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Rymo I, Fässberg MM, Kern S, Zetterberg H, Skoog I, Waern M, Sacuiu S. Mild cognitive impairment is associated with passive suicidal ideation in older adults: A population-based study. Acta Psychiatr Scand 2023; 148:91-101. [PMID: 36994943 DOI: 10.1111/acps.13549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To investigate the association between MCI and passive/active suicidal ideation in a population-based sample of older adults. METHOD The sample included 916 participants without dementia acquired from the two population-based studies Prospective Population Study of Women (PPSW) and the H70-study. Cognitive status was assessed using a comprehensive neuropsychiatric examination and classified according to the Winblad et al. criteria: 182 participants were classified as cognitively intact, 448 had cognitive impairment but did not fulfill MCI criteria and 286 were diagnosed with MCI. Passive/active suicidal ideation was assessed using the Paykel questions. RESULTS Passive or active suicidal ideation (any level) was reported by 16.0% of those with MCI and 1.1% of those who were cognitively intact. MCI was associated with past year life-weariness (OR 18.32, 95% CI 2.44-137.75) and death wishes (OR 5.30, 95% CI 1.19-23.64) in regression models adjusted for covariates including major depression. Lifetime suicidal ideation was reported more frequently in MCI (35.7%) than in cognitively intact participants (14.8%). MCI was associated with lifetime life-weariness (OR 2.90, 95% CI 1.67-5.05). Among individuals with MCI, impairments in memory and visuospatial ability were associated with both past year and lifetime life-weariness. CONCLUSION Our findings suggest reports of past year as well as lifetime passive suicidal ideation to be more frequent among individuals with MCI compared to those cognitively intact, indicating that individuals with MCI may constitute a high-risk group for suicidal behavior.
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Affiliation(s)
- Irma Rymo
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Addiction Disorders Clinic, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- UCL Institute of Neurology, Department of Neurodegenerative Disease, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychosis Department, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Simona Sacuiu
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
- Cognitive Disorders Clinic, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Appel JE, van Wijngaarden EJ. Older Adults Who Experience Their Lives to Be Completed and No Longer Worth Living: A Systematic Mini-Review Into Used Terminology, Definitions, and Interpretations. Front Psychol 2021; 12:734049. [PMID: 34744905 PMCID: PMC8566750 DOI: 10.3389/fpsyg.2021.734049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/03/2021] [Indexed: 12/04/2022] Open
Abstract
In the Netherlands and in Belgium, a political debate emerged regarding the possibility of euthanasia and assisted suicide (EAS) for older adults who experience their lives as completed and no longer worth living, despite being relatively healthy. This mini-review aimed to (1) present an overview of the terms used to denote this phenomenon as well as their definitions and to (2) explore how the underlying experiences are interpreted by the study authors. A systematic search was performed in Web of Science, MEDLINE, PsycINFO, and CINAHL, yielding 35 articles meeting the selection criteria. We selected empirical, English-language articles published in peer-reviewed journals. Participants had to have a first-person experience of the phenomenon or be assessed for it, or have a third-person experience of the phenomenon. Results show that the terms tiredness of life (ToL) and weariness of life (WoL) were used most frequently, also in the broader literature on suicidal expressions across the life span. Many studies mentioned operational definitions or synonyms rather than theoretical definitions. Moreover, inside the EAS debate, the term ToL was more common, its definition incorporated death wishes, and it was regularly framed existentially. Outside of this debate, the phenomenon was generally considered as a part of suicidal ideation distinct from death wishes, and its experience was often associated with underlying psychopathology. We discuss the need to establish consensus definitions and conclude that only a multidimensional view may be suitable to capture the complex nature of the phenomenon.
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Affiliation(s)
- Judith E Appel
- Faculty of Psychology and Educational Sciences, Research Group School Psychology and Development in Context KU Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
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Behere PB, Nagdive AB, Behere AP, Yadav R, Fernandes R. Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India. J Neurosci Rural Pract 2021; 12:623-629. [PMID: 34737494 PMCID: PMC8559082 DOI: 10.1055/s-0041-1735242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.
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Affiliation(s)
- Prakash B. Behere
- Department of Psychiatry, Dnyandeo Yashwantrao Patil University, Kolhapur, Maharashtra, India
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi, Wardha, Maharashtra, India
| | - Amit B. Nagdive
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi, Wardha, Maharashtra, India
| | - Aniruddh P. Behere
- Department of Pediatrics and Human Development, Helen Devos Children's Hospital, Michigan State University College of Human Medicine Grand Rapids, Grand Rapids, Michigan, United States
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, Maharashtra, India
| | - Richa Yadav
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, Maharashtra, India
- Department of Psychiatry and Behavioural Sciences, OU College of Medicine, Oklahoma City, Oklahoma, United States
| | - Rouchelle Fernandes
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi, Wardha, Maharashtra, India
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Vehling S, Mehnert-Theuerkauf A, Glaesmer H, Bokemeyer C, Oechsle K, Härter M, Koch U. Thoughts of death and suicidality among patients with cancer: Examining subtypes and their association with mental disorders. Psychooncology 2021; 30:2023-2031. [PMID: 33864314 DOI: 10.1002/pon.5706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Cancer is associated with an increased risk for completed suicide. We explored subtypes of thoughts of death, death wishes, suicidal ideation and behavior and their association with mental disorders and demographic and disease-related characteristics. METHODS We studied 2,141 cancer patients with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O). Assessment included 4-weeks-prevalences of thoughts of death, wish to die, suicidal ideation, suicide plans, and lifetime suicide attempts. We further assessed 4-weeks-prevalences of mood, anxiety, adjustment, somatoform, substance use, and disorders due to general medical condition. We conducted latent class analyses (LCA). RESULTS The LCA identified three classes with distinct patterns of suicidality. Class 1 (89.0% of the sample) showed no suicidality. Class 2 (6.9%) was characterized by thoughts of death without suicidal ideation. Class 3 (4.1%) was characterized by thoughts of death, suicidal ideation, and suicide plans. Death wishes occurred in both classes 2 and 3. Classes 2 and 3 were associated with a significantly higher risk for any mental disorder (OR from 4.22, adjustment disorder, to 10.20, mood disorders, p < 0.001) compared to class 1. Patients with mental disorders were equally likely in classes 2 and 3. Patients with incurable cancer were significantly more likely in class 2, and less likely in class 3. CONCLUSIONS Cancer patients with suicidal ideation are not distinctly characterized by mental disorders. Further study of concepts that consider problematic adjustment to the cancer stressor such as death anxiety and demoralization may contribute to understand psychological distress underlying subtypes of thoughts of death and suicidality in cancer.
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Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cheung G, Martinez-Ruiz A, Knell R, O'Callaghan A, Guthrie DM. Factors Associated With Terminally Ill People Who Want to Die. J Pain Symptom Manage 2020; 60:539-548.e1. [PMID: 32305576 DOI: 10.1016/j.jpainsymman.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Abstract
CONTEXT The decision to request and proceed with euthanasia or physician-assisted dying is complex, and predictors of such decisions are heterogeneous with regard to physical health, psychological, and social factors. Local research is therefore needed. OBJECTIVES To examine the interplay of demographic, clinical, and psychosocial factors routinely collected by a standardized clinical instrument, the interRAI Resident Assessment Instrument for Palliative Care (interRAI-PC), in people with a prognosis of less than 12 months who wanted to die. METHODS All New Zealanders who had an interRAI-PC in 2018 were included. The outcome variable was the single item Wants to die now. Independent variables included biopsychosocial factors and health index scales generated by interRAI-PC. A binary logistic regression was used to determine the predictive factors of Wants to die now (yes vs. no). RESULTS There were 771 individuals included (mean age 76.0 years; SD 11.6; female 50.1%); 9.3% of whom reported yes to Wants to die now, 59.8% no, and for 30.9%, the assessor was unable to determine. The factors with the largest odds ratios (ORs) were awareness of terminal prognosis (OR 4.8; 95% CI 2.2-10.3), high level of depression (OR 4.6; 95% CI 1.7-12.6), not finding meaning in day-to-day life (OR 3.8; 95% CI 1.8-8.1), and pain (less than severe: OR 3.7; 95% CI 1.3-10.4 and severe to excruciating: OR 3.5; 95% CI 1.1-10.7). CONCLUSION Addressing the significant factors we identified should form part of a multidisciplinary assessment when terminally ill patients express a wish to die, to ensure their physical, psychological, and existential needs are adequately met.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.
| | - Adrian Martinez-Ruiz
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand; National Institute of Geriatrics, Mexico City, Mexico
| | - Rebecca Knell
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada; Department of Health Science, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Carrasco-Barrios MT, Huertas P, Martín P, Martín C, Castillejos MC, Petkari E, Moreno-Küstner B. Determinants of Suicidality in the European General Population: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020; 17:E4115. [PMID: 32526975 PMCID: PMC7312422 DOI: 10.3390/ijerph17114115] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Close to one million people commit suicide each year, with suicidal attempts being the main risk factor for suicide. The aim of this systematic review and meta-analysis is to achieve a greater understanding of suicidality in the general population of Europe by studying associated factors and their statistical significance with suicidality, as well as the effect of the temporal moment in which suicidality is observed in a relationship. A search strategy was carried out in electronic databases: Proquest's Psychology Database, Scopus, PsycINFO, Medline and Embase. Odds ratios (ORs), publication bias, influential studies on heterogeneity and analysis moderators were calculated. Twenty-six studies were included after meeting the inclusion criteria. Factors statistically associated with suicidality are female gender, age over 65 years, unemployment, low social support, adulthood adversity, childhood adversity, family history of mental disorder, any affective disorder, major depression, anxiety/stress/somatoform disorders, tobacco and substance use, any mental disorder and body mass index. As a limitation, a high heterogeneity between studies was found. Factors associated with suicidality in the general population are relevant for understanding the suicidal phenomenon.
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Affiliation(s)
- María Teresa Carrasco-Barrios
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Paloma Huertas
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Paloma Martín
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Carlos Martín
- Primary Care Center of Marquesado, Área Nordeste de Granada, 18512 Granada, Spain;
| | - Mª Carmen Castillejos
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Eleni Petkari
- Social and Behavioural Sciences, European University Cyprus 6th Diogenous st., Nicosia 2063, Cyprus;
| | - Berta Moreno-Küstner
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
- Biomedical Research Institute of Malaga (IBIMA), 29010 Málaga, Spain
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Holm AL, Berland AK, Birkeland AK, Severinsson E. First-line nurse managers' perceptions of the challenges involved in decision-making when older patients' wish to die. Nurs Open 2018; 5:217-223. [PMID: 29599997 PMCID: PMC5867279 DOI: 10.1002/nop2.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/17/2018] [Indexed: 11/18/2022] Open
Abstract
Aim The aim of this study was to explore first‐line nurse managers’ perceptions of the challenges involved in decision‐making concerning older patients who wish to die. Design A descriptive qualitative design in three communities in Norway between January 2016 and June 2016. Methods Qualitative focus group interviews with eight first‐line nurse managers. Results One main theme and two themes were identified: Struggling to make the right decision, The challenge of social isolation and loneliness and When life becomes too painful and problematic. The sub‐themes revealed that: Arranging social meeting places where the older patients can talk to other older people is crucial. The participants explained that it was not an easy task to gain an overview of the older patients situation. The right decision could be encouraging the patients to talk about their problems by giving them more time, thereby showing that somebody cares about them.
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Affiliation(s)
- Anne Lise Holm
- Faculty of Health and Social Sciences Western Norway University of Applied Sciences Haugesund Norway
| | - Astrid Karin Berland
- Faculty of Health and Social Sciences Western Norway University of Applied Sciences Haugesund Norway
| | - Arvid Karl Birkeland
- Faculty of Health and Social Sciences Western Norway University of Applied Sciences Haugesund Norway
| | - Elisabeth Severinsson
- Faculty of Health and Social Sciences Centre for Women's, Family and Child Health University College Southeast Norway Kongsberg Norway
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Cheung G, Edwards S, Sundram F. Death wishes among older people assessed for home support and long-term aged residential care. Int J Geriatr Psychiatry 2017; 32:1371-1380. [PMID: 27859762 DOI: 10.1002/gps.4624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/08/2016] [Accepted: 10/19/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. METHODS Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. RESULTS Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. CONCLUSIONS Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Siobhan Edwards
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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9
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Fässberg MM, Cheung G, Canetto SS, Erlangsen A, Lapierre S, Lindner R, Draper B, Gallo JJ, Wong C, Wu J, Duberstein P, Wærn M. A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging Ment Health 2016; 20:166-94. [PMID: 26381843 PMCID: PMC4720055 DOI: 10.1080/13607863.2015.1083945] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. METHOD Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. RESULTS Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed. CONCLUSION Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.
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Affiliation(s)
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Annette Erlangsen
- Research Unit, Mental Health Centre Copenhagen, Denmark,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Reinhard Lindner
- Geriatric Psychosomatics and Psychotherapy, Medical Geriatric Clinic Albertinen-Haus, University of Hamburg, Hamburg, Germany
| | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - Paul Duberstein
- Department of Psychiatry and Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Margda Wærn
- Section of Psychiatry and Neurochemistry, University of Gothenburg/Sahlgrenska University Hospital, Gothenburg, Sweden,Corresponding author.
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10
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Mellqvist Fässberg M, Östling S, Braam AW, Bäckman K, Copeland JRM, Fichter M, Kivelä SL, Lawlor BA, Lobo A, Magnússon H, Prince MJ, Reischies FM, Turrina C, Wilson K, Skoog I, Waern M. Functional disability and death wishes in older Europeans: results from the EURODEP concerted action. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1475-82. [PMID: 24554123 PMCID: PMC4143593 DOI: 10.1007/s00127-014-0840-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/03/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Physical illness has been shown to be a risk factor for suicidal behaviour in older adults. The association between functional disability and suicidal behaviour in older adults is less clear. The aim of this study was to examine the relationship between functional disability and death wishes in late life. METHODS Data from 11 population studies on depression in persons aged 65 and above were pooled, yielding a total of 15,890 respondents. Level of functional disability was trichotomised (no, intermediate, high). A person was considered to have death wishes if the death wish/suicidal ideation item of the EURO-D scale was endorsed. Odds ratios for death wishes associated with functional disability were calculated in a multilevel logistic regression model. RESULTS In total, 5 % of the men and 7 % of the women reported death wishes. Both intermediate (OR 1.89, 95 % CI 1.42; 2.52) and high functional disability (OR 3.22, 95 % CI 2.34; 4.42) were associated with death wishes. No sex differences could be shown. Results remained after adding depressive symptoms to the model. CONCLUSIONS Functional disability was independently associated with death wishes in older adults. Results can help inform clinicians who care for older persons with functional impairment.
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Affiliation(s)
- Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Svante Östling
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arjan W. Braam
- Department of Epidemiology and Biostatistics, VU University Medical Centre, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands ,Department of Resident Training, Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Kristoffer Bäckman
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John R. M. Copeland
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Manfred Fichter
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany ,Schoen Klinik Roseneck, Prien, Germany
| | | | - Brian A. Lawlor
- Department of Psychiatry, St. James’ Hospital, Jonathan Swift Clinic, Dublin, Republic of Ireland
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) and CIBERSAM, Universidad de Zaragoza, Hospital Clínico Universitario, Zaragoza, Spain
| | - Halggrimur Magnússon
- Department of Geriatrics, Landspitali, University Hospital of Iceland, Reykjavík, Iceland
| | - Martin J. Prince
- Health Services and Population Research Department, King’s College London, Institute of Psychiatry, London, UK
| | - Friedel M. Reischies
- Arbeitsgruppe Neuropsychologie Und Experimentelle Psychopathologie, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Turrina
- University Psychiatric Unit, Department of Mental Health, Brescia University School of Medicine, Brescia Spedali Civili, Brescia, Italy
| | - Kenneth Wilson
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, Leo DD, Szanto K, Waern M. A systematic review of social factors and suicidal behavior in older adulthood. Int J Environ Res Public Health 2012; 9:722-45. [PMID: 22690159 PMCID: PMC3367273 DOI: 10.3390/ijerph9030722] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/16/2012] [Accepted: 02/22/2012] [Indexed: 01/21/2023]
Abstract
Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.
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Affiliation(s)
- Madeleine Mellqvist Fässberg
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Wallinsgatan 6, 43141 Mölndal, Sweden;
| | - Kimberly A. van Orden
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; (K.A.O.); (P.D.)
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; (K.A.O.); (P.D.)
| | - Annette Erlangsen
- Department of Mental Health, Johns Hopkins School of Public Health, 624 North Broadway, S850, Baltimore, MD 21205, USA;
| | - Sylvie Lapierre
- Département de Psychologie, Université du Québec à Trois-Rivières, 3351 des Forges blvd., Trois-Rivières, QC G9A 5H7, Canada;
| | - Ehud Bodner
- The Interdisciplinary Department of Social Sciences and the Music Department, Bar-Ilan University, Ramat-Gan, Israel;
| | - Silvia Sara Canetto
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA;
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, and Life Promotion Clinic, Mt Gravatt Campus, Griffith University,176 Messines Ridge Road, Mt Gravatt, QLD 4122, Australia;
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15260, USA;
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden
- Author to whom correspondence should be addressed; ; Tel.: +46-702-272-205; Fax: +46-31-828-163
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