1
|
Juan YC, Wang SH, Huang WL, Liao SC, Chien YL, Gau SSF, Hsu CC, Wu CS. Population-attributable fraction of psychiatric and physical disorders for suicide among older adults in Taiwan. J Affect Disord 2024; 360:88-96. [PMID: 38821366 DOI: 10.1016/j.jad.2024.05.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND This study aimed to estimate the population-attributable fraction (PAF) of psychiatric and physical disorders for suicide among older adults, focusing on sex- and age-specific factors. METHODS Data from Taiwan's National Health Insurance Research Data and National Death Registry included 9136 cases of suicide in individuals aged 65+, with 89,439 matched controls. Physical and psychiatric disorders were identified through diagnostic records. Conditional logistic regression assessed risk factors, and PAF was calculated using disorder prevalence and adjusted odds ratios. RESULTS Major suicide risk factors among older adults were depressive disorders, anxiety disorders, and sleep disorders. Physical disorders like hypertension, peptic ulcers, and cancer also showed significant PAF values. The combined PAF of physical disorders equaled that of psychiatric disorders. Psychiatric disorders had a greater impact on women and the youngest-old adults, while physical disorders had a higher contribution among men, middle-old adults, and oldest-old adults. LIMITATIONS Relying solely on claim data to identify psychiatric and physical disorders may underestimate their prevalence and associations with suicide due to unrecorded cases of individuals not seeking help and the absence of key risk factors like social isolation and family support. CONCLUSIONS This study identifies preventable or treatable risk factors for older adult suicide, emphasizing the need to target specific psychiatric and physical disorders in suicide prevention efforts while taking into account sex- and age-specific considerations. It also underscores the importance of establishing social welfare support systems to address the unique challenges older adults face.
Collapse
Affiliation(s)
- Yi-Chen Juan
- National Taiwan University Hospital-integrative Medical Database, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shi-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu Hospital, Hsin-Chu City, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan.
| |
Collapse
|
2
|
Betz ME, Frattaroli S, Knoepke CE, Johnson R, Christy A, Schleimer JP, Pear VA, McCarthy M, Kapoor R, Norko MA, Rowhani-Rahbar A, Ma W, Wintemute GJ, Swanson JW, Zeoli AM. Extreme Risk Protection Orders in Older Adults in Six U.S. States: A Descriptive Study. Clin Gerontol 2024; 47:536-543. [PMID: 37688772 PMCID: PMC11229607 DOI: 10.1080/07317115.2023.2254279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia. METHODS We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment. RESULTS Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160). CONCLUSIONS Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness. CLINICAL IMPLICATIONS ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.
Collapse
Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Shannon Frattaroli
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel Johnson
- Center for Innovative Design & Analysis, Department of Biostatistics & Informatics, Colorado School of Public health, Aurora, Colorado, USA
| | - Annette Christy
- Department of Mental Health Law and Policy at the de la Parte Florida Mental Health Institute, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Julia P Schleimer
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Veronica A Pear
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Reena Kapoor
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael A Norko
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Wenjuan Ma
- Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jeffrey W Swanson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - April M Zeoli
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Hedna K, Sigström R, Johnell K, Waern M. Determinants of suicidal behavior in dementia: A Swedish national register-based study. Int Psychogeriatr 2024; 36:415-426. [PMID: 37642016 DOI: 10.1017/s1041610223000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To examine predictors of suicidal behavior (SB) in adults aged 75 years and above with dementia. DESIGN Longitudinal national register-based study. PARTICIPANTS AND SETTING Swedish residents aged ≥75 years with dementia identified in the Swedish Dementia Registry (SveDem) between 1 January 2007 and 31 December 2017 (N = 59 042) and followed until 31 December 2018. Data were linked with numerous national registers using personal identity numbers. MEASUREMENTS Outcomes were nonfatal self-harm and suicide. Fine and Gray regression models were used to investigate demographics, comorbidities, and psychoactive medications associated with fatal and nonfatal SB. RESULTS Suicidal behavior was observed in 160 persons after dementia diagnosis; 29 of these died by suicide. Adjusted sub-hazard ratio (aSHRs) for SB was increased in those who had a previous episode of self-harm (aSHR = 14.42; 95% confidence interval [CI] = 7.06-29.46), those with serious depression (aSHR = 4.33, 95%CI = 2.94-6.4), and in those born outside Sweden (aSHR = 1.53; 95% CI = 1.03-2.27). Use of hypnotics or anxiolytics was also associated with a higher risk of SB; use of antidepressants was not. Milder dementia and higher frailty score also increased risk of SB. Risk was decreased in those who received home care (aSHR = 0.52; 95%CI = 0.38-0.71) and in the oldest group (aSHR = 0.35; 95%CI = 0.25-0.49). CONCLUSION In addition to established targets for suicidal behavior prevention (improved identification and treatment of depression and previous self-harm), several new risk factors were suggested. There is a need for innovative public health strategies to meet the needs of older dementia patients with a foreign background. Home care may have a potential positive effect to prevent SB in people with dementia, but this needs to be further explored.
Collapse
Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna Väst AB, Gothenburg, Sweden
| | - Robert Sigström
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cognition and Old Age Psychiatry, Gothenburg, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
| |
Collapse
|
4
|
Serna-Rodríguez MF, Cienfuegos-Jiménez O, Cerda-Flores RM, Marino-Martínez IA, Hernández-Ordoñez MA, Ontiveros-Sánchez de la Barquera JA, Pérez-Maya AA. The Relationship Between CYP46A1 Polymorphism and Suicide Risk: A Preliminary Investigation. Neuromolecular Med 2024; 26:11. [PMID: 38592597 DOI: 10.1007/s12017-024-08779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024]
Abstract
Suicide is a global public health issue, with a particularly high incidence in individuals suffering from Major Depressive Disorder (MDD). The role of cholesterol in suicide risk remains controversial, prompting investigations into genetic markers that may be implicated. This study examines the association between CYP46A1 polymorphisms, specifically SNPs rs754203 and rs4900442, and suicide risk in a Mexican MDD patient cohort. Our study involved 188 unrelated suicide death victims, 126 MDD patients, and 144 non-suicidal controls. Genotypic and allelic frequencies were assessed using the Real Time-polymerase chain reaction method, and associations with suicide risk were evaluated using chi-square tests. The study revealed significant differences in allelic and genotypic frequencies in rs754203 SNP between suicide death and controls. The CYP46A1 rs754203 genotype G/G was significantly linked with suicide, and the G allele was associated with a higher risk of suicide (OR = 1.370, 95% CI = 1.002-1.873). However, we did not observe any significant differences in genotype distribution or allele frequencies of CYP46A1 rs4900442. Our study suggests that carriers of the CYP46A1 rs754203 G allele (A/G + G/G) may play a role in suicidal behavior, especially in males. Our findings support that the CYP46A1 gene may be involved in susceptibility to suicide, which has not been investigated previously. These results underscore the importance of further research in different populations to elucidate the genetic underpinnings of the role of CYP46A1 in suicide risk and to develop targeted interventions for at-risk populations.
Collapse
Affiliation(s)
- María Fernanda Serna-Rodríguez
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, CP 64460, Monterrey, N.L., México
| | - Oscar Cienfuegos-Jiménez
- Centro de Investigación y Desarrollo, en Ciencias de la Salud de la Universidad Autónoma de Nuevo León, CP 64460, Monterrey, N.L., México
| | - Ricardo Martín Cerda-Flores
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, Av. Dr. José Eleuterio González 1500, Mitras Centro, CP 64460, Monterrey, N.L., Mexico
| | - Iván Alberto Marino-Martínez
- Centro de Investigación y Desarrollo, en Ciencias de la Salud de la Universidad Autónoma de Nuevo León, CP 64460, Monterrey, N.L., México
| | - Mario Alberto Hernández-Ordoñez
- Departamento de Medicina Forense, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero y Av. Gonzalitos s/n, Mitras Centro, CP 64460, Monterrey, N.L., Mexico
| | - José Alfonso Ontiveros-Sánchez de la Barquera
- Departamento de Psiquiatría, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero y Av. Gonzalitos s/n, Mitras Centro, CP 64460, Monterrey, N.L., Mexico
| | - Antonio Alí Pérez-Maya
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, CP 64460, Monterrey, N.L., México.
| |
Collapse
|
5
|
Rodrigues JFR, Rodrigues LP, de Araújo Filho GM. Alzheimer's Disease and Suicide: An Integrative Literature Review. Curr Alzheimer Res 2024; 20:758-768. [PMID: 38409712 DOI: 10.2174/0115672050292472240216052614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Suicide has been described in patients with Alzheimer's disease. Some promising medications for treating Alzheimer's disease have had their studies suspended because they increase the risk of suicide. Understanding the correlations between suicide and Alzheimer's disease is essential in an aging world. METHODS A search was carried out on electronic websites (PubMed and Scielo) using the MeSH Terms "suicide" and "Alzheimer" (1986-2023). Of a total of 115 articles, 26 were included in this review. RESULTS Depression and the allele ε4 of Apolipoprotein (APOE4) were demonstrated to be the main risk factors for suicide in patients with Alzheimer's disease. CONCLUSION Adequately delineating which elderly people are vulnerable to suicide is important so that new treatments for Alzheimer's disease can be successful. This review showed a need for new studies to investigate the interface between Alzheimer's disease and suicide.
Collapse
Affiliation(s)
- Juliano Flávio Rubatino Rodrigues
- Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brazil
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
- Unimed Bauru Cooperativa de Trabalho Médico, Bauru, SP, Brazil
| | - Livia Peregrino Rodrigues
- Faculdade de Medicina de Barbacena (FAME), Barbacena, MG, Brazil
- Faculdade de Medicina da Universidade de Marília (UNIMAR), Marília, SP, Brazil
| | | |
Collapse
|
6
|
Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
Collapse
Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| |
Collapse
|
7
|
Pilozzi A, Foster S, Mischoulon D, Fava M, Huang X. A Brief Review on the Potential of Psychedelics for Treating Alzheimer's Disease and Related Depression. Int J Mol Sci 2023; 24:12513. [PMID: 37569888 PMCID: PMC10419627 DOI: 10.3390/ijms241512513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Alzheimer's disease (AD), the most common form of senile dementia, is poised to place an even greater societal and healthcare burden as the population ages. With few treatment options for the symptomatic relief of the disease and its unknown etiopathology, more research into AD is urgently needed. Psychedelic drugs target AD-related psychological pathology and symptoms such as depression. Using microdosing, psychedelic drugs may prove to help combat this devastating disease by eliciting psychiatric benefits via acting through various mechanisms of action such as serotonin and dopamine pathways. Herein, we review the studied benefits of a few psychedelic compounds that may show promise in treating AD and attenuating its related depressive symptoms. We used the listed keywords to search through PubMed for relevant preclinical, clinical research, and review articles. The putative mechanism of action (MOA) for psychedelics is that they act mainly as serotonin receptor agonists and induce potential beneficial effects for treating AD and related depression.
Collapse
Affiliation(s)
- Alexander Pilozzi
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Simmie Foster
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David Mischoulon
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Maurizio Fava
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Xudong Huang
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| |
Collapse
|
8
|
Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
Collapse
Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| |
Collapse
|
9
|
Dieudonné Rahm N, Pautex S. Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study. Swiss Med Wkly 2023; 153:40042. [PMID: 36787459 DOI: 10.57187/smw.2023.40042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Older adults are at risk of assisted and self-initiated suicide. The links between prior attempts and assisted suicide in the elderly have not been investigated. Hence, we aimed to investigate and describe the occurrence, timing and determinants of suicide attempts prior to assisted and self-initiated suicide. METHODS We developed a retrospective study of all assisted and self-initiated suicides among people over 65 years in the canton of Geneva, Switzerland, for a 10-year period (2010-2019). Cases were identified by cross-referencing hospitals' routinely collected electronic data and a forensic report database. Cases were characterised in terms of sociodemographic factors, mental health disorders, main comorbidities, temporal sequence, methods of injury, medical complications and disclosure rates of previous attempts. The study used descriptive statistics. RESULTS A total of 26 of 497 (5.2%) and 20 of 149 (13.4%) older adults had made previous attempts before assisted and self-initiated suicide, respectively. More than half of them had made a single attempt, mostly by medication poisoning, sometimes more than 10 years before dying. Individuals who made two attempts were significantly more represented among the assisted suicide decedents. One self-initiated suicide decedent and half of the assisted suicide cases had disclosed that they had considered suicide. Individual characteristics were similar, except for assisted suicide decedents, who were eight years older than self-initiated suicide decedents. Almost all the individuals had mental disorders. Depression, anxiety and chronic pain were particularly prevalent among decedents of assisted suicide. The substantial representation of women in both groups may be an indication of their vulnerability, possibly related to chronic pain and life stressors. CONCLUSIONS Our results show commonalities between older assisted and self-initiated suicide decedents who made an attempt (s) before suicide. Further research is needed to demonstrate the overlap between the determinants of assisted suicide and other forms of suicidality and to support a suicide prevention strategy applicable to both types of suicide.
Collapse
Affiliation(s)
- Nathalie Dieudonné Rahm
- Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
10
|
Leung T, Portz J, Fischer SM, Greenway E, Johnson RL, Knoepke CE, Matlock DD, Omeragic F, Peterson RA, Ranney ML, Betz ME. A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e43702. [PMID: 36719721 PMCID: PMC9929727 DOI: 10.2196/43702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Firearm safety among individuals with Alzheimer disease and related dementias (ADRD) is an underdiscussed and underresearched concern in the United States, especially given the growing population of community-dwelling adults with ADRD. The "Safety in Dementia" (SiD) web-based decision aid was developed to support caregivers in addressing firearm access; the efficacy of SiD is unknown. OBJECTIVE Through the SiD decision aid, the Safe at Home (S@H) study aims to support caregivers in making decisions about home safety that align with their goals and values, and behaviors regarding firearm access for persons with ADRD and firearm access. METHODS The S@H study is a 2-armed randomized controlled trial to test the effect of the SiD decision aid on caregivers of community-dwelling adults with ADRD who have firearm access. S@H aims to recruit 500 ADRD caregivers (age ≥18 years, fluent in English or Spanish, and in the United States) through online or social media advertisements and through relevant organizations. Participants are randomized to view SiD or a control website at their own pace; all participants complete web-based questionnaires at baseline, 2 weeks, 2 months, and 6 months. The primary outcome is immediate preparation for decision-making; secondary outcomes include longitudinal decision outcomes and self-reported modifications to firearm access. The relative reach and effectiveness of each recruitment method (online/social media and through relevant organizations) will be assessed by examining differences in caregiver participation, retention rates, and relative cost. RESULTS The study enrollment began in May 2022. As of December 2022, a total of 117 participants had enrolled. CONCLUSIONS The S@H study is the first randomized trial of a firearm safety decision aid for ADRD caregivers. The results from this study will inform how best to support caregivers in decision-making regarding firearm safety. Further, results may guide approaches for recruiting caregivers and for dissemination of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05173922; https://clinicaltrials.gov/ct2/show/NCT05173922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43702.
Collapse
Affiliation(s)
| | - Jennifer Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stacy M Fischer
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily Greenway
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher E Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Faris Omeragic
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Brown University, Providence, RI, United States.,School of Public Health, Brown University, Providence, RI, United States.,Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| |
Collapse
|
11
|
Zhu L, Yu C, Chang Y, Sun S, Sun Z. Serum Cystatin C is Associated with Depression After Intracerebral Hemorrhage. Neuropsychiatr Dis Treat 2023; 19:1117-1126. [PMID: 37188225 PMCID: PMC10178993 DOI: 10.2147/ndt.s409421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
Purpose Cystatins are associated with neuronal degeneration and nervous system healing. Cystatin C (Cys C) has recently been linked to brain injury and immunological inflammation. This study aimed to determine the relationship between serum Cys C levels and depression following intracranial hemorrhage (ICH). Patients and Methods Between September 2020 and December 2022, 337 patients with ICH were sequentially recruited and followed up for three months. The post-stroke depression (PSD) and non-PSD groups were separated based on the 17-item Hamilton Depression Rating Scale (HAMD). The PSD diagnosis was established based on the DSM-IV criteria. Cys-C levels were documented within twenty-four hours of admission. Results Three months after ICH, 93 (27.6%) of 337 enrolled patients were diagnosed with depression. The Cys C levels were significantly higher in depressed patients than in nondepressed patients after ICH (1.32 vs 1.01; p<0.001). After adjusting for potential confounding variables, depression after ICH was associated with the highest quartile of Cys C levels (odds ratio (OR) = 3.195, 95% CI: 1.562-6.536; p=0.001). The receiver operating characteristic curve (ROC) curve predicted that the ideal cut-off for CysC levels as a predictor of depression after ICH would be 0.730, resulting in 84.5% sensitivity and 88.4% specificity, with an area under curve (AUC) of 0.880 (95% CI: 0.843-0.917; p< 0.0001). Conclusion Increased CysC concentrations were independently related to depression three months after ICH, highlighting that CysC levels at admission may be a potential biomarker for predicting the onset of depression following ICH.
Collapse
Affiliation(s)
- Lei Zhu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People’s Hospital of Huainan, Huainan, Anhui Province, People’s Republic of China
| | - Chuanqing Yu
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People’s Hospital of Huainan, Huainan, Anhui Province, People’s Republic of China
| | - Yueyue Chang
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People’s Hospital of Huainan, Huainan, Anhui Province, People’s Republic of China
| | - Shiyu Sun
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People’s Hospital of Huainan, Huainan, Anhui Province, People’s Republic of China
| | - Zhongwu Sun
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Correspondence: Zhongwu Sun, Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China, Email
| |
Collapse
|
12
|
Disability and suicidal behaviors among women of reproductive age. Arch Womens Ment Health 2022; 25:1009-1019. [PMID: 36322287 DOI: 10.1007/s00737-022-01275-z] [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: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Limited research exists on suicidal behaviors among women with disabilities. This study examined disability, suicidal behaviors, and associated health determinants among non-pregnant women of reproductive age. Data from the 2015-2019 National Survey on Drug Use and Health (n = 76,750) were used to estimate associations between disability and suicidal behaviors and evaluate the effects of health determinants on suicidal behaviors among non-pregnant women of reproductive age with disabilities. Approximately 22% of non-pregnant women of reproductive age with disabilities reported suicidal behaviors compared to only 4.3% of women without disabilities. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (AOR 1.73; 95% CI 1.60-1.87) than those without disabilities. Psychological distress (OR 3.66; 95% CI 2.98-4.49), major depressive episode (OR 3.22; 95% CI 2.82-3.67), unmet perceived mental health need (OR 2.29; 95% CI 1.98-2.65), age 18-25 years (OR 1.65; 95% CI 1.43-1.92), and illicit drug use (OR 1.40; 95% CI 1.20-1.64) were significantly associated with higher odds of suicidal behaviors, and specifically suicidal ideation, among women with disabilities. Non-pregnant women of reproductive age with disabilities are at increased risk for exhibiting suicidal behaviors. Better understanding of suicidal behaviors among women with disabilities can assist public health officials and medical professionals in developing meaningful prevention, detection, and intervention programs.
Collapse
|
13
|
Patel D, Andersen S, Smith K, Ritter A. Completed Suicide by Firearm in an Individual With the Agrammatic Variant of Primary Progressive Aphasia: Case Report. Front Neurol 2022; 13:828155. [PMID: 35370921 PMCID: PMC8965452 DOI: 10.3389/fneur.2022.828155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
The agrammatic or nonfluent variant of Primary Progressive Aphasia (nfvPPA) is a form of Frontotemporal Dementia (FTD) that is characterized by progressive language dysfunction, poor sentence construction, and low verbal fluency. Individuals with nfvPPA have intact insight into their decline, which may manifest as frustration and hopelessness, and show signs of impulsivity and disinhibition. Little is known about suicide risk in this patient population. Here we describe a case of an 84 year-old male with nfvPPA who, over the course of his care, experienced a decline in language and motoric functioning which coincided with increasing irritability and impulsivity. Despite this significant decline, he denied depressive symptoms or showed any suicidal tendencies, and he seemed to be looking forward to future events. His suicide, committed with a handgun during what appeared to be a rather innocuous trip to the garage, came as a significant shock to his spouse, family, and his clinical care team. To our knowledge, this is the first reported case of completed suicide in a patient with the nfvPPA subtype of FTD. Though this patient demonstrated demographic risk factors for suicide (advanced age, retired military veteran with easy access to firearms) there is a lack of data regarding how FTD may have contributed. Retained insight especially seems to be a risk factor for suicide across all forms of dementia. Impulsivity may be key when considering suicidality amongst FTD patients. Additionally, this case demonstrates the importance of addressing gun safety as there are few guidelines around gun ownership in this patient population.
Collapse
Affiliation(s)
- Deepal Patel
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Shaun Andersen
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Kyler Smith
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Aaron Ritter
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| |
Collapse
|
14
|
Naismith H, Howard R, Stewart R, Pitman A, Mueller C. Suicidal ideation in dementia: associations with neuropsychiatric symptoms and subtype diagnosis. Int Psychogeriatr 2022; 34:1-8. [PMID: 35331357 DOI: 10.1017/s1041610222000126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate factors associated with suicidal ideation (SI) around the time of dementia diagnosis. We hypothesised relatively preserved cognition, co-occurring physical and psychiatric disorders, functional impairments, and dementia diagnosis subtype would be associated with a higher risk of SI. DESIGN Cross-sectional study using routinely collected electronic mental healthcare records. SETTING National Health Service secondary mental healthcare services in South London, UK, serving a population of over 1.36 million residents. PARTICIPANTS Patients who received a diagnosis of dementia (Alzheimer's, vascular, mixed Alzheimer's/vascular, or dementia with Lewy bodies) between 1 Nov 2007-31 Oct 2021: 18,252 people were identified during the observation period. MEASUREMENTS A natural language processing algorithm was used to identify recorded clinician recording of SI around the time of dementia diagnosis. Sociodemographic and clinical characteristics were also measured around the time of diagnosis. We compared people diagnosed with non-Alzheimer's dementia to those with Alzheimer's and used statistical models to adjust for putative confounders. RESULTS 15.1% of patients had recorded SI, which was more common in dementia with Lewy bodies compared to other dementia diagnoses studied. After adjusting for sociodemographic and clinical factors, SI was more frequent in those with depression and dementia with Lewy bodies and less common in those with impaired activities of daily living and in vascular dementia. Agitated behavior and hallucinations were not associated with SI in the final model. CONCLUSIONS Our findings highlight the importance of identifying and treating depressive symptoms in people with dementia and the need for further research into under-researched dementia subtypes.
Collapse
Affiliation(s)
- Hamish Naismith
- Central and North West London NHS Foundation Trust, London, UK
- UCL Division of Psychiatry, London, UK
| | - Robert Howard
- UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
15
|
Affiliation(s)
- Elena Portacolone
- Address correspondence to: Elena Portacolone, PhD, MPH, MBA, Institute for Health & Aging, University of California San Francisco, 490 Illinois Street, 12th Floor, San Francisco, CA 94158, USA. E-mail:
| | - Amy L Byers
- School of Medicine, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Jodi Halpern
- University of California Berkeley-University of California San Francisco Joint Medical Program, School of Public Health, University of California, Berkeley, California, USA
| | - Deborah E Barnes
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
16
|
Thériault V, Guay D, Bravo G. Extending Medical Aid in Dying to Incompetent Patients: A Qualitative Descriptive Study of the Attitudes of People Living with Alzheimer’s Disease in Quebec. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1084452ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: In Quebec, medical aid in dying (MAiD) is legal under certain conditions. Access is currently restricted to patients who are able to consent at the time of the act, which excludes most people with dementia at an advanced stage. However, recent legislative and political developments have opened the door to an extension of the legislation that could give them access to MAiD. Our study aimed to explore the attitudes of people with early-stage dementia toward MAiD should it become accessible to them. Methods: We used a qualitative descriptive design consisting of eight face-to-face semi-structured interviews with persons living with early-stage Alzheimer’s disease, followed by a thematic analysis of the contents of the interviews. Results and Interpretations: Analysis revealed three main themes: 1) favourable to MAiD; 2) avoiding advanced dementia; and 3) disposition to request MAiD. Most participants anticipated dementia to be a painful experience. The main reasons for supporting MAiD were to avoid cognitive loss, dependence on others for their basic needs, and suffering for both themselves and their loved ones. Every participant said that they would ask for MAiD at some point should it become available to incompetent patients and most wished that it would be legal to access it through a request written before losing capacity. Conclusion: The reasons for which persons with Alzheimer’s disease want MAiD are related to the particular trajectory of the disease. Any policy to extend MAiD to incompetent patients should take their perspective into account.
Collapse
Affiliation(s)
- Vincent Thériault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Diane Guay
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Gina Bravo
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
17
|
Cooper SA, Szymanski BR, Karel MJ, Katz IR, McCarthy JF. Suicide among Veterans receiving Veterans Health Administration Home Based Primary Care and following discharge from Community Living Centers. Suicide Life Threat Behav 2021; 51:1055-1066. [PMID: 34333781 DOI: 10.1111/sltb.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Veterans who receive Veterans Health Administration (VHA) Home Based Primary Care (HBPC) services and those discharged from VHA Community Living Centers (CLC) may be at increased risk of suicide. No studies to date have assessed suicide risks among HBPC patients. This study examined suicide risks among recipients of VHA HBPC services and following discharge from VHA CLCs, as compared to other Veteran VHA users. METHODS We identified three cohorts of 2013 Veteran VHA patients: 47,842 HBPC users, 17,725 with live discharges from CLCs, and 5,554,635 other VHA users. Using proportional hazards regression, we assessed risk of suicide through 2016. RESULTS Overall, HBPC recipients did not differ from the other cohorts in suicide risk. Although in unadjusted analyses CLC discharged patients had greater suicide risk than the general VHA patient cohort (hazard ratio (HR) = 1.73, 95% confidence interval = 1.25-2.41), this became nonsignificant when controlling for diagnoses. CONCLUSIONS Overall findings did not identify differential suicide risk among VHA HBPC recipients in 2013, when compared to other Veteran VHA patient cohorts. Veterans discharged from VHA CLCs have increased mental health morbidity, which was associated with increased suicide risk.
Collapse
Affiliation(s)
- Samantha A Cooper
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| | - Benjamin R Szymanski
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| | - Michele J Karel
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Ira R Katz
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - John F McCarthy
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| |
Collapse
|
18
|
Associations of serum cystatin C with depressive symptoms and suicidal ideation in major depressive disorder. BMC Psychiatry 2021; 21:576. [PMID: 34789194 PMCID: PMC8596898 DOI: 10.1186/s12888-021-03509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) have high suicidal ideation. There is evidence that serum cystatin C (Cys C) may be involved in the pathophysiology of MDD. The present study aimed to investigate Cys C concentration in patients with MDD and clarify its possible association with depressive symptoms and suicidal ideation. METHODS An online cross-sectional survey of 159 patients diagnosed with MDD was conducted. Serum Cys C levels were measured using ADVIA 2400 biochemical analyzer. The 24-item Hamilton Depression Scale (HAMD-24) was administered to evaluate the depressive symptoms. Generalized linear regression, logistic regression and restricted cubic spline models were used to examine the association of serum Cys C levels with depressive symptoms and suicidal ideation. RESULTS Serum Cys C levels were higher in MDD patients than in controls (p = 0.001) and were positively associated with scores on HAMD-24 in unadjusted (gender distribution, age, smoking, alcohol consumption, family history of depression and traumatic life events; (p = 0.003) and fully adjusted linear regression model (p = 0.005). The fully adjusted regression coefficient with 95% confidence intervals for serum Cys C levels and HAMD-24 score was 30.339 (9.602 to 51.077). The level of Cys C in the suicidal ideation (SI) group was significantly higher than that in the non-suicide ideation (non-SI) group (p = 0.001). Serum Cys C levels were positively associated with suicidal ideation in each logistic regression model (all p < 0.05). CONCLUSION Serum Cys C levels were elevated in MDD patients and appeared to be positively correlated with depressive symptoms and suicidal ideation. These findings suggest that the dysfunction of Cys C may be involved in the severity of depression and in the pathophysiological process of MDD. Thus, regulation of serum Cys C could potentially be an effective predictor of the severity of depression and potentially, play a role in reducing the risk of suicide in MDD patients.
Collapse
|
19
|
Risk factors for suicide in psychiatric emergency patients in Beijing, China: A large cross-sectional study. Psychiatry Res 2021; 304:114067. [PMID: 34303942 DOI: 10.1016/j.psychres.2021.114067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/14/2021] [Indexed: 11/20/2022]
Abstract
Psychiatric emergency patients constitute a population at high risk of suicidal thoughts and behaviors (STB). However, the risk factors for STB in this population have not been clearly defined. This study aimed to explore the risk factors for STB in psychiatric emergency patients in China. A cross-sectional analysis was conducted at the emergency department of psychiatry, Anding Hospital, Capital Medical University from 2015 to 2017. The Chinese suicide risk factors scale was used to test the STB of the patients. Multivariable logistic regression analysis was used to determine the risk factors of STB. A total of 12,345 patients were included. Their average age was 36 years. According to the suicide risk scale, 3436 cases (27.83%) were at risk of STB, mainly young adults. The multivariable analysis showed that urban residence, years of education, living in Beijing, ethnic Han, living alone, unemployment, poor relationship with parents, one or more siblings, visit time in the night, family history, disease course, total duration, the total number of psychiatric hospitalizations, a clear diagnosis, Brief Psychiatric Rating Scale total score ≥28.5, Hamilton Depression Rating Scale total score ≥20, and Young Mania Rating Scale total score ≥12 were independent risk factors for STB.
Collapse
|
20
|
Schwertner E, Zelic R, Secnik J, Johansson B, Winblad B, Eriksdotter M, Religa D. Biting the Bullet: Firearm Ownership in Persons with Dementia. A Registry-Based Observational Study. J Alzheimers Dis 2021; 81:179-188. [PMID: 33720891 PMCID: PMC8203223 DOI: 10.3233/jad-201365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: In Sweden, 2,296,000 firearms were legally owned by private persons in 2017 and there were 150,000 persons living with a dementia diagnosis. A proportion of these persons owning a firearm may pose safety concerns. Objective: The aim was to describe firearm ownership in persons with dementia in Sweden and examine which characteristics are explaining physicians’ decision to report a person to the police as unsuitable to possess a firearm. Methods: This was a registry-based observational study. 65,717 persons with dementia registered in the Swedish Dementia Registry were included in the study. Logistic regression was used to evaluate which of the persons’ characteristics were most important in predicting the likelihood of being reported as unsuitable to possess a firearm. Relative importance of predictors was quantified using standardized coefficients (SC) and dominance analysis (DA). Results: Out of 53,384 persons with dementia, 1,823 owned a firearm and 419 were reported to the police as unsuitable owners. Firearm owners were predominantly younger, males, living alone, and without assistance of homecare. The most important predictors of being reported to the police were: living with another person (SC = 0.23), frontotemporal dementia (SC = 0.18), antipsychotics prescription (SC = 0.18), being diagnosed in a memory/cognitive clinic (SC = –0.27), female gender (SC = 0.18), mild (SC = –0.25) and moderate (SC = –0.21) dementia, and hypnotics prescription (SC = 0.17). Conclusion: Firearm owners with dementia were mostly younger males who were still living more independent lives. The decision to remove a weapon was not solely based on a diagnosis of dementia but a combination of factors was considered.
Collapse
Affiliation(s)
- Emilia Schwertner
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Renata Zelic
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Juraj Secnik
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Björn Johansson
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Dorota Religa
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| |
Collapse
|
21
|
Ji X, Zhao J, Li H, Pizzagalli DA, Law S, Lin P, Fan L, Zhang P, Fang S, Wang X, Yao S, Wang X. From motivation, decision-making to action: An fMRI study on suicidal behavior in patients with major depressive disorder. J Psychiatr Res 2021; 139:14-24. [PMID: 34004553 DOI: 10.1016/j.jpsychires.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We explored the neural mechanisms underlying disadvantageous risk decision making in un-medicated major depressive disorder patients who had recent suicide attempts. METHODS 53 patients with major depressive disorder (MDD), including 23 with a history of suicide attempts (SA) and 30 without (NS), and 30 healthy controls (HCs) completed pertinent psychometric assessments, and the dynamic decision making balloon analogue risk task (BART) under fMRI. We also built a 4-parameter Bayesian computational modeling for decision making analyses. RESULTS Several distinct findings emerged. First, SA patients had no depression intensity difference but higher pain avoidance in psychometrics, and more risk aversion in the BART when compared to the NS patients, with computational modeling confirming such reduced risk-taking propensity. Second, SA patients showed smaller left insular cortex activation than NS patients during the high risk, decisional phase of BART, and the modulation correlated with pain avoidance in both SA and NS groups. Third, during feedback phase of loss trials of the BART, SA patients had greater activation in the left dorsolateral prefrontal cortex (dlPFC) than NS patients. CONCLUSION Taken together, we present novel findings and propose interpretations that the differential insula activation likely relates to high uncertainty-aversion in SA patients, contrary to the typical view that they are impulsive and risk prone. The differential left dlPFC activation likely suggests hypersensitivity to loss, contributing to conservative decision-making at large, and extreme choices such as suicide when value estimations are compromised and emotionally overwhelmed. The interactive interpretation places a renewed focus on psychological pain avoidance as a robust motivator for suicidal behavior.
Collapse
Affiliation(s)
- Xinlei Ji
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Jiahui Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing, China
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Samuel Law
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Pan Lin
- Department of Psychology and Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, Hunan, China
| | - Lejia Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Panwen Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Shulin Fang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Xiaosheng Wang
- Department of Human Anatomy and Neurobiology, Xiangya School of Medicine, Central South University, Central South University, Changsha, Hunan, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China.
| |
Collapse
|
22
|
Günak MM, Barnes DE, Yaffe K, Li Y, Byers AL. Risk of Suicide Attempt in Patients With Recent Diagnosis of Mild Cognitive Impairment or Dementia. JAMA Psychiatry 2021; 78:659-666. [PMID: 33760039 PMCID: PMC7992018 DOI: 10.1001/jamapsychiatry.2021.0150] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Little is known about the association between mild cognitive impairment (MCI) and suicide. Most studies have focused on dementia and suicidal behavior, with inconsistent results. OBJECTIVES To examine the association between diagnoses of MCI and dementia and suicide attempt and explore potential psychiatric moderators and to assess whether the association differs based on recency of diagnosis. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study integrated 5 national databases from the Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services and included all VA medical centers in the US. US veterans 50 years or older with MCI diagnoses at baseline (October 1, 2011, to September 30, 2013) or earlier (October 1, 2007, to September 30, 2011) were propensity matched 1:3 with (1) patients with dementia diagnoses and (2) patients without either diagnosis based on demographic characteristics and the Charlson Comorbidity Index. Diagnoses of MCI or dementia were defined as recent if there were no diagnosis codes before baseline. Data were analyzed from March 16, 2020, to January 15, 2021. MAIN OUTCOMES AND MEASURES Information on suicide attempts through December 31, 2016, provided by the National Suicide Prevention Applications Network (nonfatal) and Mortality Data Repository (fatal). RESULTS The study population of 147 595 participants included 21 085 patients with MCI, 63 255 with dementia, and 63 255 in the propensity-matched comparison group. Participants had a mean (SD) age of 74.7 (10.3) years, 143 353 (97.1%) were men, 4242 (2.9%) were women, and 127 065 (86.1%) were non-Hispanic White. A total of 138 patients with MCI (0.7%) and 400 patients with dementia (0.6%) attempted suicide during follow-up, compared with 253 patients without MCI or dementia (0.4%). Exploratory analyses revealed that no psychiatric comorbidity moderated the association between MCI or dementia and suicide attempt. After adjustment for demographic details and medical and psychiatric comorbidities, risk of suicide attempt was consistently highest for patients with a recent MCI or dementia diagnosis, with adjusted hazard ratios (HRs) of 1.73 (95% CI, 1.34-2.22; P < .001) for recent MCI and 1.44 (95% CI, 1.17-1.77; P = .001) for recent dementia. Risk associated with prior diagnosis was not significant (HR for prior MCI, 1.03 [95% CI, 0.78-1.36; P = .84]; HR for prior dementia, 1.14 [95% CI, 0.95-1.36; P = .15]). CONCLUSIONS AND RELEVANCE This study found that older adults with recent MCI or dementia diagnoses were at increased risk of attempting suicide. These findings suggest that involvement of supportive services at the time of or soon after diagnoses of MCI or dementia may help mitigate risk of suicide attempts.
Collapse
Affiliation(s)
- Mia Maria Günak
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Deborah E. Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco,San Francisco Veterans Affairs Health Care System, San Francisco, California,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco,San Francisco Veterans Affairs Health Care System, San Francisco, California,Department of Epidemiology and Biostatistics, University of California, San Francisco,Department of Neurology, University of California, San Francisco
| | - Yixia Li
- Northern California Institute for Research and Education, The Veterans Health Research Institute, San Francisco, California
| | - Amy L. Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco,San Francisco Veterans Affairs Health Care System, San Francisco, California,Department of Medicine, Division of Geriatrics, University of California, San Francisco
| |
Collapse
|
23
|
Armstrong MJ, Sullivan JL, Amodeo K, Lunde A, Tsuang DW, Reger MA, Conwell Y, Ritter A, Bang J, Onyike CU, Mari Z, Corsentino P, Taylor A. Suicide and Lewy body dementia: Report of a Lewy body dementia association working group. Int J Geriatr Psychiatry 2021; 36:373-382. [PMID: 33169435 DOI: 10.1002/gps.5462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Public Health, Boston, Massachusetts, USA
| | - Katherine Amodeo
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Angela Lunde
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Debby W Tsuang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Mark A Reger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Jee Bang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.,Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| |
Collapse
|
24
|
Horgan D, Nobili F, Teunissen C, Grimmer T, Mitrecic D, Ris L, Pirtosek Z, Bernini C, Federico A, Blackburn D, Logroscino G, Scarmeas N. Biomarker Testing: Piercing the Fog of Alzheimer's and Related Dementia. Biomed Hub 2021; 5:19-40. [PMID: 33564663 DOI: 10.1159/000511233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022] Open
Abstract
Alzheimer's disease (AD) and related dementia is one of the growing threats to the sustainability of health and care systems in developed countries, and efforts to find therapies have had scant success. The main reasons for this are lack of efficient therapy, which is linked to too late discovery of the disease itself. With this in mind, biomarkers are recognised as an element which can bring a major contribution to research, helping elucidate the disease and the search for treatments. They are also playing an increasing role in early detection and timely diagnosis, which are considered the principal hopes of effective management in the absence of an effective drug. The current arsenal of biomarkers could already, if more widely deployed, provide an effective minimum service to patients and health systems. A concerted action by policy makers and stakeholders could drive progress in access to AD biomarker testing to provide an optimum service in the medium term. This paper discusses how to improve the use of and access to biomarker testing in the detection and diagnosis of AD and other diseases featuring dementia, and how EU healthcare systems could benefit. It outlines the challenges, lists the achievements to date, and highlights the actions needed to allow biomarker testing to deliver more fully on their potential in AD.
Collapse
Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Charlotte Teunissen
- Neurochemistry Lab, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Timo Grimmer
- Klinikum rechts der Isar, School of Medicine, Technical University on Munich, Munich, Germany
| | - Dinko Mitrecic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Chiara Bernini
- European Alliance for Personalised Medicine, Brussels, Belgium
| | | | | | | | - Nikos Scarmeas
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| |
Collapse
|
25
|
Tryptophan Intake and Metabolism in Older Adults with Mood Disorders. Nutrients 2020; 12:nu12103183. [PMID: 33081001 PMCID: PMC7603218 DOI: 10.3390/nu12103183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
The role of serotonin in the pathogenesis of depression is well-documented, while the involvement of other tryptophan (TRP) metabolites generated in the kynurenine pathway is less known. The aim of this study was to assess the intake and metabolism of TRP in elderly patients with mood disorders. Ninety subjects in three groups, 30 subjects each, were enrolled in this study: controls (healthy young adults, group I) and elderly individuals without (group II) or with (group III) symptoms of mild and moderate depression, as assessed by the Hamilton Depression Rating Scale (HAM-D) and further referred to as mood disorders. The average TRP intake was evaluated with the nutrition calculator. Urinary levels of TRP, 5-hydroxyindoleacetic acid (5-HIAA), L-kynurenine (KYN), kynurenic acid (KynA), xanthurenic acid (XA), and quinolinic acid (QA) were determined by liquid chromatography with tandem mass spectrometry and related to creatinine level. The average daily intake of TRP was significantly lower in group III than the remaining two groups, but group III was also characterized by higher urinary levels of KYN, KynA, XA, and QA as compared with younger adult individuals and elderly patients without mood disorders. Therefore, mild and moderate depression in the elderly may be associated with a lower intake of TRP and changes in its kynurenine metabolic pathway, which suggests a potential dietary TRP-based intervention in this group of patients.
Collapse
|
26
|
Azarpazhooh MR, Amiri A, Morovatdar N, Steinwender S, Rezaei Ardani A, Yassi N, Biller J, Stranges S, Tokazebani Belasi M, Neya SK, Khorram B, Sheikh Andalibi MS, Arsang-Jang S, Mokhber N, Di Napoli M. Correlations between COVID-19 and burden of dementia: An ecological study and review of literature. J Neurol Sci 2020; 416:117013. [PMID: 32659508 PMCID: PMC7334961 DOI: 10.1016/j.jns.2020.117013] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Current evidence on the association between COVID-19 and dementia is sparse. This study aims to investigate the associations between COVID-19 caseload and the burden of dementia. METHODS We gathered data regarding burden of dementia (disability-adjusted life years [DALYs] per 100,000), life expectancy, and healthy life expectancy (HALE) from the Global Burden of Disease (GBD) 2017 study. We obtained COVID-19 data from Our World in Data database. We analyzed the association of COVID-19 cases and deaths with the burden of dementia using Spearman's rank correlation coefficient. RESULTS Globally, we found significant positive (p < .001) correlations between life expectancy (r = 0.60), HALE (r = 0.58), and dementia DALYs (r = 0.46) with COVID-19 caseloads. Likewise, we found similar correlations between life expectancy (r = 0.60), HALE (r = 0.58) and dementia DALYs (r = 0.54) with COVID-19 mortality. CONCLUSION Health policymakers should clarify a targeted model of disease surveillance in order to reduce the dual burden of dementia and COVID-19.
Collapse
Affiliation(s)
- M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amin Amiri
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sandy Steinwender
- Health Information Science, PhD (candidate) Western University, London, Ontario, Canada.
| | - Amir Rezaei Ardani
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nawaf Yassi
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Jose Biller
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine Schulich School of Medicine, Dentistry Western University, London, ON, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Masoud Tokazebani Belasi
- Research Centre for Prevention of cardiovascular disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Sepideh Kazemi Neya
- Research Centre for Prevention of cardiovascular disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Bita Khorram
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Mohammad Sobhan Sheikh Andalibi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Shahram Arsang-Jang
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Naghmeh Mokhber
- Department of Psychiatry, St Joseph's Health Care London, Western University, Canada.
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
| |
Collapse
|
27
|
Michaud-Dumont G, Lapierre S, Viau-Quesnel C. The Experience of Adults Bereaved by the Suicide of a Close Elderly Relative: A Qualitative Pilot Study. Front Psychol 2020; 11:2331. [PMID: 33041904 PMCID: PMC7521108 DOI: 10.3389/fpsyg.2020.538678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Suicide in older persons is a serious issue in many countries. The act of intentionally causing one’s own death is often associated with lack of social support, thwarted belongingness, or chronic interpersonal difficulties. Therefore, suicide has a significant interpersonal dimension that can influence those left behind. However, studies that have investigated the impact of older adults’ suicide on their family are scarce. The objective of this pilot study was to assess the feasibility of a qualitative research on the psychosocial experience of adults bereaved by the suicide of an elderly relative. This research could recruit three participants (daughter, grand-son, and grand-niece) who had lost to suicide a close family member aged between 75 and 90. The analysis of the content of the semi-structured interviews revealed seven main themes: (1) finding an explanation to the suicide, (2) give meaning to the loss, (3) the emotional processes of mourning, (4) the repercussions of the suicide on the individual and the family, (5) looking for support, (6) the taboo and secrecy of suicide, and (7) perceptions of aging and the end of life. To explain the suicide of their loved one, the bereaved mentioned various factors related to aging, such as loss of autonomy, illness, and fear of placement. Although the older relative was perceived to be approaching death because of his/her age, the suicide was still unexpected and shocking and led to various emotions (shock, anger, and guilt) and to family conflicts. Suicide remains a taboo subject, but the newly legalized medical assistance in dying is seen as a potential solution to suffering in old age. Further investigation is clearly needed on this topic and this pilot study indicates that the main difficulties will lie in the choice of selection criteria for participants and in the recruitment process.
Collapse
Affiliation(s)
- Gabrielle Michaud-Dumont
- Laboratoire interdisciplinaire de recherche en gérontologie (LIREG), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life Practices (CRISE), Université du Québec à Montréal, Montréal, QC, Canada
| | - Sylvie Lapierre
- Laboratoire interdisciplinaire de recherche en gérontologie (LIREG), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life Practices (CRISE), Université du Québec à Montréal, Montréal, QC, Canada
| | - Charles Viau-Quesnel
- Laboratoire interdisciplinaire de recherche en gérontologie (LIREG), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| |
Collapse
|
28
|
Álvarez Muñoz FJ, Rubio-Aparicio M, Gurillo Muñoz P, García Herrero AM, Sánchez-Meca J, Navarro-Mateu F. Suicide and dementia: Systematic review and meta-analysis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 13:213-227. [PMID: 32507727 DOI: 10.1016/j.rpsm.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To analyse the possible relationship between dementia in the elderly and the subsequent development of suicide ideation, attempts and / or completed suicides. METHODS Systematic review and meta-analysis. SELECTION CRITERIA studies that analysed the relationship between dementia and suicide. SEARCH STRATEGY i) in PubMed, EMBASE, CINAHL, IME and Lilacs until December 2018; ii) manual search of the bibliography of selected articles; iii) contact with leading authors. Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers. The effect size index was calculated using Odds Ratio (OR) and its 95% confidence interval (random-effects model). Heterogeneity was evaluated with forest plots, Cochran's Q and I2 index. Assessment of publication bias using funnel plots ("trim-and-fill" method) and the Egger test. The analysis of moderating variables was performed using a multiple meta-regression under a mixed-effects model. RESULTS 37 studies and 47 basic units of study were identified. Effect size of the association of dementia with: Suicidal Ideation OR = 1.37 (95% CI: .78-2.39); Suicide Attempt: OR = 2.24 (95% CI: 1.01-4.97); and Completed Suicide: OR = 1.28 (95% CI: .77-2.14). Possible publication bias was ruled out. CONCLUSIONS A trend towards suicidal events is identified, especially suicide attempts in people with dementia. Greater attention and care are recommended after a recent diagnosis of dementia, especially with adequate assessment of comorbidities, which could influence the occurrence and outcome of suicidal events.
Collapse
Affiliation(s)
- Francisco Javier Álvarez Muñoz
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Regional de Salud Mental, Servicio Murciano de Salud, Murcia, España
| | - María Rubio-Aparicio
- Departamento de Psicología de la Salud, Facultad de Ciencias de la Salud, Universidad de Alicante, Alicante, España.
| | | | | | - Julio Sánchez-Meca
- Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Murcia, España
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Regional de Salud Mental, Servicio Murciano de Salud, Murcia, España; Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Murcia, España; CIBER de Epidemiología y Salud Pública (CIBERESP) IMIB-Arrixaca, Murcia, España
| |
Collapse
|
29
|
Cybulski M, Cybulski L, Krajewska-Kulak E, Orzechowska M, Cwalina U, Kowalewska B. Occurrence of mood disorders among educationally active older adults in Bialystok, Poland: a cross-sectional study. Ann Gen Psychiatry 2020; 19:35. [PMID: 32514282 PMCID: PMC7254768 DOI: 10.1186/s12991-020-00285-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/16/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Mood disorders in older people are an increasingly serious health and social problem, and their prevalence increases with age. The most common mood disorders are bipolar disorder, which is the occurrence of mania and hypomania, and depressive disorders. The aim of this study was to determine the prevalence of mood disorders in a group of educationally active elderly people living in Bialystok, Poland. METHODS The study included a total of 162 people-residents of Bialystok-aged 60 or older; 135 women (83.33%) and 27 men (16.67%). The study used five standardized psychometric scales: The Mood Disorder Questionnaire (MDQ), Hypomania Check List (HCL-32), Geriatric Depression Scale (GDS) and The Zung Self-Rating Depression Scale (Zung SDS). RESULTS Nearly 90.00% of the respondents obtained GDS scores indicating the presence of mild depressive symptoms; however, on the Zung SDS, which also evaluates depression symptom levels, the result obtained in almost the same number of respondents showed an absence of these symptoms. A similar percentage of respondents also obtained values on the MDQ that allow to determine a lack of bipolar disorder characteristics in the studied population. Over half of the respondents (58.02%) did not show symptoms of hypomania using the HCL-32. There was a significant correlation between the results of the GDS and Zung SDS, the HCL-32 and MDQ, as well as the HCL-32 and Zung SDS in the total studied group. CONCLUSIONS Mood disorders, particularly depression, constitute a significant social and health problem in the group of educationally active older adults living in Bialystok. In light of the obtained research results, it is recommended to conduct and improve already realized health education programs for the elderly on the subject of mood disorder prevention and their impact on quality of life. There is a need for further research on mood disorders in the elderly to determine their prevalence on a national scale.
Collapse
Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie Str, 15-096 Bialystok, Poland
| | - Lukasz Cybulski
- Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Elzbieta Krajewska-Kulak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie Str, 15-096 Bialystok, Poland
| | - Magda Orzechowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie Str, 15-096 Bialystok, Poland
| | - Urszula Cwalina
- Department of Statistics and Medical Informatics, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Beata Kowalewska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie Str, 15-096 Bialystok, Poland
| |
Collapse
|
30
|
Lennon JC. Etiopathogenesis of Suicide: A Conceptual Analysis of Risk and Prevention Within a Comprehensive, Deterministic Model. Front Psychol 2019; 10:2087. [PMID: 31572269 PMCID: PMC6751268 DOI: 10.3389/fpsyg.2019.02087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022] Open
Abstract
Suicide is a rising global health concern receiving disproportionate attention in comparison to other health conditions. In spite of substantial technological and scientific advancements, suicide research has continued to move slowly in terms of clinical translation due to the complexity of neural mechanisms, and subjective experiences that seem to underpin this complex human behavior. This paper analyzes the concepts of risk and prevention in the context of suicide in an attempt to bridge the large methodological and theoretical gaps between the biological, psychological, and sociological dimensions. This paper aims to accomplish the following objectives: (1) operationalize the concepts of suicide risk and prevention as they relate to current knowledge and capabilities; (2) synthesize and integrate suicide research across biological, psychological, and sociological dimensions; (3) discuss limitations of each dimension in isolation; (4) suggest a model of etiopathogenesis that incorporates extant literature and bridges unnecessary gaps between dimensions; and (5) suggest future directions for multidimensional research through the inclusion of principles from the physical sciences. Ultimately, this paper provides a basis for a comprehensive model of suicide within a deterministic, chaotic system.
Collapse
Affiliation(s)
- Jack C Lennon
- Department of Psychology, Adler University, Chicago, IL, United States.,Section of Parkinson's Disease and Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.,Department of Behavioral Sciences, Rush Neurobehavioral Center, Rush University Medical Center, Skokie, IL, United States
| |
Collapse
|
31
|
Egan MF, Mukai Y, Voss T, Kost J, Stone J, Furtek C, Mahoney E, Cummings JL, Tariot PN, Aisen PS, Vellas B, Lines C, Michelson D. Further analyses of the safety of verubecestat in the phase 3 EPOCH trial of mild-to-moderate Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2019; 11:68. [PMID: 31387606 PMCID: PMC6685277 DOI: 10.1186/s13195-019-0520-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Verubecestat, a BACE1 inhibitor that reduces Aβ levels in the cerebrospinal fluid of humans, was not effective in a phase 3 trial (EPOCH) of mild-to-moderate AD and was associated with adverse events. To assist in the development of BACE1 inhibitors, we report detailed safety findings from EPOCH. METHODS EPOCH was a randomized, double-blind, placebo-controlled 78-week trial evaluating verubecestat 12 mg and 40 mg in participants with mild-to-moderate AD diagnosed clinically. The trial was terminated due to futility close to its scheduled completion. Of 1957 participants who were randomized and took treatment, 652 were assigned to verubecestat 12 mg, 652 to verubecestat 40 mg, and 653 to placebo. Adverse events and relevant laboratory, vital sign, and ECG findings were assessed. RESULTS Verubecestat 12 mg and 40 mg were associated with an increase in the percentage of participants reporting adverse events versus placebo (89 and 92% vs. 82%), although relatively few participants discontinued treatment due to adverse events (8 and 9% vs. 6%). Adverse events that were increased versus placebo included falls and injuries, suicidal ideation, weight loss, sleep disturbance, rash, and hair color change. Most were mild to moderate in severity. Treatment differences in suicidal ideation emerged within the first 3 months but did not appear to increase after 6 months. In contrast, treatment differences in falls and injuries continued to increase over time. CONCLUSIONS Verubecestat was associated with increased risk for several types of adverse events. Falls and injuries were notable for progressive increases over time. While the mechanisms underlying the increased adverse events are unclear, they may be due to BACE inhibition and should be considered in future clinical development programs of BACE1 inhibitors. TRIAL REGISTRATION ClinicalTrials.gov NCT01739348 , registered on 29 November 2012.
Collapse
Affiliation(s)
- Michael F Egan
- Merck & Co., Inc., Kenilworth, NJ, USA. .,Merck & Co., Inc., UG 4C-06, P.O. Box 1000, North Wales, PA, 19454-1099, USA.
| | | | | | | | | | | | | | - Jeffrey L Cummings
- University of Nevada Las Vegas Department of Brain Health, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | - Paul S Aisen
- University of Southern California, San Diego, CA, USA
| | - Bruno Vellas
- Gerontopole, INSERM U 1027, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France
| | | | | |
Collapse
|
32
|
Mokhtari AM, Sahraian S, Hassanipour S, Baseri A, Mirahmadizadeh A. The epidemiology of suicide in the elderly population in Southern Iran, 2011-2016. Asian J Psychiatr 2019; 44:90-94. [PMID: 31326771 DOI: 10.1016/j.ajp.2019.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epidemiology of suicide within the elderly is unique to each cultural setting. In most countries, despite the higher rate of suicide attempts among adolescents and young people, the rate of suicide deaths in the elderly is higher than other age groups. The purpose of this study was to investigate the suicide rates among persons 65 years and above in Fars, Iran. METHODS In this cross-sectional study, we investigated suicide cases (65 years and older) during 2011-2016 in Fars, Iran. The data were collected from the Mental Health and Suicide Surveillance Systems of Fars province, using filled forms that included suicide and demographic information. After eliminating duplications, suicidal rates were calculated. RESULTS Of 299 suicide attempts, 64.9% were men, and 69.6% were urban residents. The rate of suicide attempts and deaths were 21.47 and 4.52 per 100,000 population, respectively; and the case fatality rate (CFR) of suicide was 21.07% during the study period. The rate of suicide attempts and deaths in this population showed an increase during the study years. CONCLUSIONS Considering the increasing trend of suicide rates in the elderly in Fars, Iran, measures should be taken to facilitate the access of this group to the mental health care system and psychological counseling.
Collapse
Affiliation(s)
| | - Sadaf Sahraian
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Baseri
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
33
|
Annor FB, Bayakly RA, Morrison RA, Bryan MJ, Gilbert LK, Ivey-Stephenson AZ, Holland KM, Simon TR. Suicide Among Persons With Dementia, Georgia, 2013 to 2016. J Geriatr Psychiatry Neurol 2019; 32:31-39. [PMID: 30477384 PMCID: PMC6690600 DOI: 10.1177/0891988718814363] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Findings from studies examining the relationship between dementia and suicide have been inconsistent. This study examined the characteristics, precipitants, and risk factors for suicide among persons with dementia. METHODS Data from the Georgia Alzheimer's Disease and Related Dementia registry were linked with 2013 to 2016 data from Georgia Vital Records and Georgia Violent Death Reporting System. Descriptive statistics were calculated and logistic regression was used to examine risk factors for suicide. RESULTS Ninety-one Georgia residents with dementia who died by suicide were identified. Among decedents with known circumstances, common precipitants included depressed mood (38.7%) and physical health problems (72.6%). Suicide rate among persons with dementia was 9.3 per 100 000 person-years overall and substantially higher among those diagnosed in the past 12 months (424.5/100 000 person-years). Being male, dementia diagnosis before age 65, and a recent diagnosis of dementia independently predicted suicide, but not depression or cardiovascular diseases. CONCLUSION Prevention strategies that identify at-risk individuals, provide support, and ensure continuity of care for persons diagnosed with dementia may help reduce suicide in this population.
Collapse
Affiliation(s)
- Francis B. Annor
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Leah K. Gilbert
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Asha Z. Ivey-Stephenson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristin M. Holland
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas R. Simon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
34
|
Beaudreau SA, Jordan JT, O'Hara R. Commentary on "High Occurrence of Psychiatric Disorders and Suicidal Behavior Across Dementia Subtypes". Am J Geriatr Psychiatry 2018; 26:1202-1203. [PMID: 30401607 DOI: 10.1016/j.jagp.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Sherry A Beaudreau
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (SAB, RO), VA Palo Alto Health Care System, Palo Alto, CA; Department of Psychiatry and Behavioral Sciences (SAB, RO), Stanford University School of Medicine, Stanford, CA; School of Psychology (SAB), University of Queensland, Brisbane, Australia.
| | - Joshua T Jordan
- Department of Psychiatry (JTJ), University of California, CA
| | - Ruth O'Hara
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (SAB, RO), VA Palo Alto Health Care System, Palo Alto, CA; Department of Psychiatry and Behavioral Sciences (SAB, RO), Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
35
|
Abstract
OBJECTIVES The objective of this literature review and synthesis of data was to consider the presence, drivers, and protectors of suicidality in people diagnosed with dementia. The review also considered what factors represented an increased risk of suicidality. Finally, it reflected on the morality and ethics of choice when discussing dying in dementia. METHOD This article used a critical interpretive synthesis model which interpreted data associated with the subject of suicidality in dementia. A sample frame was used to determine the quality and relevance of extracted data, and finally to construct a critical interpretive synthesis. Data were extracted from eight key papers. RESULTS The review and synthesis concluded with eight synthetic constructs, and two concluding synthesised arguments. Argument one was the substantial increased risk of suicidality in people diagnosed with dementia and clinical depression. The second argument was that end-of-life discussions are common place in people with a dementia diagnosis and their families. CONCLUSION Death remains a difficult subject for some to discuss, especially when talking about suicidality. Nevertheless, having these conversations is possible, even when there are added complexities that a dementia diagnosis can bring. These conversations do, however, need to be individualized and measured. And, whilst respecting the person's pre-morbid wishes, advance decisions and ethics of choice, we also need to consider the ongoing arguments of the 'right to life' versus the 'right to die'. However, before these conversations can take place, additional suicidality risk factors such as a new and early dementia diagnosis and mental health comorbidities such as depression need to be acknowledged and addressed.
Collapse
Affiliation(s)
- Gary Hodge
- Livewell Southwest and University of Plymouth, Plymouth, UK
| |
Collapse
|