ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE GERIATRIC SUICIDE IDEATION SCALE (GSIS) IN MIDDLE-AGED AND OLDER MEN

Middle-aged and older men have high rates of suicide, necessitating focused risk detection. We developed the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006) as an age-specific, multidimensional suicide risk assessment tool. The GSIS has shown strong psychometric properties in clinical, community, and residential samples (see Heisel & Flett, 2016), yet research has lagged investigating its utility with middle-aged and older men. The purpose of the present study was thus to assess the psychometric properties of the GSIS administered to 82 men, 55 years and older (M=63.3, SD=4.6 years), who participated in a meaning-centered psychological intervention group for those concerned about or struggling with the transition to retirement (Heisel et al., 2020). Psychometric analyses included investigation of participant response characteristics, internal consistency, and construct validity. Findings demonstrated acceptable internal consistency for GSIS totals (α =.88) and for its Suicide Ideation, Death Ideation, Loss of Personal and Social Worth, and Perceived Meaning in Life subscales (α =.62-.81). Positive associations between the GSIS and negative psychological factors (depression, anxiety, hopelessness, loneliness, perceived lack of mattering to others, and history of suicidal behavior; r =.30 to .51) and negative associations with positive factors (life satisfaction, psychological well-being, perceived support, and meaning in life; r = -.21 to -.51) supported its construct validity. These and other findings will be discussed in the broader context of upstream population level approaches to suicide risk detection and prevention.

IS NARCISSISTIC PERSONALITY ASSOCIATED WITH SUICIDE IDEATION IN MIDDLE-AGED AND OLDER MEN?

Older adults have high rates of suicide, necessitating theory and research on factors that contribute to suicide risk and may be targets for intervention. Clark (1993) theorized that age-related losses and transitions can trigger narcissistic injury in older men, and lead to mood decline, substance misuse, loss of insight, and suicide ideation and behavior. We tested elements of Clark’s model in a secondary analysis of a geriatric depression clinic database (n=574), and reported a positive association between clinician-diagnosed Narcissistic Personality (NP) and suicide ideation and behavior, controlling for depression severity (Heisel et al., 2007). We sought to replicate and extend these findings in 82 community-residing men, 55 years and older (M=63.3, SD=4.6), who participated in a trial of Meaning-Centered Men’s Group (MCMG; Heisel et al., 2020) for those concerned about or struggling with the transition to retirement. Participants completed the Pathological Narcissism Inventory (Pincus et al., 2009), Geriatric Suicide Ideation Scale (Heisel & Flett, 2006), and Geriatric Depression Scale (Yesavage et al., 1983). Linear regression analyses indicated a significant association between PNI-Contingent Self-Esteem and GSIS totals (t=2.41, p=.019) and GSIS Loss of Personal Worth (t=2.10, p=.040) and Perceived Meaning in Life Subscales (t=2.80, p=.007), controlling for depressive symptom severity (Geriatric Depression Scale; Yesavage et al., 1983), suggesting an association between suicide ideation and self-esteem issues. These and other findings will be discussed in a broader thematic context regarding masculinity, loss, life transitions, and suicide prevention.

A Pandemic Paradox: Innovations in Psychological Resiliency and Suicide Prevention in Older Adults

The COVID-19 pandemic has had a substantial negative impact on the health and well-being of older adults, a demographic with the highest proportion of fatalities in North America. Long-term care and retirement homes have been especially hard hit. Sheltering in place can increase social isolation among older adults and contribute to feelings of stigmatization, burden, stress, anxiety, anger, and despair. As older adults also account for high rates of suicide, fear of infection, reduced access to professional and social supports, and growing apathy, hopelessness, and social isolation could amplify suicide risk (see Zortea et al., 2020). The speaker will discuss how his program of research on psychological resiliency and suicide prevention in older adults has pivoted online over the past year, and how the pandemic has paradoxically inspired innovative approaches to research, education, clinical practice, and social advocacy for older adults that will likely continue well beyond the present time.

Testing Online Men’s Groups to Promote Psychological Well-Being and Reduce Despair During the COVID-19 Pandemic

Assisted living is generally understood to offer a greater degree of privacy and independence than a nursing home; most residents pay privately, with some receiving support from state subsidies and Medicaid; regulation and oversight are the purview of state agencies. Within these broad parameters, however, one assisted living community may look quite different from another across the country, or down the street, in its resident population and the regulations that govern its operating license. The purpose of this symposium is to explore that variation. The papers leverage an in-depth review of changes in assisted-living regulation from 2007 to 2019 and a methodology to identify Medicare beneficiaries in assisted living using ZIP codes. To set the stage, the first paper examines variation across assisted living licenses to identify six regulatory types and compare their populations’ characteristics and health-care use. The second paper analyzes trends over time in the clinical acuity of assisted living residents associated with changes in nursing home populations. The third paper investigates racial disparities in assisted living associated with memory-care designations and proportions of Medicaid recipients. The fourth investigates how regulation of hospice providers in assisted living affect end-of-life care and place of death. The final paper describes requirements related to care for the residents with mental illness in seven states. The symposium concludes with an expert in long-term care disparities and quality discussing the implications for policymakers, providers, and the population needing long-term care in assisted living.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide

OBJECTIVES

Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over.

METHOD

The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded.

RESULTS

This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures.

CONCLUSION

Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology

OBJECTIVES

Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).

DESIGN

An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.

SETTING

International.

PARTICIPANTS

Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.

OUTCOME MEASURES

Definitions of English-language terms for suicidal behaviours.

RESULTS

The recommended definition of 'suicide' describes a fatal act initiated and carried out by the actors themselves. The definition of 'suicide attempt' was restricted to non-fatal acts with intent to die, whereas definition of 'self-harm' more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of 'suicidal ideation', 'death wishes' and 'suicide plan'. 'Aborted suicide attempt' and 'interrupted suicide attempt' were not considered components of 'preparatory suicidal behaviour'. There were several differences between representatives from HICs and LMICs.

CONCLUSION

This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.

The BEACON study: protocol for a cohort study as part of an evaluation of the effectiveness of smartphone-assisted problem-solving therapy in men who present with intentional self-harm to emergency departments in Ontario

BACKGROUND

Patients who present to emergency departments after intentional self-harm are at an increased risk of dying by suicide. This applies particularly to men, who represent nearly two-thirds of those who die by suicide in Ontario. One way of potentially addressing this gap is to offer a course of blended problem-solving therapy, comprised of a brief course of evidence-based psychotherapy for individuals at risk for suicide, facilitated by the use of a patient-facing smartphone application and a clinician-facing "dashboard." This approach has the potential to combine the benefits of face-to-face therapy and technology to create a novel intervention.

METHODS

This is a cohort study nested within a larger pragmatic multicentre pre- and post-design cluster randomised trial. Suicidal ideation assessed by the Beck Scale for Suicide Ideation is the primary outcome variable. Secondary outcome measures include depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder 7-item scale), post-traumatic stress disorder (Primary Care PTSD Screen), health-related quality of life (EuroQol 5-dimension 5-level questionnaire), meaning in life (Experienced Meaning in Life Scale), perceived social supports (Multidimensional Scale of Perceived Social Support), alcohol use (Alcohol Use Disorders Identification Test), drug use (Drug Abuse Screening Test Short Form 10), problem-solving skills (Social Problem-Solving Inventory-Revised Short Form), and self-reported healthcare costs, as well as health service use measured using Ontario administrative health data. A process evaluation will also be conducted following study completion.

DISCUSSION

The cohort study will test whether better adherence to the intervention results in better outcomes. The value of the cohort study design is that we can examine in more detail certain subgroups or other variables that are not available in the larger cluster randomised trial. This trial will aim to improve standards by informing best practice in management of men who self-harm and present to hospitals in Ontario.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT03473535 . Registered on March 22, 2018.

Characterization of 30 76 Ge enriched Broad Energy Ge detectors for GERDA Phase II

The GERmanium Detector Array (Gerda) is a low background experiment located at the Laboratori Nazionali del Gran Sasso in Italy, which searches for neutrinoless double-beta decay of 76 Ge into 76 Se+2e - . Gerda has been conceived in two phases. Phase II, which started in December 2015, features several novelties including 30 new ⁷⁶Ge enriched detectors. These were manufactured according to the Broad Energy Germanium (BEGe) detector design that has a better background discrimination capability and energy resolution compared to formerly widely-used types. Prior to their installation, the new BEGe detectors were mounted in vacuum cryostats and characterized in detail in the Hades underground laboratory in Belgium. This paper describes the properties and the overall performance of these detectors during operation in vacuum. The characterization campaign provided not only direct input for Gerda Phase II data collection and analyses, but also allowed to study detector phenomena, detector correlations as well as to test the accuracy of pulse shape simulation codes.

Probing Majorana neutrinos with double-β decay

A discovery that neutrinos are Majorana fermions would have profound implications for particle physics and cosmology. The Majorana character of neutrinos would make possible the neutrinoless double-β (0νββ) decay, a matter-creating process without the balancing emission of antimatter. The GERDA Collaboration searches for the 0νββ decay of ⁷⁶Ge by operating bare germanium detectors in an active liquid argon shield. With a total exposure of 82.4 kg⋅year, we observe no signal and derive a lower half-life limit of T _1/2 > 0.9 × 10²⁶ years (90% C.L.). Our T _1/2 sensitivity, assuming no signal, is 1.1 × 10²⁶ years. Combining the latter with those from other 0νββ decay searches yields a sensitivity to the effective Majorana neutrino mass of 0.07 to 0.16 electron volts.

Improved Limit on Neutrinoless Double-β Decay of ^{76}Ge from GERDA Phase II

The GERDA experiment searches for the lepton-number-violating neutrinoless double-β decay of ^{76}Ge (^{76}Ge→^{76}Se+2e^{-}) operating bare Ge diodes with an enriched ^{76}Ge fraction in liquid argon. The exposure for broad-energy germanium type (BEGe) detectors is increased threefold with respect to our previous data release. The BEGe detectors feature an excellent background suppression from the analysis of the time profile of the detector signals. In the analysis window a background level of 1.0_{-0.4}^{+0.6}×10^{-3}  counts/(keV kg yr) has been achieved; if normalized to the energy resolution this is the lowest ever achieved in any 0νββ experiment. No signal is observed and a new 90% C.L. lower limit for the half-life of 8.0×10^{25}  yr is placed when combining with our previous data. The expected median sensitivity assuming no signal is 5.8×10^{25}  yr.

A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm

BACKGROUND

Blended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm.

OBJECTIVE

To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy.

METHODS

After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach.

FINDINGS

Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments.

CONCLUSIONS

In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people.

CLINICAL IMPLICATIONS

Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions.

TRIAL REGISTRATION NUMBER

NCT02718248.

Towards a shared understanding: Perspectives from Toronto's first media forum for suicide prevention

Media reporting on suicide may have harmful and/or protective effects on deaths by suicide, depending on the nature of the coverage. Canada's first forum on this important issue was held in Toronto on November 6, 2015. Participating in the forum were public health policy-makers, mental health and suicide prevention experts and senior media representatives. This commentary summarizes the content of the forum and highlights the need for ongoing collaboration between suicide prevention experts and media professionals aimed at safe and respectful reporting that maintains the public's need to be informed.

SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes

BACKGROUND

Previous classification systems of acute ischemic stroke (Causative Classification System, CCS, of acute ischemic stroke, Trial of Org 10172 in Acute Stroke Treatment, TOAST) established the diagnosis of large artery disease (LAD) based on the presence or absence of carotid stenosis. However, carotid plaque burden is a stronger predictor of cardiovascular risk than stenosis. Our objective was to update definitions of ischemic stroke subtypes to improve the detection of LAD and to assess the validity and reliability of a new classification system: SPARKLE (Subtypes of Ischaemic Stroke Classification System).

METHODS

In a retrospective review of clinical research data, we compared three stroke subtype classifications: CCS, TOAST and SPARKLE. We analyzed a random sample of 275 patients presenting with minor stroke or transient ischemic attack (TIA) in an Urgent TIA Clinic in London, Ont., Canada, between 2002 and 2012.

RESULTS

There was substantial overall agreement between SPARKLE and CCS (κ = 0.75), with significant differences in the rate of detection of LAD, cardioembolic and undetermined causes of stroke or TIA. The inter-rater reliability of SPARKLE was substantial (κ = 0.76) and the intra-rater reliability was excellent (κ = 0.91).

CONCLUSION

SPARKLE is a valid and reliable classification system, providing advantages compared to CCS and TOAST. The incorporation of plaque burden into the classification of LAD increases the proportion of cases attributable to LAD and reduces the proportion classified as being of 'undetermined' etiology.

Results on neutrinoless double-β decay of 76Ge from phase I of the GERDA experiment

Neutrinoless double beta decay is a process that violates lepton number conservation. It is predicted to occur in extensions of the standard model of particle physics. This Letter reports the results from phase I of the Germanium Detector Array (GERDA) experiment at the Gran Sasso Laboratory (Italy) searching for neutrinoless double beta decay of the isotope (76)Ge. Data considered in the present analysis have been collected between November 2011 and May 2013 with a total exposure of 21.6 kg yr. A blind analysis is performed. The background index is about 1 × 10(-2) counts/(keV kg yr) after pulse shape discrimination. No signal is observed and a lower limit is derived for the half-life of neutrinoless double beta decay of (76)Ge, T(1/2)(0ν) >2.1 × 10(25) yr (90% C.L.). The combination with the results from the previous experiments with (76)Ge yields T(1/2)(0ν)>3.0 × 10(25) yr (90% C.L.).

Validity of the SF-36 five-item Mental Health Index for major depression in functionally impaired, community-dwelling elderly patients

OBJECTIVES

To examine criterion and construct validity of the five-item Mental Health Index (MHI-5) of the 36-item Short Form health survey (SF-36) in relation to the presence of major depression in functionally impaired, community-dwelling elderly patients and of eight subsamples defined by cognitive functioning, levels of functional impairment, and proxy report versus self-report.

DESIGN

Cross-sectional observational.

SETTING

Nineteen counties in western New York, West Virginia, and Ohio.

PARTICIPANTS

One thousand four hundred forty-four functionally impaired, community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Primary and Consumer-Directed Care Demonstration.

MEASUREMENTS

MHI-5, Mini-International Neuropsychiatric Interview Major Depressive Episode (MINI-MDE) module.

RESULTS

The MHI-5 demonstrated sufficient criterion validity (area under the receiver operating characteristic curve=0.837; sensitivity=78.7% and specificity=72.1% using a cutpoint of 59/60) with respect to the presence of depression for the entire sample. A significant correlation between MHI-5 scores and presence of major depression as identified using the MINI-MDE (Spearman correlation=-0.426, P<.001), a strong correlation between the MHI-5 and the SF-36 role emotional scale (Spearman correlation=0.522) and a weak correlation with the SF-36 physical functioning scale (Spearman correlation=0.133) provided evidence for construct validity. Additional evidence is provided by decline in mean MHI-5 score as level of formal education and number of close friends and relatives decreased. All eight subsamples demonstrated similar criterion and construct validity. A Cronbach alpha of 0.794 demonstrated internal consistency reliability.

CONCLUSION

This study provides evidence for adequate criterion and construct validity of the MHI-5 in relation to the presence of major depression among functionally impaired, community-dwelling elderly Medicare patients.

Use of recombinant factor VIIa (rFVIIa) to control intraoperative bleeding in pediatric brain tumor patients

Surgical bleeding during the resection of brain tumors in children may be related to tumor vascularity, pathology, and location. Despite improvements in neurosurgical technique, neuroanesthesia, and blood product replacement, bleeding can be life-threatening in these surgeries. We report eight pediatric patients in whom recombinant factor VIIa (rFVIIa) was used to control intraoperative bleeding during surgical resection of pediatric brain tumors. rFVIIa should be considered as a method to control intraoperative bleeding that is unresponsive to conventional interventions. Additional studies are needed to determine optimal patient selection and drug dosing, efficacy and safety.

Intrathoracic extravasation of sclerosing agents associated with central venous catheters

Two children receiving continuous infusions of vesicant chemotherapy through central venous catheters (CVCs) developed venous thrombosis, and intrathoracic extravasations ensued. One child receiving a continuous vincristine infusion presented with signs of thoracic venous obstruction, fever, and respiratory distress and had pleural effusions and pulmonary infiltrates on his chest roentgenogram. The other child was receiving a continuous doxorubicin infusion and developed superior vena cava thrombosis and retrograde extravasation along the catheter tunnel site. Both children improved after chemotherapy was discontinued and the CVCs removed. Catheter placement and the continuous infusion of sclerosing agents are discussed.

Inhibition by bovine endothelial cells of degradation by HT-1080 fibrosarcoma cells of extracellular matrix proteins

Medium conditioned by bovine arterial endothelial cells inhibited the degradation by human fibrosarcoma cells of living cultures of rat smooth muscle cells or their cell-free extracellular matrices. Endothelial cell-conditioned medium had no effect on the growth kinetics of fibrosarcoma cells, and the inhibitory influence of conditioned medium on matrix degradation was greatest with low numbers of tumor cells. Conditioned medium inhibited the production of tumor cell plasminogen activators, enzymes previously found to play a role in matrix glycoprotein degradation. The endothelial factor was heat- and acid-stable and non-dialyzable, and mixing experiments showed that it did not directly inactivate the tumor cell plasminogen activator. Endothelial cells may therefore modulate the production of proteolytic enzymes important in the implantation stage of tumor metastasis.