Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older

The association between living alone and depressive symptoms in older adults population: evidence from the China Health and Retirement Longitudinal Study

Objective

The goal of this research was to reveal the association between living alone and depressive symptoms in older adults. It also aims to explore the mediating role of social activity and adult children's relationship satisfaction. Ultimately, the study seeks to add to the body of knowledge for lowering the risk of depression among older people and promoting positive aging.

Methods

Based on information from the 2020 China Health and Retirement Longitudinal Study, the ordinary least square (OLS) regression model and propensity score matching (PSM) were used to investigate the association between living alone and depressive symptoms in older adults and to explore possible heterogeneity in different groups. Utilizing the SPSS PROCESS macro application, the mediation model was constructed. The significance of the mediation effect was investigated using the Bootstrap technique.

Results

The average level of depressive symptoms of older people living alone (10.55 ± 6.962) was higher than that of older people who do not live alone (8.80 ± 6.363). The baseline regression analysis revealed a significant connection between living alone and the depressive symptoms of older people (β = 0.842, p < 0.001). The association between living alone and the level of depressive symptoms was significantly higher in those aged 60-74 years (β = 1.698, p < 0.001) than in those aged 75 and older (β = 0.953, p < 0.05). The association between living alone and depressive symptoms was significantly higher in rural older adults (β = 1.512, p < 0.001) than in urban older adults (β = 1.141, p < 0.001). Between living alone and the level of depressive symptoms experienced by older people, there was a substantial mediation impact on social engagement and adult children's relationship satisfaction, which contributed to 2.91 and 13.62% of the overall effect.

Conclusion

For older age groups, living alone is associated with higher levels of depressive symptoms. This effect is stronger in older adults aged 60-74 or rural areas. In older age groups, the association between living alone and depressive symptoms is mediated by social activity and adult children's relationship satisfaction.

Suicidal ideation, attempt and associated factors among people with cancer attending cancer center, eastern Ethiopia

Background

Suicide is one of the most common public health problems and the second leading cause of death among individuals 15-29 years of age. Suicidal ideation and attempt are one of the common psychiatric emergence in patients with cancer that needs early detection and management before patients end their lives. Therefore, the aim of the study was to assess the magnitude of suicidal ideation, attempts, and associated factors among people with cancer in Eastern Ethiopia.

Methods

An institutional-based cross-sectional study design was conducted among 362 participants. A composite international diagnostic interview was used to evaluate suicidal ideation and attempt. Epi-Data version 4.6.2 was used for data entry, and SPSS version 20 was used for analysis. Logistic regression analysis was done to identify associated factors for both suicidal ideation and attempt. p-values less than 0.05 are considered statistically significant, and the strength of the association will be represented by an adjusted odds ratio with a 95% confidence interval.

Results

The magnitude of suicidal ideation and attempt among people with in this study was 22.9% [95% CI, 18.7-27.4] and 9.8% [95%CI, 6.7-12.8] respectively. Being living alone [AOR = 4.90, 95% CI, 2.08-11.90], and having depressive symptoms [AOR = 3.28, 95% CI, 1.37-7.73], female ([AOR = 1.53, 95% CI, 1.30-3.23], anxiety symptoms [AOR = 3.06, 95% CI, 1.35-6.73)] and having poor social support [AOR = 3.08, 95% CI, 1.72-5.05], were significantly associated suicidal ideation whereas, Being living alone [AOR = 2.89, 95% CI, 1.09-7.65], having a depressive symptoms [AOR = 4.88, 95% CI, 1.45-13.28], being divorced/widowed [AOR = 3.46, 95% CI, 1.09-10.09] and stage four cancer [AOR = 5.53, 95% CI 2.97-7.47] were significantly associated with suicidal attempt.

Conclusion

Nearly one-quarter and one-tenth of people with cancer have suicide ideation and attempt, respectively. Suicidal behavior among cancer patients was found in this study to be a common problem. Living alone, having depressive and anxiety symptoms, being a female, having poor social support, and being in forth stage of cancer were risk factors for suicide. Therefore, early screening, diagnosing, and treating suicide and its factors will be mandatory and expected from health care providers and non-governmental organizations.

Mindfulness mediates the relationship between positive parenting and aggression, depression, and suicidal ideation: A longitudinal study in middle school students

Previous research has indicated that parenting factors affect the risk of maladaptive psychological outcomes (e.g., aggression, depression, or suicidal ideation), and that positive parenting is a prospective risk factor for maladaptive psychological outcomes. However, the mechanisms underlying the relationships between positive parenting, mindfulness, and maladaptive psychological outcomes remain unknown, as do the processes that mediate the effect of positive parenting on maladaptive psychological outcomes in adolescents. The objective of the present study was to investigate the longitudinal relationship between positive parenting, mindfulness, and maladaptive psychological outcomes in middle school students, as well as the mediating effect of mindfulness in the relationships between positive parenting and depression, aggression, and suicidal ideation. In this study, 386 middle school children (aged 12–16) were tested three times over a period of 6 months. Positive parenting was assessed at Time 1, mindfulness at Time 2, and depression, aggression, and suicidal ideation at Time 3. Using structural equation modeling, positive parenting was revealed to be longitudinally associated with mindfulness and negatively associated with maladaptive psychological outcomes. More crucially, mindfulness mediated the relationship between positive parenting and maladaptive psychological outcomes. This research provides important insights into how to effectively decrease adolescent maladaptive psychological outcomes and highlights the importance of teaching mindfulness to youths.

Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort study

Background

Owing to the COVID-19 outbreak, older adults living alone, who can only connect socially outside their homes, are at risk of social isolation and poor mental health. This study aimed to identify the changes, before and after COVID-19, by sex and age, in social relationships (social activity, social network, and social support) and mental health (depression and suicide ideation) among older adults living alone.

Methods

This is a prospective cohort study of community-dwelling older adults who were at least 65 years old and living alone in South Korea. The study was conducted during 2018–2020 with 2,291 participants (795, 771, and 725 for the 1st to 3rd waves, respectively). The data were collected via face-to-face interviews. A generalized linear mixed modeling framework was used to test for changes over three years.

Results

Social activity was reduced after the COVID-19, with an interaction effect of sex: older women (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.15–0.23; p < .001) showed greater reduction than older men (OR, 0.50; 95% CI, 0.34–0.75; p < .001). Interaction with neighbors also reduced after the pandemic, but there was no significant evidence of interaction effects. Interaction with family members increased in both sexes during the pandemic, with the interaction effect of sex: older women (OR, 1.40; 95% CI, 1.11–1.76; p = .004) showed greater increase than men (OR, 1.55; 95% CI, 1.13–2.14; p = .007). Social support increased in both sexes during the pandemic, but there was no significant evidence of interaction effects. Depression and suicide ideation showed no significant differences before and after the pandemic.

Conclusions

The findings provide health administrators and health providers with explorative insights into the impact of the COVID-19 on social relationships and mental health among older adults living alone and can guide further studies of interventions considering specific properties of social relationships.

Association between hearing loss and suicidal ideation among middle-aged and older adults

OBJECTIVES

Hearing loss (HL) is regarded as a major risk factor for late-life depression. This study aims to further examine the association between HL and suicidal ideation (SI) among middle-aged and older adults using a nationally representative sample.

METHOD

The study sample comprised 34,142 adults (aged 50+) drawn from the 2015 to 2018 National Survey on Drug Use and Health. SI was measured by response to the question, 'At any time in the past year, did you seriously think about trying to kill yourself?' HL was assessed by asking respondents whether they were deaf or had serious difficulty hearing. Multivariate logistic regression analyses were conducted to examine the association between HL and SI after adjusting for a comprehensive list of covariates.

RESULTS

Compared to those without HL, middle-aged and older adults with HL experienced significant health disparities regarding history of hospitalization, poor perceived health, higher prevalence of chronic diseases, depression, substance use, and SI. HL was positively associated with SI in the past year in both middle-aged (aOR = 1.59, 95% CI [1.14, 2.21], p < .001) and older adult groups (aOR = 1.58, 95% CI [1.07, 2.33], p < .001), controlling for depression, substance use, health status, and sociodemographic variables.

CONCLUSION

Given the high prevalence of hearing loss (HL) in aging populations, this study aimed to expand our knowledge of the relative strength of association between HL and SI. Findings implied that healthcare providers should consider screening for SI in those with HL.

The Social Hopelessness Questionnaire (SHQ): Psychometric properties, distress, and suicide ideation in a heterogeneous sample of older adults

BACKGROUND

Older adults have high rates of suicide, necessitating attention to psychological factors that confer risk for suicide. Hopelessness is significantly associated with psychological despair and suicide risk factors; however, research has been limited by unidimensional treatment of the construct. The purpose of the present study was thus to investigate the psychometric properties of the Social Hopelessness Questionnaire (SHQ; Flett et al., 2021), a 20-item measure of hopelessness in the interpersonal domain, in a heterogeneous sample of older adults.

METHODS

Ninety adults 65 years of age or older were recruited from community, residential, or healthcare facilities in the context of a validation study of the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006). Participants voluntarily completed the SHQ, a demographics form, and concurrent measures of global hopelessness, depressive symptom severity, suicide ideation, and subjective well-being.

RESULTS

The SHQ demonstrated strong internal consistency, construct validity by way of significant positive associations with negative psychological factors and negative associations with positive factors, and differentiated older adults recruited from community and mental health settings. It also explained significant variability in depression, suicide ideation, and subjective well-being beyond that accounted for by an age-specific measure of global hopelessness.

LIMITATIONS

Findings were limited by a small clinical sub-sample, relatively few male participants, cross-sectional analysis, and focus on suicide ideation rather than suicide behavior.

CONCLUSION

These findings suggest that the SHQ is a reliable and valid measure of an interpersonal form of hopelessness for use with older adults across diverse settings.

Screening for suicide risk among older adults: assessing preliminary psychometric properties of the Brief Geriatric Suicide Ideation Scale (BGSIS) and the GSIS-Screen

OBJECTIVES

To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen).

METHODS

A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173).

RESULTS

Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings.

CONCLUSION

Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.

The Relationship Between Living Alone and Depressive Symptoms Among Older Gay Men: The Moderating Role of Age

Living alone is a risk factor for depressive symptoms among older gay men. It is likely this relationship strengthens as gay men age, due to social isolation and fewer family supports. This study investigated whether the relationship between living alone and depressive symptoms was moderated by age among older gay men. A community sample of 270 Australian gay men aged 60 to 91 years (M = 68.81, SD = 8.69) completed the Center for Epidemiologic Studies-Depression Scale. Results supported the moderation model. The Johnson-Neyman analysis indicated that living alone was associated with depressive symptoms among gay men aged older than 66.28 years. Results imply that gay men older aged in their mid-sixties and older who live alone are at increased risk of depressive symptoms, and are a group of men that need targeted interventions to reduce depressive symptoms.

Social isolation and suicide risk: Literature review and perspectives

Background

Suicide is a major public health problem and a cause of premature mortality. With a view to prevention, a great deal of research has been devoted to the determinants of suicide, focusing mostly on individual risk factors, particularly depression. In addition to causes intrinsic to the individual, the social environment has also been widely studied, particularly social isolation. This paper examines the social dimension of suicide etiology through a review of the literature on the relationship between suicide and social isolation.

Methods

Medline searches via PubMed and PsycINFO were conducted. The keywords were “suicid*” AND “isolation.”

Results

Of the 2,684 articles initially retrieved, 46 were included in the review.

Conclusions

Supported by proven theoretical foundations, mainly those developed by E. Durkheim and T. Joiner, a large majority of the articles included endorse the idea of a causal relationship between social isolation and suicide, and conversely, a protective effect of social support against suicide. Moreover, the association between suicide and social isolation is subject to variations related to age, gender, psychopathology, and specific circumstances. The social etiology of suicide has implications for intervention and future research.

Suicide among older adults: Interactions among key risk factors

OBJECTIVE

The present study aimed to understand how key risk factors of older adult suicide interact to ultimately lead to death by suicide using data collected post-mortem.

METHOD

A psychological autopsy was used to gather detailed information about psychiatric diagnosis, medical problems, social isolation, and negative attitudes expressed by the individual during the six months prior to their death. Interviews with next-of-kin, medical and psychiatric records, and the Cumulative Illness Rating Scale for Geriatrics were used. Subjects included 32 older adults who died by suicide and 45 older adults who died by natural causes.

RESULTS

Hopelessness, depression, and negative health attitudes were strongly correlated with suicide. Older age was associated with social isolation, suggesting an indirect relationship with suicide via hopelessness, depression, and negative health attitudes. Physical illness did not increase risk. Multivariate analyses suggested that hopelessness fully mediated the effects of social isolation, negative health attitudes, and depression on suicide.

CONCLUSIONS

Psychological factors played the largest role in suicide deaths compared to social isolation and physical illness. Suicide interventions aimed at older adults should ensure hopelessness, depression, and negative health attitudes are primary targets.

Suicide Distribution and Trends Among Male Older Adults in the U.S., 1999-2018

INTRODUCTION

This study examines the distribution and trends in suicide death rates among male adults aged ≥65 years in the U.S. from 1999 to 2018.

METHODS

Suicide mortality data were derived from Multiple Cause of Death from the Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database. Suicides were identified from the underlying causes of death. Joinpoint regression examined the distribution and shift in suicide age-adjusted death rates overall and by age groups, race/ethnicity, method of suicide, and urbanicity. Analyses were conducted in 2020.

RESULTS

Between 1999 and 2018, a total of 106,861 male adults aged ≥65 years died of suicide (age-adjusted rate=31.4 per 100,000 population, 95% CI=31.2, 31.6). Suicide rates showed a V-shaped trend. They were declining annually by 1.8% (95% CI= -2.4, -1.2); however, starting in 2007, there was a shift upward, increasing significantly by 1.7% per year for the next decade (95% CI=1.0, 1.6). Suicide rates were highest among those aged ≥85 years (48.8 per 100,000 population with an upward shift in 2008), Whites (35.3 per 100,000 population with an upward shift in trend in 2007), and the most rural communities (39.0 per 100,000 population). Most suicides were due to firearms (78.3% at a rate of 24.7 per 100,000 population), especially in rural areas, and shifted upward after 2007.

CONCLUSIONS

Increases in suicide rates among male older adults in the U.S., particularly after the 2007-2008 economic recession, are concerning. Tailored suicide prevention intervention strategies are needed to address suicide-related risk factors.

Determinants of Suicidal Ideation among Older Adults

Abstract. This study examined the relationship of depression and life satisfaction with suicidal ideation among older Iranian adults. In this cross-sectional study, a total of 159 older adults in Tehran (73% community-residing, 60 years or older) participated. The data were gathered using the Beck Scale for Suicidal Ideation (BSSI), the Geriatric Depression Scale (GDS), and the Life Satisfaction Index-Z (LSIZ). According to the results, depression and life satisfaction are significantly related to suicidal ideation; the two variables predict 0.39% of the variance of suicidal ideation in older adults ( p < .01). The interaction between depression and life satisfaction is a stronger predictor of suicidal ideation in older adults than each of the variables alone.

Excess Mortality From Suicide During the Early COVID-19 Pandemic Period in Japan: A Time-Series Modeling Before the Pandemic

BACKGROUND

Suicide amidst the coronavirus disease (COVID-19) pandemic is an important issue. In Japan, the number of suicides in April 2020 decreased by nearly 20% from that in 2019. To assess the impact of an infectious disease pandemic, excess mortality is often discussed. Our main purpose was evaluating excess mortality from suicide in Japan during the early pandemic period.

METHODS

We used data on suicides collected by the National Police Agency of Japan until June 2020. We estimated excess mortality during the early pandemic period (March-June 2020) using a time-series model of the number of suicides before the pandemic. A quasi-Poisson model was employed for the estimation. We evaluated excess mortalities by the categories of age and sex, and by prefecture.

RESULTS

No significant excess mortality was observed throughout the early pandemic; instead, a downward trend in the number of suicides for both sexes was noted. For males, negative values of excess mortalities below the lower bound of the 95% prediction interval were observed in April and May. All numbers of females during the period were included in the interval, and the excess mortalities in June were positive and higher than those in April and May. In Tokyo, the number of suicides was below the lower bound throughout the period.

CONCLUSION

Our results suggest that various changes, such as communication, and social conditions amid the early COVID-19 pandemic induced a decrease in suicides in Japan. However, continuous monitoring is needed to evaluate the long-term effects of the pandemic on suicides.

Development of a Suicide Prevention Toolkit for VA Home-Based Primary Care Teams

The U.S. Department of Veterans Affairs Home-Based Primary Care program (HBPC) serves Veterans with multiple comorbid physical and psychological conditions that can increase suicide risk. HBPC teams are uniquely able to implement suicide risk assessment and prevention practices, and the team's mental health provider often trains other team members. An online suicide prevention toolkit was developed for HBPC mental health providers and their teams as part of a quality improvement project. Toolkit development was guided by a needs assessment consisting of first focus group and then data from surveys of HBPC program directors (n = 53) and HBPC mental health providers (n = 56). Needs identified by both groups included training specific to the HBPC patient population and more resources if mental health needs could not be fully managed by the HBPC team. HBPC mental health providers within integrated care teams play a key role in clinical intervention, policy development, and interprofessional team education on suicide prevention. HBPC teams have specific learning and support needs around suicide prevention that can be addressed with a feasible, easily accessible clinical and training resource.

The Importance of Suicide Risk Formulation in Schizophrenia

Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.

Aging and Feeling Valued Versus Expendable During the COVID-19 Pandemic and Beyond: a Review and Commentary of Why Mattering Is Fundamental to the Health and Well-Being of Older Adults

The current commentary and review examines the potentially protective role of feelings of mattering among elderly people during typical times and the current atypical times associated with the COVID-19 global pandemic. Mattering is the feeling of being important to others in ways that give people the sense that they are valued and other people care about them. We contrast this feeling with messages of not mattering and being expendable and disposable due to ageism, gaps in the provision of care, and apparently economically focused positions taken during the pandemic that disrespect the value, worth, and merits of older persons. We provide a comprehensive review of past research on individual differences in mattering among older adults and illustrate the unique role of mattering in potentially protecting older adults from mental health problems. Mattering is also discussed in terms of its links with loneliness and physical health. This article concludes with a discussion of initiatives and interventions that can be modified and enhanced to instill a sense of mattering among older adults. Key directions for future research are also highlighted along with ways to expand the mattering concept to more fully understand and appreciate the relevance of mattering among older adults.

Clinical validation of the nursing diagnosis risk for suicide in the older adults

OBJECTIVE

To clinically validate risk factors for the nursing diagnosis risk for suicide in older adults.

METHODS

Case-control study (105 older adults). The strength of the association between variables was assessed using odds ratio (OR). Risk factors were grouped into hierarchical blocks according to the Integrated Motivational-Volitional Model of Suicidal Behaviour.

RESULTS

Anxiety; guilt; divorce; hostility; inability to express feelings; loss of important relationship; financial problems; apathy; low self-esteem; hopelessness; dependence and functional incapacity; unhappiness; failure; frustration; marked change in attitude and behavior; sadness; self-neglect; stockpiling medication; depression; ideation and suicidal plans; and mental disorders were associated with risk for suicide.

CONCLUSIONS

It is expected that this study will contribute to clinical nursing practice by the identification of this diagnosis in a safer and more precise manner. Descriptors: clinical judgment, nursing diagnosis, psychiatric nursing, suicide, older adult.

Association between personality traits and suicidality by age groups in a nationally representative Korean sample

Suicide is a leading health issue, which substantially contributes to the causes of death worldwide. Personality traits are some of the major risk factors for suicidality. We sought to identify the relationships between personality traits and suicidality by age group.The Big-Five Inventory-10 traits were measured in community-dwelling individuals in a nationally representative sample in the Republic of Korea. Because personality traits are long-standing patterns throughout one's lifetime, suicidality was measured based on lifetime history, rather than in a recent period. To comprehensively examine independent influences of personality traits on suicidality, psychiatric comorbidity and sociodemographic data were adjusted for.A total of 6022 subjects (3714 females and 2308 males) were included. Agreeableness (odds ratio (OR) [95% confidential intervals (CI)] = 0.79 [0.64-0.98]) was negatively associated with suicidal ideation, whereas neuroticism (1.27 [1.05-1.54]) and openness (1.36 [1.11-1.67]) were positively associated with suicidal ideation among young adults. Openness (1.25 [1.10-1.43]) had a positive association, and conscientiousness (0.86 [0.75-0.98]) had a negative association with suicidal ideation among the middle-aged group. Neuroticism is the only influencing factor for suicidal attempts among the young adult (1.88 [1.24-2.86]) and older (1.65 [1.24-2.20]) groups.Given the differential associations between personality traits and suicidality by age groups, future studies are needed to comprehensively identify possible roles of personality in suicide by age.

Self-compassion and family cohesion moderate the association between suicide ideation and suicide attempts in Chinese adolescents

BACKGROUND

In recent years, many studies have examined risks factors that facilitated the transition from suicide ideation to suicide attempts. Few studies, however, have examined protective factors against this transition. The current study thus assessed two protective factors, self-compassion and family cohesion, in buffering the transition from suicide ideation to suicide attempts.

METHOD

A number of 520 Chinese adolescents (43.46% females, mean age = 12.96 years) completed questionnaires assessing self-compassion, family cohesion, suicide ideation, and suicide attempts two times with a 12-month interval.

RESULTS

Self-compassion significantly moderated the association between Wave 1 SI and later SA. The positive dimension of self-compassion thwarted the transition from SI and SA, and the negative dimension of self-compassion strengthened the associations. In addition, family cohesion also significantly moderated the transition from SI to SA.

CONCLUSION

Increasing the levels of self-compassion and family cohesion may be the targets for treating adolescents with suicide ideation to prevent them from attempting suicide.

Enhancing the Assessment of Resiliency to Suicide Ideation among Older Adults: The Development and Initial Validation of the Reasons for Living-Suicide Resiliency Scale (RFL-SR)

Objectives: To derive a brief late-life suicide resiliency scale from the 69-item Reasons for Living Scale-Older Adult version (RFL-OA).Methods: We conducted a series of secondary analyses of RFL-OA data (N = 204) from a dataset combining: 1. A follow-up assessment of nursing home residents in the Geriatric Suicide Ideation Scale (GSIS) development study; 2. A trial of Interpersonal Psychotherapy (IPT) with suicidal older adults; 3. A longitudinal study of risk and resiliency to late-life suicide ideation. We specifically assessed the distributions of RFL-OA items and their associations with suicide ideation and behavior to create an RFL-Suicide Resiliency subscale (RFL-SR); we then tested the psychometric properties of this measure's items drawn from the larger RFL-OA.Results: Nine RFL-OA items were significantly associated with suicide ideation and history of suicide behavior and were not highly correlated with social desirability. Psychometric analyses supported the internal consistency, test-retest reliability, and construct validity of this scale.Conclusions: The items of the RFL-SR demonstrated strong psychometric properties with older adults in clinical and community settings.Clinical Implications: The RFL-SR may make a useful addition to suicide risk assessment in gerontological research and clinical practice.

The Relationship between living alone, sense of belonging, and depressive symptoms among older men: the moderating role of sexual orientation

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.

Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement

Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.

A study on household headship, living arrangement, and recipient of pension among the older adults in association with suicidal risks

BACKGROUND

This study aims to examine whether variation in socioeconomic factors indicative of lower status within families in later life, such as the elderly losing their household headship, living with descendants, and having no pension are associated with suicidal risks among the older adults aged 60 years and above in the world.

METHODS

Using the data from the Global Burden of Disease Study in 2015, the suicide age ratios (i.e., suicide rate ratios between older adults aged >=60 years versus the younger groups aged <60 years) for the 173 regions were computed and compared. The suicide age ratio rather than the actual rate is used to adjust the difference in base rates among different countries. Forest plots were performed to assess whether late-life status within families moderated the worldwide patterns of suicide age ratios. Regression analyses were used to estimate the extent to which the factors reflecting family status affect suicide age ratios. Gender-specific analyses were also performed.

RESULTS

The results showed that higher suicide age ratios were significantly found in regions with lower percentages of the elderly being heads of households (ratios=1.69 vs 2.73, P<0.01), higher percentages of co-residence of the elderly with their descendants (ratios=2.72 vs 1.39, P<0.01), and lower percentages of the elderly receiving a pension (ratios=1.42 vs 2.76, P<0.01). In the adjusted regression, having no pension remained to be a significant determinant for both overall population (P = 0.01) and men (P<0.01) but not for women (P = 0.29), and loss of household headship was only significant for men (P = 0.05) but not for either overall population (P = 0.22) or women (P = 0.55), whereas the elderly living with their descendants was no longer significant for either overall population (P = 0.60) or both genders (men: P = 0.72; women P = 0.11).

LIMITATIONS

The cross-sectional data do not allow to explore causal effect analyses.

CONCLUSIONS

This is the first global study to reveal associations between lower socioeconomic status within families and higher rates of suicide among older adults aged 60 years and above compared with the younger population. Thus, the present ecological findings suggest that strategies to enhance the socioeconomic status of older adults may be important to prevent suicides in later life both within and across countries.

Geographical Patterns in Drug-Related Mortality and Suicide: Investigating Commonalities in English Small Areas

There are increasing concerns regarding upward trends in drug-related deaths in a number of developed societies. In some countries, these have been paralleled by upward trends in suicide. Of frequent concern to public health policy are local variations in these outcomes, and the factors underlying them. In this paper, we consider the geographic pattern of drug-related deaths and suicide for 2012-2016 across 6791 small areas in England. The aim is to establish the extent of commonalities in area risk factors between the two outcomes, with a particular focus on impacts of deprivation, fragmentation and rurality.

Social Relationships and Suicidal Ideation Among the Elderly Who Live Alone in Republic of Korea: A Logistic Model

With population aging and change in family structure, the number of the elderly who live alone is rapidly increasing in Korea. The aim of this study was to explore the association between social relationships—especially newly formed formal social relationships (FSRs)—and suicidal ideation among Korean elderly who live alone. The elderly who live alone (N = 2509) from the 2014 Survey of Living Conditions and Welfare Needs of Older Koreans were analyzed using logistic regression. This study found that informal social relationships (ISRs) (eg, children, friends and neighbors) of the elderly who live alone had statistically significant association with suicidal ideation, whereas FSRs (eg, formal helper and social participation) did not have significant association with suicidal ideation. The findings of this study suggest that the Korean Government needs to strengthen public system for alleviating social isolation of the elderly living alone. Therefore, this study proposed 2 strategic approaches to maintain and strengthen ISRs and to develop different types of FSRs (eg, the measures to combine FSRs with ISRs, gatekeepers, etc).

Associations between health-related self-efficacy and suicidality

BACKGROUND

Few studies have focused on exploring the association of self-efficacy and suicidal behaviour. In this study, we aim to investigate the association between health-related self-efficacy and suicidality outcomes, including lifetime/recent suicidal ideation, suicidal attempts and future intent of suicide.

METHODS

A computer-assisted telephone interview (CATI) system was used to draw potential respondents aged over 15 in Taiwan via telephone numbers, which were selected by a stratified proportional randomization method according to the distribution of population size in different geographic areas of Taiwan. We obtained available information on suicide behaviours for the analysis of 2110 participants. Logistic regression was applied to investigate the independent effect of health-related self-efficacy on life-time suicidal thoughts and attempts.

RESULTS

Suicidality measured as suicide ideation and attempted suicide was reported as 12.6 and 2.7% respectively in the sample. Among those with suicide ideation, 9.8% had thoughts of future suicide intent. Female gender, low education, people living alone or separated, history of psychiatric disorders, substance abuse, poor self-rated mental health and physical health were associated with suicidality factors. Low health-related self-efficacy was associated with lifetime suicide ideation, prior suicide attempt and future suicidal intent. Among those with recent suicidal ideation, low health self-efficacy was independently associated with future suicide intent after adjustment of gender, age, education, marital status, substance abuse, psychological distress, poor mental and physical health.

CONCLUSION

Health-related self-efficacy was associated with suicide risks across different time points from prior ideation to future intention. Evaluation of the progress of self-efficacy in health may be long-term targets of intervention in suicide prevention strategies.

An interesting phenomenon in immigrant spouses and elderly suicides in Taiwan

BACKGROUND

Immigration is a global issue. Taiwan has a high proportion of immigrant spouses who take care of the aging parents-in-law at home mainly based on filial piety. Difficulties in communication in many aspects of daily life occur between the elderly and immigrant spouses, and result in the elderly becoming vulnerable and thus, influencing their psychological well-being. Although past studies demonstrated that due to cultural differences, employed foreign care providers negatively influenced elder care quality (e.g., care receipts' health or mortality rates), no studies have explored whether immigrant spouses, as family caregivers, have any influence on elderly suicides due to cross cultural communication differences.

OBJECTIVE

To address the above gap, this study was to examine the static relationship between immigrant spouses and elderly suicides.

METHOD

National-level authority data, comprising a 10-year longitudinal nationwide sample, were used. The number of immigrant spouses was treated as a proxy of cultural differences. Twelve models of outcomes with and without city- and time-fixed effects were conducted using panel data analysis.

RESULTS

Descriptive statistics of the study variables are provided. The results revealed that overall the number of immigrant spouses had a positive correlation with suicides in older adults. Further, the gender of immigrant spouses had different impacts on elderly suicides.

CONCLUSIONS

This is the first study to examine relation between immigrant spouses and the elderly suicides. The study results provide another viewpoint of understanding of the role of immigrant spouses in elder care, while promoting elder-caregiver interactions for optimal elder health outcomes.

The relationship between living alone and depressive symptoms among older gay men: the moderating role of sense of belonging with gay friends

BACKGROUND

Living alone is a risk factor for depressive symptoms among older adults, although it is unclear if it is a risk factor for older gay men. A sense of belonging to the gay community is protective and might compensate for living alone. This research investigated whether a sense of belonging with gay friends weakened the relationship between living alone and depressive symptoms among older gay men.

METHODS

A community sample of 160 Australian gay men aged 65-92 years completed the Center for Epidemiologic Studies Depression Scale and two visual analogue scales assessing a sense of belonging with gay friends.

RESULTS

Results supported the moderation model, with increasing levels of belonging with gay friends weakening the relationship between living alone and depressive symptoms.

CONCLUSION

Results imply that enhancing a sense of belonging with gay friends among older gay men who live alone is likely to be a protective factor in relation to depressive symptoms.

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

OBJECTIVES

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

DESIGN

Retrospective, observational, epidemiological study using routinely collected data.

SETTING

Jiading District, Shanghai.

METHODS

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

RESULT

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

CONCLUSIONS

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

Reasons for living and hope as the protective factors against suicidality in Chinese patients with depression: a cross sectional study

BACKGROUND

The risk factors of suicidal ideation and attempts have been discussed in many researches. Few studies have examined reasons for living and hope as protective factors against suicide in a clinical population. It is unclear if these factors help to reduce suicide rates in patients with depression. The study aimed to assess the role of reasons for living and hope in the identification and reduction of suicidality and explore the influence of reasons for living or hope in the transition from suicidal ideation to suicide attempts.

METHODS

Patients with depression (N = 115) completed the Beck Depression Inventory, Reasons for Living Inventory, and Adult Suicidal Ideation Questionnaire.

RESULTS

There were significant correlations among depression, hope, total reasons for living, and suicidal ideation and attempts. Further, after controlling for depression, reasons for living and hope had significant main effects on suicidal ideation. Hope also had a significant predictive effect in the transition of suicidal ideation to suicide attempt.

CONCLUSIONS

We concluded that reasons for living and hope may protect against suicidal ideation and attempts in patients with depression. Especially hope could reduce the possibility of suicide attempt.

Reasons for living, meaning in life, and suicide ideation: investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults

OBJECTIVES

To investigate the roles of reasons for living (RFL) and meaning in life (MIL) in potentially promoting mental health and well-being and protecting against suicide ideation among community-residing older adults and to investigate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA).

METHOD

Of 173 older adults initially recruited into a longitudinal study on late-life suicide ideation, 109 completed the RFL-OA and measures of cognitive and physical functioning and positive and negative psychological factors at a two-year follow-up assessment. We tested a model in which RFL and MIL protect against suicide ideation, controlling for demographic and clinical factors. We also assessed the psychometric properties of the RFL-OA in community-residing older adults, investigating its internal consistency and its convergent (MIL, perceived social support, and life satisfaction), divergent (loneliness, depressive symptom severity, and suicide ideation), and discriminant validity (cognitive and physical functioning).

RESULTS

RFL-OA scores explained significant variance in suicide ideation, controlling for age, sex, depressive symptom severity, and loneliness. MIL explained significant unique variance in suicide ideation, controlling for these factors and RFL, and MIL significantly mediated the association between RFL and suicide ideation. Psychometric analyses indicated strong internal consistency (α = .94), convergent, divergent, and discriminant validity for the RFL-OA relative to positive and negative psychological factors and cognitive and physical functioning.

CONCLUSION

These findings add to a growing body of literature suggesting merit in investigating positive psychological factors together with negative factors when assessing suicide risk and planning psychological services for older adults.

Understanding suicide among older adults: a review of psychological and sociological theories of suicide

OBJECTIVES

Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions.

METHOD

In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults.

RESULTS

Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults.

CONCLUSION

To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory.

Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults

OBJECTIVES

To investigate the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults.

METHOD

We recruited 173 voluntary participants, 65 years and older, into a 2+ year longitudinal study of the onset or exacerbation of depressive symptoms and suicide ideation. We assessed the internal consistency of the GSIS and its four component subscales, and its shorter and longer duration test-retest reliability, convergent (depression, social hopelessness, and loneliness), divergent (psychological well-being, life satisfaction, perceived social support, and self-rated health), discriminant (basic and instrumental activities of daily living and social desirability), criterion (history of suicide behavior), and predictive validity (future suicide ideation).

RESULTS

The GSIS demonstrated strong test-retest reliability and internal consistency. Baseline GSIS scores were significantly positively associated with suicide risk factors, negatively associated with potential resiliency factors, and not associated with functional impairment or social desirability. GSIS scores significantly differentiated between participants with as compared to those without a history of suicide behavior. Baseline GSIS scores significantly predicted suicide ideation at a 2+ year follow-up assessment.

CONCLUSION

Findings suggest strong measurement characteristics for the GSIS with community-residing older adults, including impressive consistency over time. These results are consistent with research attesting to the empirical and pragmatic strengths of this measure. These findings have implications for the monitoring of suicide risk when aiming to enhance mental health and well-being and prevent suicide in later life.

Do reasons for living protect against suicidal thoughts and behaviors? A systematic review of the literature

BACKGROUND

Few studies have investigated protective factors against suicide.

OBJECTIVES

To identify whether reasons for living (RFL), measured with the Reasons for Living Inventory (RFLI), protect against suicidal ideation (SI), attempts (SA) and suicide death.

METHOD

This systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) statement guidelines. PubMed database was searched for studies published until October 2015. Studies were eligible if they used RFLI or one of its versions. All eligible studies were included, regardless of study design, quality indicators, and target populations. No publication year limit was imposed. We included 39 studies.

RESULTS

RFL may protect against SI and SA and yield a predictive value. The role of two specific reasons for living (Moral Objections to Suicide and Survival and Coping Beliefs) was particularly emphasized. No study investigating suicide death was found.

CONCLUSION

RFL may moderate suicide risk factors and correlate with resilience factors. Moreover, RFL may depend on and interact with numerous factors such as DSM-IV Axis I disorders, personality disorders and features, coping abilities and social support. Clinicians could develop therapeutic strategies aimed at enhancing RFL, like Dialectical Behavior Therapy and Cognitive Behavioral Therapies, to prevent suicidal thoughts and behaviors and improve the care management of suicidal patients.

Measurement Scales of Suicidal Ideation and Attitudes: A Systematic Review Article

Background: The main aim of this study was to accumulate research evidence that introduce validated scales to measure suicidal attitudes and ideation and provide an empirical framework for adopting a relevant assessment tool in studies on suicide and suicidal behaviors.

Methods: Medical Subject Headings’ (MeSH) terms were used to search Ovid Medline, PROQUEST, Wiley online library, Science Direct and PubMed for the published articles in English that reported application of an scale to measure suicidal attitudes and ideation from January 1974 onward.

Results: Fourteen suicidal attitude scale and 15 scales for assessing suicidal ideation were identified in this systematic review. No gold standard approach was recognized to study suicide related attitudes and ideations.

Conclusion: Special focus on generally agreed dimensions of suicidal ideation and attitudes and cross-cultural validation of the introduced scales to be applicable in different ethnic and socially diverse populations could be a promising area of research for scholars.

Middle-aged and older adults who had serious suicidal thoughts: who made suicide plans and nonfatal suicide attempts?

BACKGROUND

High suicide rates in late middle-aged and older adults are significant public health problems. Although suicide risk and protective factors are well established, more research is needed about suicide planners and attempters. Using multi-year, national epidemiologic survey data, this study identified correlates of making suicide plans and nonfatal suicide attempts among U.S. adults aged 50+ years.

METHODS

Data are from the 2008 to 2012 U.S. National Survey on Drug Use and Health (NSDUH). Descriptive statistics were used to examine sample characteristics by past-year serious suicidal thoughts, suicide plans, and suicide attempts. Binary logistic regression analyses were used to examine potential correlates (sociodemographic factors, health status, religiosity, psychiatric and substance use disorders (SUDs), and mental health and substance abuse treatment use) of suicide plans and suicide attempts among those who reported serious suicidal thoughts.

RESULTS

Of the 2.5% of the study population that had serious suicidal thoughts (n = 804), 28% made suicide plans and 11.5% attempted suicide. Although 42% of those with serious suicidal thoughts had major depressive episode (MDE), MDE was not significantly associated with suicide plans or attempts in multivariate models. Being employed decreased the odds of making suicide plans, while mental health service use was associated with increased odds of suicide plans. SUDs increased the odds of suicide attempts.

CONCLUSIONS

It is important to screen middle-aged and older adults for severe mental and SUDs and suicidal thoughts and to target interventions for likely planners and attempters.

Adapting interpersonal psychotherapy for older adults at risk for suicide

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.

Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study

BACKGROUND

Suicide is a global issue among the elderly, but few studies have explored the experiences of suicide ideation in older Asian psychiatric outpatients.

METHOD

Older psychiatric outpatients (N = 24) were recruited by convenience from one medical centre and one regional hospital in northern Taiwan. Participants were recruited if they met these inclusion criteria: 1) ≥ 65 years old, 2) without severe cognitive deficit, 3) outpatients in the psychiatric clinics at the selected hospitals, and 4) self-reported first episode of suicidal ideation within the previous year. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis.

RESULTS

Suicide ideation was triggered by illness and physical discomfort, conflicts with family members/friends, illness of family members, death of family members/friends, and loneliness. Participants' reasons for not executing suicide were family members' and friends' support, receiving treatment, finding a way to shift their attention, fear of increasing pressure on one's children, religious beliefs, and not knowing how to execute suicide.

CONCLUSION

Understanding these identified triggers of suicide ideation may help psychiatrists open a channel for conversation with their elderly clients and more readily make their diagnosis. Understanding these identified protective factors against executing suicide can help psychiatrists not only treat depression, but also enhance protective factors for their clients.

Psychosocial predictors of suicidal ideation in patients diagnosed with chronic illnesses in Jordan

Suicide ideation (SI) is considered a major psychiatric emergency in patients diagnosed with chronic illnesses. Suicide ideation is a multifaceted issue that involves bio- psychosocial and cultural factors that interfere with patients' abilities. The purpose of this study is to investigate the psychosocial predictors of SI among Jordanian patients with chronic illnesses. A cross-sectional design using self-administered questionnaires was used to collect data from 480 patients diagnosed with diabetes mellitus, cardiovascular diseases, and cancer. The mean score of suicide ideation was 4.07 (SD  =  1.7) and almost 20% (n  =  85) of the participants found to be suicidal, the majority were suffering from moderate to severe depressive symptoms and low levels of life satisfaction. Also, the analysis showed that the patients had a high level of optimism and moderate perception of social support from family, friends, and significant other. Type of illness has a significant relation to the 'seriousness' component of SI (p  =  0.023). Depression (β  =  0.345, p<0.001) was a significant risk factor for 'thought' component of SI, and optimism (β  =  -0.008, p<0.05) a significant protective factor against the thought component of SI. Patients with chronic illnesses suffer serious psychological disturbances and are in need of psychological care, and periodic psychological screening to maintain their psychological wellbeing.

Serotonergic genes and suicidal ideation 2 weeks and 1 year after stroke in Korea

OBJECTIVES

Serotonergic genes are associated with suicidal behavior; this association has not been tested in stroke survivors, however. In this study, we investigated whether serotonin transporter (5-HTT) and serotonin 2a receptor (5-HTR2a) genes were associated with suicidal ideation at 2 weeks and at 1 year after stroke.

METHODS

A total of 286 patients were evaluated 2 weeks after stroke, and 222 (78%) participated in a follow-up evaluation one year later. Suicidal ideation was ascertained using the "suicidal thoughts" item of the Montgomery and Asberg Depression Rating Scale. Associations between suicidal ideation and 5-HTTLPR, STin2 VNTR, 5-HTR2a 1438A/G, and 5-HTR2a 102T/C genotypes were estimated using logistic regression models, and gene-gene interactions were investigated using the generalized multifactor dimensionality reduction method after adjustment for potential covariates, including depression.

RESULTS

The 5-HTR2a 1438 A/A genotype was significantly associated with suicidal ideation 2 weeks after stroke, before and after statistical adjustment. The 5-HTTLPR short allele was associated with suicidal ideation 2 weeks after stroke, although the significance of this finding was not evident after adjustment. No significant associations were observed between any genotype and suicidal ideation one year after stroke. No significant gene-gene interactions were detected.

CONCLUSIONS

Individuals with the 5-HTR2a 1438 A/A genotype were more susceptible to suicidal ideation 2 weeks after stroke. Careful evaluation and management are indicated for those with increased genetic vulnerability, particularly during the acute phase of stroke.

Suicide and death ideation in older adults obtaining aging services

OBJECTIVES

To assess the frequency and correlates of death and suicide ideation in older adults accessing aging services.

DESIGN

Cross-sectional.

SETTING

Data for this study were collected via in-home interviews.

PARTICIPANTS

Aging Services Network (ASN) care management clients aged 60 years and older (N = 377) were recruited for this study.

MEASUREMENT

The PHQ-9 and the Paykel Suicide Scale were used to assess death and suicide ideation. Correlates of death and suicide ideation were also examined.

RESULTS

Fourteen percent of subjects endorsed current death or suicide ideation, 27.9% of subjects endorsed death ideation in the past year, and 9.3% of subjects endorsed suicide ideation in the last year. Current death and suicide ideation were associated with greater depressive symptoms. As compared with individuals without ideation, individuals with death ideation demonstrated higher levels of depressive symptoms, more medical conditions, and lower social support. Individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and less perceived social support. Finally, as compared with individuals with death ideation, individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and more alcohol misuse.

CONCLUSIONS

Death and suicide ideation are common among ASN clients. There were both differences and similarities between correlates of death and suicide ideation. ASN providers are uniquely situated to address many of the correlates of suicide ideation identified in this study; in order to effectively manage suicide ideation in an ASN setting, however, links to primary and mental health care providers are necessary.

Suicide: An Indian perspective

Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. There has been an increase in the rates of suicide in India over the years, although trends of both increases and decline in suicide rates have been present. Distinct from global demographic risk factors, In India, marital status is not necessarily protective and the female: male ratio in the rate of suicide is higher. The motives and modes of suicide are also distinct from western countries. Preventive strategies implemented at a community level and identifying vulnerable individuals maybe more effective than global strategies.