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Lundy ME, Zhang B, Ditillo M. Management of the Geriatric Trauma Patient. Surg Clin North Am 2024; 104:423-436. [PMID: 38453311 DOI: 10.1016/j.suc.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
With a rapidly aging worldwide population, the care of geriatric trauma patients will be at the forefront of every career in Trauma and Acute Care Surgery. The unique intersection of advanced age, comorbidities, frailty, and physiologic changes presents a challenge in the care of elderly injured patients. It is well established that increasing age is associated with higher mortality and worse outcomes after injury, but it is also clear that there is room for improvement in the management of this special patient population.
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Affiliation(s)
- Megan Elizabeth Lundy
- University of Arizona Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 1501 North Campbell Avenue, Tucson, AZ 85724, USA. https://twitter.com/MLundyMD
| | - Bo Zhang
- University of Arizona Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 1501 North Campbell Avenue, Tucson, AZ 85724, USA. https://twitter.com/bo_zhang1
| | - Michael Ditillo
- University of Arizona Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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Mameniškienė R, Puteikis K. Can family members reliably assess mood and suicidal ideation in individuals with epilepsy? Epilepsy Behav 2023; 149:109537. [PMID: 37976790 DOI: 10.1016/j.yebeh.2023.109537] [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: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Routine detection of depression, anxiety and suicidal ideation in people with epilepsy (PWE) remains suboptimal. We investigated the level of agreement between PWE and their proxies when evaluating these psychiatric symptoms. METHODS From October 2021 to March 2022, we conducted a cross-sectional anonymous survey at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania). Persons accompanying PWE completed different scales measuring symptoms of depression and anxiety and evaluated suicidal ideation among PWE (defined as a non-zero score of the suicide item of the Beck depression inventory (BDI) or as a score > 1 of the item 4 of the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E). Agreement between PWE and their proxies was measured using the Wilcoxon test for paired samples and Pearson's correlation analysis. RESULTS The study included 140 PWE (mean age 41.0 ± 18.1, 71 (50.7 %) female) and 140 proxies (mean age 49.0 ± 15.01, 105 (75.0 %) female, 57 (40.7 %) were parents, 51 (36.4 %) - spouses, 15 (10.7 %) - partners, 11 (7.9 %) - children and 6 (4.3 %) - siblings of PWE). There were no statistical differences in paired scores of the BDI, Hospital Anxiety and Depression scale, Generalized Anxiety Disorder scale-7, and the NDDI-E (p > 0.05). Proxies reported statistically higher scores on the Geriatric Depression Scale (Z = - 2.026, p = 0.043) than PWE. The correlation between PWE and proxy evaluations for all instruments was moderate (varying from r = 0.500 to r = 0.688, p < 0.001). For most psychometric scales proxies became less accurate with higher scale scores for anxiety and depression and tended to underestimate the level of such symptoms (correlation between scale results and signed (PWE - proxy) mismatch varied from r = 0.368 to r = 0.641, p < 0.001). The measure of proxy-PWE agreement on suicidal ideation was low (Cohen's Κ = 0.192, p = 0.025); proxies missed 63 % (NDDI-E) to 70 % (BDI) of cases of suicidal ideation. CONCLUSION Companions of PWE provided comparable reports of participant anxiety and depression on a group level but tended to underestimate psychiatric symptoms as their scale scores became higher. Proxies significantly underreported suicidal ideation in those people who did express it. While proxy reporting should not be used interchangeably on an individual level, its use in group studies may be useful and ought to be investigated further.
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Affiliation(s)
- Rūta Mameniškienė
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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3
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Zang E, Guo A, Pao C, Lu N, Wu B, Fried TR. Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States. J Aging Health 2022; 34:720-735. [PMID: 35040695 DOI: 10.1177/08982643211060948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ObjectivesTo identify and examine heterogeneous trajectories of general health status (GHS) and depressive symptoms (DS) among persons with cognitive impairment (PCIs). Methods: We use group-based trajectory models to study 2361 PCIs for GHS and 1927 PCIs for DS from the National Health and Aging Trends Survey 2011-2018, and apply multinomial logistic regressions to predict identified latent trajectory group memberships using individual characteristics. Results: For both GHS and DS, there were six groups of PCIs with distinct trajectories over a 7-year period. More than 40% PCIs experienced sharp declines in GHS, and 35.5% experienced persistently poor GHS. There was greater heterogeneity in DS trajectories with 55% PCIs experiencing improvement, 16.4% experiencing persistently high DS, and 30.5% experiencing deterioration. Discussion: The GHS trajectories illustrate the heavy burden of poor and declining health among PCIs. Further research is needed to understand the factors underlying stable or improving DS despite declining GHS.
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Affiliation(s)
- Emma Zang
- Department of Sociology, 5755Yale University, New Haven, CT, USA
| | - Anna Guo
- Department of Biostatistics, 5755Yale University, New Haven, CT, USA
| | - Christina Pao
- Department of Sociology, 6396University of Oxford, Oxford, UK
| | - Nancy Lu
- Harvard Medical School, 1811Harvard University, Boston, MA, USA
| | - Bei Wu
- Rory Meyers College of Nursing, 5894New York University, New York, NY, USA
| | - Terri R Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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McManimen SL, McClellan D, Stoothoff J, Jason LA. Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome. JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 46:959-971. [PMID: 30311972 PMCID: PMC7944645 DOI: 10.1002/jcop.21984] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 05/29/2023]
Abstract
Prior research has found a heightened risk of suicide in patients with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). It is possible that a number of factors including stigma, unsupportive social interactions, and severe symptoms could lead to the development of depression, suicidal ideation, and heightened risk of suicide in this patient population. Prior studies have indicated that patients often report the legitimacy of their illness being questioned by family, friends, and even their physicians. This study aimed to determine whether stigma experienced, social support, symptomology, and functioning may be associated with depression and endorsement of suicidal ideation (SI) in patients with a self-reported diagnosis of ME or CFS. Findings indicated that participants that endorsed both SI and depression, in contrast to those that did not, experienced more frequent unsupportive social interactions in the form of blame for their illness, minimization of its severity, and social distancing from others. In addition, 7.1% of patients with ME and CFS endorsed SI but do not meet the criteria for clinical depression These findings highlight the importance of stigma and unsupportive social interactions as risk factors for suicidal thoughts or actions among patients with ME and CFS. Community psychologists have an important role to play in helping educate health care professionals and the public to these types of risk factors for patients marginalized by ME and CFS.
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Brooks SE, Burruss SK, Mukherjee K. Suicide in the Elderly: A Multidisciplinary Approach to Prevention. Clin Geriatr Med 2018; 35:133-145. [PMID: 30390980 DOI: 10.1016/j.cger.2018.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suicide in the elderly is a growing problem. The elderly population is increasing, and elderly patients have multiple issues that place them at higher risk of suicidality. These issues include physical illnesses, mental illness, loss of functional status, isolation, and family, financial, and social factors. Access to firearms is another significant risk factor, because elderly patients are more likely to use firearms in suicide attempts; interventions to reduce firearms mortality may save lives. Tackling the difficult problem of suicide in the elderly may require a multidisciplinary, community-based series of interventions.
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Affiliation(s)
- Steven E Brooks
- Division of Trauma and Surgical Critical Care, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA
| | - Sigrid K Burruss
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA.
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Huang LB, Tsai YF, Liu CY, Chen YJ. Influencing and protective factors of suicidal ideation among older adults. Int J Ment Health Nurs 2017; 26:191-199. [PMID: 27452945 DOI: 10.1111/inm.12247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022]
Abstract
Suicide is a global issue, but few studies have explored the triggers and psychological feelings of suicidal ideation in older adults. A qualitative design with face-to-face semistructured interviews examined the experience of suicidal ideation in adults aged 65 years and older. A purposive sampling of 32 outpatients with suicidal ideation from a medical centre in northern Taiwan participated. Interview data identified three themes: triggers for suicidal ideation, contributing psychological changes, and factors of adaptive response. The triggers for suicidal ideation included physical discomfort, loss of respect and/or support from family, impulsive emotions due to conflicts with others, and painful memories. Psychological changes contributed to suicidal ideation: feelings of loneliness, a sense of helplessness, or lack of self-worth. Participants described adaptive responses that acted as protective factors of suicidal ideation: support from family and friends, control of emotions, establishing a support network, comfort from religion, medication, and focussing on the family. Mental health nurses and clinicians should incorporate evaluations of stressful life events and psychological changes into a screening scale for older adults to improve detection of those at risk for suicide. Teaching coping strategies could provide timely interventions to secure the safety of this older population of adults.
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Affiliation(s)
- Li-Bi Huang
- Department of Nursing, Shuyow Recovery Home, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Psychiatry, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Ying-Jen Chen
- Department of Internal Medicine, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
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Abstract
Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered.
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Affiliation(s)
- Casper Reske-Nielsen
- Emergency Medicine, Boston Medical Center, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Ron Medzon
- Emergency Medicine, Boston Medical Center, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA.
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Jamison EC, Bol KA. Previous Suicide Attempt and Its Association With Method Used in a Suicide Death. Am J Prev Med 2016; 51:S226-S233. [PMID: 27745611 DOI: 10.1016/j.amepre.2016.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/17/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Non-fatal suicide attempts are a risk factor for suicide, but less is known about its effect on the method of injury used in an eventual suicide death. This study examines the association between history of non-fatal suicide attempt and the risk of a poisoning suicide versus firearm or hanging suicide in Colorado. METHODS Nine years (2004-2012, N=7,020) of suicide deaths in Colorado were compiled through the National Violent Death Reporting System. With these data, a retrospective cohort study was conducted in 2015, examining the risk associated with a history of suicide attempt and an eventual suicide death by poisoning versus a firearm or hanging suicide death. Multivariable log-binomial regression modeling was used to analyze the possible confounders of age and county type and gender as an effect modifier. RESULTS Suicide decedents with evidence of prior suicide attempt were twice as likely to eventually die by suicide via self-poisoning rather than by firearm injury (relative risk=1.94, 95% CI=1.8, 2.1, p<0.001). A significant interaction (p<0.001) between prior attempt and gender was identified and the relationship between prior attempt and method (poisoning versus firearm) was stronger among male than female suicides (female attempt history, 1.16, 95% CI=1.07, 1.27, p<0.001; male attempt history, 1.91, 95% CI=1.69, 2.16, p<0.001). CONCLUSIONS Individuals with a history of non-fatal suicide attempt are more likely to die by suicide via poisoning rather than firearm. Gender has a significant effect on this association. This information can be useful when discussing means restriction and suicide prevention efforts.
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Affiliation(s)
- Ethan C Jamison
- Center for Health and Environmental Data, Colorado Department of Public Health and Environment, Denver, Colorado.
| | - Kirk A Bol
- Center for Health and Environmental Data, Colorado Department of Public Health and Environment, Denver, Colorado
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Abstract
BACKGROUND Personality disorder traits are relatively prevalent among older adults, and can be associated with complex and chronic difficulties, including suicide risk. However, there is a lack of research regarding personality disorders and suicide ideation in older adults. Depressive symptoms and hopelessness may be important to the relation between personality disorders and suicide risk. Additionally, variables from the interpersonal theory of suicide, perceived burdensomeness and thwarted belongingness, may be critical risk factors for suicide in this population. We hypothesized that perceived burdensomeness and thwarted belongingness, theory-based variables, would act as parallel mediators of the relation between personality disorder traits and suicide ideation, whereas depressive symptoms and hopelessness would not. METHODS The hypothesis was tested in a sample of 143 older adults recruited from a primary care setting. Participants completed self-report questionnaires of personality traits, suicide ideation, depressive symptoms, hopelessness, perceived burdensomeness, and thwarted belongingness. RESULTS Findings from a non-parametric bootstrapping procedure indicated that perceived burdensomeness, thwarted belongingness, and depressive symptoms mediated the relation between total personality disorder traits and suicide ideation. Hopelessness did not act as a mediator. CONCLUSIONS These findings indicate that perceived burdensomeness, thwarted belongingness, and depressive symptoms are likely important risk factors for suicide ideation among older adults. Clinicians should be aware of these issues when assessing and treating suicide risk among older adults.
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Minayo MCDS, Cavalcante FG. Tentativas de suicídio entre pessoas idosas: revisão de literatura (2002/2013). CIENCIA & SAUDE COLETIVA 2015; 20:1751-62. [DOI: 10.1590/1413-81232015206.10962014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
Foi realizada revisão da literatura sobre as principais questões associadas às tentativas de suicídio em pessoas idosas. O estudo abrangeu o período de 2002 a 2013, a partir das bases Medline, Lilacs, PubMed, PsychInfo, SciELO, Biblioteca Virtual em Violência e Saúde da Bireme e Biblioteca Virtual de Saúde Pública (BVS/SP). Foram selecionadas 105 referências e analisadas 75. Os estudos se ampliaram na América do Norte, Europa e Ásia, são raros na América Latina e inexistem na África. Predominam investigações epidemiológicas. Os principais fatores predisponentes são doenças graves e degenerativas, dependência física, distúrbios e sofrimentos mentais e depressão severa. A depressão é o mais relevante fator explicativo associado a sofrimento físico crônico, perdas, abandonos, solidão e conflitos familiares. Diferenças de gênero, etnia, avanço da idade, questões sociais e traços culturais foram encontrados. O tema em pauta é da mais alta relevância para o Sistema Único de Saúde, mas não tem sido abordado no Brasil nem na teoria e nem na prática. Que esta revisão seja base para estudos empíricos que favoreçam o apoio à saúde do idoso e promova um envelhecer saudável.
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Eichorst MK, Allen RS, Halli-Tierney AD, Scogin F, Kvale EA. Health Care Communication and Agreement and Disagreement About Symptoms Within the Context of Multimorbidity. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:346-66. [PMID: 26654065 DOI: 10.1080/15524256.2015.1116484] [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] [Indexed: 06/05/2023]
Abstract
Informal caregivers for older adults often act as medical 'proxies' based on their assumed knowledge of the care recipient's illness-related symptoms. Differences between symptom descriptions given by care recipients and caregivers, however, raise questions about the validity of proxy reports. Community-dwelling caregivers and their care recipients with chronic, multi-morbid conditions revealed similar numbers of symptoms reported as well as average symptom distress. Dyads with care recipients who scored higher on negative affect were more likely to have significantly lower. Results suggested the possibility of identifying and intervening with dyads who may be 'at-risk' for divergent symptom reporting. This awareness may increase the ability to engage in informed and shared medical decision making throughout the illness trajectory.
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Affiliation(s)
- Morgan K Eichorst
- a Department of Psychology , Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Rebecca S Allen
- a Department of Psychology , Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Anne D Halli-Tierney
- b College of Community Health Sciences and Alabama Research Institute on Aging , The University of Alabama , Tuscaloosa , Alabama , USA
| | - Forrest Scogin
- c Department of Psychology and Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Elizabeth A Kvale
- d Center for Palliative and Supportive Care , University of Alabama at Birmingham, and Birmingham-Atlanta Geriatric Research Education and Clinical Center, Veterans Administration Medical Center , Birmingham , Alabama , USA
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Abstract
OBJECTIVE To determine whether the increased risk of suicide for individuals with cancer may be explained by functional limitations, lack of social support, or other factors. METHOD In this population-based case-control study, interviews of primary informants for suicides in the state of North Carolina were compared to interviews with participants in the Piedmont Health Study of the Elderly to estimate adjusted odds ratios for suicide and self-reported, physician diagnosed cancer, heart attack, stroke, and hip fracture. RESULTS Adjusting for all other factors, there was a statistically significant association of suicide and cancer (odds ratio [OR] 2.62, 95% confidence interval [CI] CI 1.84-3.73), but not heart attack, hip fracture, or stroke. The risk of suicide was also elevated for men vs. women (OR 17.15, CI 10.88-27.02), whites vs. blacks (OR 9.70, CI 6.07-15.50), and individuals with stressful life events (OR 2.75, CI 1.97-3.86) or limitations of instrumental (OR 2.93, CI 2.03-4.22) but not physical activities of daily living. Suicide cases were not more likely to be short of breath or poor sleep quality. Suicide was statistically significantly less likely for study participants who were married with spouse living vs. other (OR 0.61, CI 0.43-0.88) or who had one or more indicators of social support (OR 0.27, CI 0.19-0.39). CONCLUSION After adjustment for other risk factors, suicide was strongly associated with cancer but not with other disabling, potentially fatal conditions.
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Affiliation(s)
- Thomas B Cole
- a Department of Social Medicine , University of North Carolina School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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Cukrowicz KC, Duberstein PR, Vannoy SD, Lin EH, Unützer J. What factors determine disclosure of suicide ideation in adults 60 and older to a treatment provider? Suicide Life Threat Behav 2014; 44:331-7. [PMID: 24494695 DOI: 10.1111/sltb.12075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Correlates of patient disclosure of suicide ideation to a primary care or mental health provider were identified. Secondary analyses of IMPACT trial data were conducted. Of the 107 patients 60 years of age or older who endorsed thoughts of ending their life at least "a little bit" during the past month, 53 indicated they had disclosed these thoughts to a mental health or primary care provider during this period. Multiple logistic regression was used to identify predictors of disclosure to a provider. Significant predictors included poorer quality of life and prior mental health specialty treatment. Among participants endorsing thoughts of suicide, the likelihood of disclosing these thoughts to a provider was 2.96 times higher if they had a prior history of mental health specialty treatment and 1.56 times higher for every one-unit decrease in quality of life. Variation in disclosure of thoughts of suicide to a mental health or primary care provider depends, in part, on patient characteristics. Although the provision of evidence-based suicide risk assessment and guidelines could minimize unwanted variation and enhance disclosure, efforts to routinize the process of suicide risk assessment should also consider effective ways to lessen potential unintended consequences.
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Sousa GSD, Silva RMD, Figueiredo AEB, Minayo MCDS, Vieira LJEDS. Circunstâncias que envolvem o suicídio de pessoas idosas. ACTA ACUST UNITED AC 2014. [DOI: 10.1590/1807-57622013.0241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O trabalho analisa experiências e relações familiares que antecederam o suicídio de idosos. Trata-se de pesquisa qualitativa, com método de autópsia psicossocial. Contempla casos de 16 idosos que cometeram suicídio entre 2006 a 2009 em três municípios do Nordeste Brasileiro. À luz da Análise de Conteúdo, elucidaram-se as categorias: experiências que antecederam o suicídio de pessoas idosas e enunciação do suicídio pelo idoso aos seus componentes familiares. Destacam-se os fatores associados ao suicídio: alterações de humor e expressões de estados depressivos, conflitos familiares permeados por dificuldades financeiras, e uso abusivo de álcool e ideação suicida por anunciação do desejo de antecipar seu fim. Tornam-se necessários o olhar abrangente e o ouvir reflexivo sobre o idoso por parte dos agentes sociais, familiares, amigos e diversos setores, especificamente o setor saúde, gestores e profissionais que provoquem mudanças significativas na dinâmica do serviço.
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Trivedi MH, Morris DW, Wisniewski SR, Nierenberg AA, Gaynes BN, Kurian BT, Warden D, Stegman D, Shores-Wilson K, Rush AJ. Clinical and sociodemographic characteristics associated with suicidal ideation in depressed outpatients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:113-22. [PMID: 23442899 DOI: 10.1177/070674371305800209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify clinical and sociodemographic characteristics associated with suicidal ideation (SI) among patients seeking care for depression in routine primary and psychiatric care settings. METHODS We examined data from 4041 treatment-seeking outpatients with major depressive disorder (MDD) to compare baseline sociodemographic and clinical characteristics of those with and without SI, and the presence or absence of baseline depressive symptoms and psychiatric comorbidities in those with SI. RESULTS SI was significantly (P < 0.01) associated with numerous sociodemographic characteristics (that is, lower level of education, Caucasian or African American, male, unemployed, and treated in psychiatric care) and clinical features (that is, previous suicide attempt, younger age of MDD onset, greater baseline depressive symptom severity, greater number of depressive symptoms, and presence of agoraphobia and [or] generalized anxiety disorder). Elevated levels of SI at baseline were associated with decreased remission rates. CONCLUSIONS Consistent with past findings, increased rates of SI were associated with greater depressive symptom severity as well as other features suggestive of severity of illness. Our results confirm previous findings of associations between SI and panic and (or) phobic symptoms and anxiety, but did not confirm previous findings of an association between SI and alcohol or drug use and (or) dependence. While selective serotonin reuptake inhibitor monotherapy appeared significantly helpful in reducing SI during the course of treatment, the presence of SI at baseline was found to be a associated with decreased treatment response, with patients reporting SI at the start of treatment being less likely to achieve remission. CLINICAL TRIAL REGISTRATION NUMBER Sequenced Treatment Alternatives to Relieve Depression, NCT00021528.
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Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Abstract
BACKGROUND The study has a dual objective: (1) to investigate the extent to which, and how and to whom, elderly people gave warning (according to the definition of the term given by the American Association of Suicidology) prior to suicide; (2) to investigate how these warnings were perceived by the recipients of them, and what reactions the recipients had to the warnings. METHODS This is a psychological autopsy study based on qualitative interviews. Sixty-three informants were interviewed about 23 suicides by individuals aged over 65 in Norway. The informants comprised relatives, general practitioners (GPs) and home-based care nurses. In general, the analysis of the interviews follows the systematic text condensation method. RESULTS The interviews contained four main themes regarding reactions to the warnings: "not taken seriously," "helplessness," "exhaustion," and "acceptance." A total of 14 of the 23 elderly people gave warning before the suicides occurred. The warnings were given to relatives (11), home-based care nurses (5), and GPs (2). CONCLUSIONS Even though more than half of the elderly people had given warning (most frequently to relatives) before the suicide, the warnings did not initiate preventive measures. Together with passive attitudes, the lack of recognition of both the risk of suicide and the opportunities for treatment prevented possible measures being implemented. The paper discusses the grounds for the reactions as well as how suicide warnings given by elderly people can be taken seriously.
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