longitudinal interval follow-up evaluation was used to assess weekly depressive symptom status over the previous 6 months, which was used to construct a measure of any suicidal ideation during the study. RESULTS Residents of CTs with median household incomes of less than $30,000/yr were more likely to experience suicidal ideation than residents of higher income CTs (unadjusted odds ratio [OR], 4.60; 95% confidence interval [CI], 1.64-12.86). Adjustment for demographic and baseline clinical factors did not eliminate the association (OR, 5.44; 95% CI, 1.71-17.24). Subsequent models that adjusted for medical, functional, and psychosocial variables did not explain this association either. CONCLUSIONS There is a robust association between lower CT income and the occurrence of suicidal ideation in a primary care cohort of older adults over 1 year. These findings indicate the need for more research into how social worlds come to influence the emotional well being of older adults and whether social factors such as CT income can be used to identify individuals at increased risk for suicidal behavior.
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Minayo MCDS, Cavalcante FG. Suicídio entre pessoas idosas: revisão da literatura. Rev Saude Publica 2010; 44:750-7. [DOI: 10.1590/s0034-89102010000400020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/07/2010] [Indexed: 11/21/2022] Open
Abstract
Foi realizada revisão da literatura sobre os principais fatores associados à ideação, tentativas e suicídio propriamente dito de pessoas idosas. Foram pesquisadas as seguintes bases de dados: MEDLINE, PsychInfo, SciELO e Biblioteca Virtual em Violência e Saúde da BIREME, referentes ao período de 1980 a 2008. Foram selecionadas e analisadas 52 referências, que mostraram forte relação entre ideação, tentativas e efetivação do ato fatal em pessoas idosas, que resulta da interação de fatores complexos: físicos, mentais, neurobiológicos e sociais. O suicídio associado à depressão em idosos é prevenível desde que a pessoa esteja devidamente tratada. Há necessidade de investimento em pesquisa no Brasil, dado o crescimento persistente das taxas de suicídio entre idosos, sobretudo do sexo masculino.
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Sánchez-Villegas A, Pimenta AM, Beunza JJ, Guillen-Grima F, Toledo E, Martinez-Gonzalez MA. Childhood and young adult overweight/obesity and incidence of depression in the SUN project. Obesity (Silver Spring) 2010; 18:1443-8. [PMID: 19875985 DOI: 10.1038/oby.2009.375] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study included 11,825 participants of a Spanish dynamic prospective cohort based on former students from University of Navarra, registered professionals from some Spanish provinces, and university graduates from other associations, followed-up for 6.1 years. We aimed to assess the association between childhood or young adult overweight/obesity and the risk of depression. Participants were asked to select which of nine figures most closely represented their body shape at ages 5 and 20 years. Childhood and young adult overweight/obesity was defined as those cases in which participants reported body shape corresponding to the figures 6-9 (more obese categories) at age 5 or 20, respectively. A subject was classified as incident case of depression if he/she was initially free of depression and reported physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of biannual follow-up questionnaires. The association between childhood and young adult overweight/obesity and incidence of depression was estimated by multiple-adjusted hazard ratio (HR) and its 95% confidence interval (95% CI). Overweight/obesity at age 5 years predicted an increased risk for adult depression (HR = 1.50, 95% CI = 1.06-2.12), and a stronger association was observed at age 20 years ((HR = 2.22, 95% CI = 1.22-4.08), (subjects younger than 30 years at recruitment were excluded from this last analysis)). Childhood or young adult overweight/obesity was associated with elevated risk of adult depression. These results, if causal and confirmed in other prospective studies, support treating childhood and young adult overweight/obesity as part of comprehensive adult depression prevention efforts.
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Affiliation(s)
- Almudena Sánchez-Villegas
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention. Am J Geriatr Psychiatry 2010; 18:256-65. [PMID: 20224521 DOI: 10.1097/jgp.0b013e3181bf9edd] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine a) whether the Geriatric Depression Scale (GDS) can predict clinician-rated suicide ideation and depression, using the 15-, 5-, and 4-item versions, b) whether an additional suicide-ideation item would improve the performance, and c) whether the results vary by age groups. METHODS First-time psychiatric outpatients responded to the GDS. They were subsequently assessed by psychiatrists blind to the GDS, who also indicated whether suicide ideation was present. The performance of the GDS scales was evaluated using receiver operating characteristic curves. Analyses were conducted separately for young-old (aged 60-74 years) and old-old (aged 75 years or older) adults. RESULTS Areas under the curves showed that the different GDS versions were comparable in detecting depression and suicide ideation. For identifying depression, thresholds of 7, 2, and 2 for the 15-, 5-, and 4-item versions were optimal, respectively. In terms of detecting suicide ideation, all measures performed better in old-old than in young-old adults. A single, self-report suicide-ideation item performed better than all multiitem GDS measures. CONCLUSIONS Both the 4- and the 5-item versions are excellent alternatives to the 15-item version, and all are reasonable tools for detecting the presence of suicide ideation also. However, to improve the effectiveness of screening, brief measures of suicide risk should also be included. Even a 1-item measure of suicide ideation can improve clinical decisions tremendously.
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Abstract
OBJECTIVES Older adults have high rates of suicide and typically seek care in primary medical practices. Older adults often do not directly or spontaneously report thoughts of suicide, which can impede suicide prevention efforts. Therefore, the use of additional approaches to suicide risk detection is needed, including the use of screening tools. The objective of this study was to assess whether brief screens for depression have acceptable operating characteristics in identifying suicide ideation among older primary care patients and to examine potential sex differences in the screen's accuracy. METHODS We administered the 15-item Geriatric Depression Scale (GDS), which includes a 5-item GDS subscale (GDS-SI) designed to screen for suicide ideation, to a cross-sectional cohort of 626 primary care patients (235 men, 391 women) 65 years of age or older in the Northeastern United States. We assessed presence of suicide ideation with items from the Hamilton Rating Scale for Depression and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS Patients expressing suicide ideation (n = 69) scored higher on the GDS and GDS-SI than those who did not (n = 557). A GDS cut score of 4 maximized sensitivity (0.754) and specificity (0.815), producing an area under the curve of 0.844 (P < .001) and positive and negative predictive values of 0.335 and 0.964, respectively. Optimal cut scores were 5 for men and 3 for women. A GDS-SI cut score of 1 was optimal for the total sample and for both men and women. CONCLUSIONS The GDS and GDS-SI accurately identify older patients with suicide ideation. Research is needed to examine their acceptability and barriers to routine use in primary care.
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Abstract
SummarySuicide is accepted as a major health problem worldwide, especially in the young and middle aged. It is, however, a significant health problem in older people as well, and those aged 65 years and over generally have the highest suicide rates compared with all other age groups. In research literature from the last decade, there has been an increased interest in disentangling the phenomenon of suicide in later life. This paper aims to critically review the literature on suicide and suicidality in later life published from 2000 to 2009. Prevalence rates as well as risk and protective factors are mapped and correlates reviewed. The association between suicidality and help-seeking behaviour is considered. Finally, potential prevention strategies are reviewed.
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Kim O, Byeon YS, Kim JH, Endo E, Akahoshi M, Ogasawara H. Loneliness, Depression and Health Status of the Institutionalized Elderly in Korea and Japan. Asian Nurs Res (Korean Soc Nurs Sci) 2009; 3:63-70. [DOI: 10.1016/s1976-1317(09)60017-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 02/04/2009] [Accepted: 04/30/2009] [Indexed: 11/29/2022] Open
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Cukrowicz KC, Duberstein PR, Vannoy SD, Lynch TR, McQuoid DR, Steffens DC. Course of suicide ideation and predictors of change in depressed older adults. J Affect Disord 2009; 113:30-6. [PMID: 18617271 PMCID: PMC2673909 DOI: 10.1016/j.jad.2008.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 05/16/2008] [Accepted: 05/17/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rates of suicide among older adults in the United States are higher than that of other age groups. Therefore, it is critically important to deepen understanding of the processes that drive suicide risk among at-risk older patients. To this end, we examined the longitudinal course of suicide ideation in a sample of treatment-seeking depressed adults 60 years of age or older. METHODS Secondary analyses were conducted with a longitudinal dataset including 343 older adults seeking treatment for depression in the context of a naturalistic treatment setting. Participants completed assessments of depressive symptoms and thoughts of suicide every three months for one year. Multi-level mixed models were used to examine the trajectory of suicide ideation over five waves. RESULTS Depressive symptoms contributed significantly to change in thoughts of suicide early in treatment for depression. Age-related differences were also observed, such that increasing age was associated with significantly greater reports of suicide ideation. LIMITATIONS Use of a single measure to ascertain severity of depressive symptoms and thoughts of suicide. CONCLUSIONS Clinicians should expect to see the most pronounced decrease in thoughts of suicide during the first two months of depression treatment for older adults. Further, clinicians should be especially vigilant to monitor suicide ideation for adults, with increasing vigilance for those at more advanced ages.
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Affiliation(s)
- Kelly C Cukrowicz
- Department of Psychology, Texas Tech University, Lubbock, TX 79409-2051, USA.
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Current world literature. Curr Opin Psychiatry 2008; 21:651-9. [PMID: 18852576 DOI: 10.1097/yco.0b013e3283130fb7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Britton PC, Duberstein PR, Conner KR, Heisel MJ, Hirsch JK, Conwell Y. Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older. Am J Geriatr Psychiatry 2008; 16:736-41. [PMID: 18757767 PMCID: PMC2763305 DOI: 10.1097/jgp.0b013e31817b609a] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adults with mood disorders are at elevated risk for suicide. Psychological features such as hopelessness increase their risk for suicide ideation. Few studies have examined psychological constructs posited to lower risk for suicide ideation. The authors tested the hypothesis that reasons for living (RFL) are inversely related to suicide ideation. DESIGN This report is a secondary analysis of cross-sectional data. SETTING Participants were recruited from the clinical services of three teaching hospitals in Rochester, NY. PARTICIPANTS The sample consisted of 125 adults 50 years or older receiving treatment for a mood disorder. MEASUREMENTS A diagnostic interview and measures of suicide ideation, depression, hopelessness, and RFL were included in the assessment battery. Dependent variables were presence and severity of suicide ideation. Data were analyzed using multivariate logistic and linear regressions. RESULTS Patients who reported higher levels of fear of suicide were less likely to report suicide ideation. The relationships between hopelessness and both the presence and severity of suicide ideation were stronger among those who reported greater levels of responsibility to family. CONCLUSIONS Clinicians working with at-risk older adults are encouraged to explore their patients' RFL. These cross-sectional findings point to the need for prospective research examining the associations among different RFL, hopelessness, and suicide ideation in depressed older adults.
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Abstract
OBJECTIVES The aim of the present cross-sectional study was to evaluate the role of several variables hypothesized in previous research to be associated with suicide in older adults. DESIGN Psychological autopsy study. SETTING Suicides who were resident in the province of Parma and Piacenza and who died between 1994 and 2004. PARTICIPANTS Ninety-nine elderly suicides (age >or=65 years; 77 men and 22 women) and 134 younger comparison suicides (115 men and 19 women). Younger victims were subdivided in two more homogeneous groups: young adults (age <36 years) and adults (age: 36-64 years). MEASUREMENTS Direct proxy-based interviews with relatives and family physicians. RESULTS Elderly victims were nine times (OR = 9.09; 95% CI: 1.32-62.63) more likely to live alone, 26 times (OR = 26.76; 95% CI: 9.04-79.24) more likely to be retired, and 14 times (OR = 14.57; 95% CI: 2.48-85.65) more likely to have attended school for no more than 5 years than adult suicides. Although, more than 50% of older suicides were diagnosed as DSM-IV-TR depressed, only 20%-30% of them had been treated with medications. CONCLUSION Diverse patterns of risk factors for suicide have to be evaluated in older adults. Physicians must be aware that the concomitant presence of depressive symptoms and several life events (especially loss and loneliness in women and physical illness in men) should be considered warning signs for suicidal behavior.
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