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Ichiki T, Koyama A, Imai M, Nishi Y, Abe Y, Fukunaga R, Murakami R, Nagaoka M, Takebayashi M, Fujise N. The trajectory of non-depressed suicidal ideation in community-dwelling older people in a rural area in Japan: a prospective longitudinal study with a 3-year follow-up. Psychogeriatrics 2023; 23:831-837. [PMID: 37448176 DOI: 10.1111/psyg.13006] [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] [Received: 11/25/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post-baseline in a rural area of Japan, and to examine the subsequent course of depression among non-depressed older people with suicidal ideation. METHODS In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non-depression group using 15-item Geriatric Depression Scale scores 3 years post-baseline. Logistic regression analysis was used to identify predictive factors of late-life depression 3 years post-baseline. RESULTS We received 597 valid responses, with a 3-year follow-up rate of 78.8%. Regarding suicidal ideation, 6.7% of non-depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post-baseline. Logistic regression analysis indicated that development of late-life depression is significantly associated with suicidal ideation, being female, and poor health-related quality of life (HRQOL). CONCLUSIONS The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late-life depression 3 years post-baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community-dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people.
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Affiliation(s)
- Takahiro Ichiki
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
- Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Asuka Koyama
- Faculty of Social Welfare, Kumamoto Gakuen University, Kumamoto, Japan
| | - Masaki Imai
- Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
- Kumamoto Mental Health Hospital, Kumamoto, Japan
| | | | | | | | | | - Maiko Nagaoka
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
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Ha A, Kim SH, Kang G, Yoon HJ, Kim YK. Association between sight-threatening eye diseases and death by suicide in South Korea: a nationwide population-based cohort study. Ophthalmology 2023:S0161-6420(23)00195-1. [PMID: 37001591 DOI: 10.1016/j.ophtha.2023.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE Although associations between visual impairment (VI) and suicide are posited, specific risks across the sight-threatening eye disease (STED) spectrum remain to be assessed. We determined whether individuals with STED die more often by suicide than do other people and assessed the temporal associations. DESIGN A nationwide, population-based cohort study. PARTICIPANTS All persons aged 40 years or older in South Korea from 2010 to 2020. METHODS Persons diagnosed with STEDs (i.e., glaucoma, exudative age-related macular degeneration [AMD], or diabetic retinopathy [DR]) were identified in the Korean National Health Insurance (NHI) service database. Both NHI health checkup records and the National Disability Registration were used for coexisting severe VI. Death by suicide was defined as diagnostic codes as recorded in the Korea National Statistical Office. Incidence rate ratios (IRRs) were estimated by quasi-Poisson regressions and adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and VI. The temporal relationship between time since first STED diagnosis and suicide risk was determined by identifying patients with STED newly diagnosed during the period from 2010 to 2011. MAIN OUTCOME MEASURES The IRR of death by suicide in people with STED relative to those without. RESULTS Of the 2.8 million people (45% male) observed for 24 300 969 person-years, 13 205 died by suicide. Among them, 34% (n = 4514) had a STED diagnosis, for a suicide rate of 69 per 100 000 person-years (95% confidence interval [CI], 67-72), relative to 51 per 100 000 person-years (95% CI, 50-52) for non-STED individuals. People with STED had an adjusted IRR of 1.33 (95% CI, 1.26-1.41) relative to those without. The largest excess adjusted IRR of suicide mortality was that for DR (1.40, 95% CI, 1.29-1.52). For exudative AMD, the adjusted IRR was 1.20 (95% CI, 1.04-1.39), whereas for glaucoma, the corresponding value was 1.09 (95% CI, 1.02-1.17). With coexisting severe VI, the IRR for any STED was 1.49 (95% CI, 1.29-1.73). The highest suicide hazard ratio was between 3 and 6 months postdiagnosis (5.33; 95% CI, 4.59-6.20). CONCLUSIONS In South Korea between 2010 and 2020, a higher suicide rate was evident among those with diagnosed STED than for persons not so diagnosed. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea; Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Su Hwan Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Goneui Kang
- EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Jin Yoon
- Medical Bigdata Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Kook Kim
- EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
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Zettergren A, Jonson M, Mellqvist Fässberg M, Najar J, Rydberg Sterner T, Seidu NM, Kern S, Blennow K, Zetterberg H, Skoog I, Waern M. Passive and active suicidal ideation in a population-based sample of older adults: Associations with polygenic risk scores of relevance for suicidal behavior. Front Psychiatry 2023; 14:1101956. [PMID: 36896349 PMCID: PMC9989261 DOI: 10.3389/fpsyt.2023.1101956] [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: 11/18/2022] [Accepted: 01/26/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION There are few studies investigating genetic factors related to suicidal ideation or behavior in older adult populations. Our aim was to test associations between passive and active suicidal ideation and polygenic risk scores (PRSs) for suicidality and other traits of relevance for suicidality in old age (i.e. depression, neuroticism, loneliness, Alzheimer's disease, cognitive performance, educational attainment, and several specified vascular diseases) in a population-based sample aged 70 years and older. METHODS Participants in the prospective H70 study in Gothenburg, Sweden, took part in a psychiatric examination that included the Paykel questions on active and passive suicidal ideation. Genotyping was performed with the Neurochip (Illumina). After quality control of the genetic data the sample included 3467 participants. PRSs for suicidality and other related traits were calculated based on summary statistics from recent GWASs of relevance. Exclusion of persons with dementia or incomplete data on suicidal ideation yielded 3019 participants, age range 70-101 years. Associations between past year suicidal ideation (any level) and selected PRSs were analysed using general estimation equation (GEE) models, adjusted for sex and age. RESULTS We observed associations between passive/active suicidal ideation and PRSs for depression (three versions), neuroticism, and general cognitive performance. After excluding individuals with current major depressive disorder (MDD), similar associations were seen with PRS for neuroticism, general cognitive performance and two PRSs for depression. No associations were found between suicidal ideation and PRSs for suicidality, loneliness, Alzheimer's disease, educational attainment, or vascular disease. DISCUSSION Our results could indicate which types of genetic susceptibility that are of importance for suicidality in old age, and these findings can help to shed light on potential mechanisms that may be involved in passive and active suicidal ideation in late-life, also in those with no current MDD. However, due to the limited sample size, the results need to be interpreted with caution until replicated in larger samples.
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Affiliation(s)
- Anna Zettergren
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden
| | - Mattias Jonson
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Affective Clinic, Gothenburg, Sweden
| | - Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden
| | - Jenna Najar
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nazib M Seidu
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,UK Dementia Research Institute at UCL, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Mölndal, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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Chendo I, Fabbri M, Godinho C, Simões RM, Sousa CS, Coelho M, Voon V, Ferreira JJ. High frequency of Depressive Disorders and Suicidal Phenomena in Late-Stage Parkinson´s Disease - A Cross-Sectional Study. J Geriatr Psychiatry Neurol 2022:8919887221135556. [PMID: 36278309 DOI: 10.1177/08919887221135556] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depressive disorders (DD) are widely recognized as one of the most frequent neuropsychiatric disorders in Parkinson´s disease. Patients with late-stage Parkinson´s disease (LSPD) continue to be a neglected population, and little is known about DD frequency in LSPD. OBJECTIVES To determine the frequency of DD in LSPD patients through a clinical diagnostic interview (CDI) and according to diagnostic DSM- 5 criteria. Secondary objectives were to determine the predictive ability of depressive scales to detect DD, to identify potential predictors of DD in LSPD and, to evaluate suicidal phenomena in LSPD. METHODS A cross-sectional study including LSPD patients (≥7 years from symptom onset and Hoehn and Yahr scale score >3 or a Schwab and England scale score <50% in the ON condition) was conducted. Patients were subjected to psychiatric, neurological, and neuropsychological evaluations. Six depression scales were applied. RESULTS 92 LSPD patients were included. 59.78% of LSPD patients had a current diagnosis of DD according to CDI, 38.04% patients had a diagnosis of major depressive disorder, and 21.72% non-major depressive disorder. Suicidal ideation was present in 36.96% of patients. All applied scales were able to detect depressive disorders. CONCLUSIONS More than half of LSPD patients met DD diagnostic criteria and over one-third were diagnosed with major depressive disorder. Overall, the LSPD population seem to have a unique clinical phenotype regarding the frequency and features of DD, whose early identification and treatment could improve the quality of life of patients and caregivers.
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Affiliation(s)
- Inês Chendo
- Psychiatry Department, Department of Neurosciences, 70899Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Margherita Fabbri
- 89237Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) Do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Almada, Portugal
| | - Rita Moiron Simões
- CNS - Campus Neurológico, Torres Vedras, Portugal.,Neurology Department, 467035Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Severiano Sousa
- 89237Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel Coelho
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Neurology Service, Department of Neurosciences, 70899Hospital Santa Maria, Lisbon, Portugal
| | - Valerie Voon
- Department of Psychiatry, 104867University of Cambridge, UK
| | - Joaquim J Ferreira
- CNS - Campus Neurológico, Torres Vedras, Portugal.,89237Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Obuobi-Donkor G, Nkire N, Agyapong VIO. Prevalence of Major Depressive Disorder and Correlates of Thoughts of Death, Suicidal Behaviour, and Death by Suicide in the Geriatric Population-A General Review of Literature. Behav Sci (Basel) 2021; 11:142. [PMID: 34821603 PMCID: PMC8614881 DOI: 10.3390/bs11110142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023] Open
Abstract
Background: There has been an increase in deaths by suicide in old age in the last decade. Depression and suicide in the elderly, 60 years and above, is a major global public health concern. Determining the prevalence of depression, and correlates of death by suicide in the geriatric population, is an important first step toward addressing this public health concern. This literature review aims to determine the prevalence of major depressive disorders and the correlates of death by suicide in the geriatric population. Methods: This general review of the literature was performed using relevant search terms to determine both the prevalence of depression and the correlates of death by suicide among the geriatric population. Databases such as MEDLINE, PsycINFO, CINAHL, and PubMed were searched. Relevant and current articles were extracted, reviewed, and analyzed. The elderly population was defined as individuals 60 years and above. Only full texts articles in English were reviewed. Findings: The prevalence estimates of major depressive disorder in the elderly ranged from 5.37 to 56%. Adults aged 60 years and older have a high risk of depression that exposes them to suicide. Moreover, elderly women are more likely to experience depression than elderly men, but successful suicide is more common in men. Depression and other mental health conditions (schizophrenia, anxiety disorders) and perceived stress were found to be predictors of suicide in the elderly. Other predictors included physical illnesses such as malignancies, financial constraints, cuckoldry, and sexual dysfunction, and also social factors like living alone triggers depressive symptoms and increases suicidal risk in the elderly. Hanging was found to be the most common method of death by suicide for both sexes. While elderly women preferred poisoning, elderly men in Western countries preferred firearms. Differences in gender, the aging process and social issues were also contributing factors to methods used for suicide. Conclusions: Depression and debilitating physical illnesses were identified as significant contributors to suicide risk in the elderly population, and emphasis should be placed on identifying these factors early and treating them. Recognizing and addressing factors that predict suicide in the elderly will help to improve the mental wellbeing of the elderly.
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Affiliation(s)
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
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Still ready to give up on life? A longitudinal phenomenological study into wishes to die among older adults. Soc Sci Med 2021; 284:114180. [PMID: 34266673 DOI: 10.1016/j.socscimed.2021.114180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE There is a paucity of empirical studies exploring wishes to die (WTD) in older adults without a life-threatening disease or psychiatric disorder, especially on how these WTD evolve over time. OBJECTIVE This study aims to deepen our understanding of living with a WTD by elucidating multifaceted trajectories of death wishes in older adults without a life-threatening disease or psychiatric disorder. METHODS Interviews were conducted between 2013 and 2019 with Dutch men and women aged 70 and older who expressed a WTD (preferably at a self-chosen moment). Using a phenomenological, longitudinal analysis approach, 35 serial interviews were analyzed. RESULTS This resulted in four thematic meanings following four trajectories, namely: 1) a realized WTD, facing the ultimate decision with both freedom and a sense of fate; 2) an intensifying WTD, reaching a deadlock; 3) a diminishing WTD, experiencing tentative space for new possibilities; and 4) a vanishing WTD, being surprised by an unexpected turn. In the cases examined, the individuals' WTD was characterized by ambivalence and subject to change over time. Fluctuating, often asynchronous patterns of physical, social, psychological, and existential distress were lived intertwined. The WTD should thus be understood as dynamic and unpredictable, often impacted by external circumstances. CONCLUSIONS An important clinically relevant finding is that even persons with a pronounced WTD can experience openness to new possibilities, leading to a diminished or vanished WTD and/or desire to act on their WTD. Often such changes were related to (re-)establishment of connections with other people and/or society or with themselves. Since most research in this area is cross-sectional, the current longitudinal findings of this study are unique in providing insight into changes over time, thus contributing to the fields of death and suicide studies.
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Fagerström C, Welmer AK, Elmståhl S, Tuvesson H. Life weariness, suicidal thoughts and mortality: a sixteen-year longitudinal study among men and women older than 60 years. BMC Public Health 2021; 21:1359. [PMID: 34243751 PMCID: PMC8268207 DOI: 10.1186/s12889-021-11329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Suicide in old age is a significant contributor to mortality. However, the extent to which life weariness and suicidal thoughts impact on mortality in a long-term perspective is unknown. The aim of this study was to investigate the effect of life weariness and suicidal thoughts on long-term survival (16 years) in an older Swedish population, controlling for demographic and social network factors and depression. A further aim was to investigate differences in sex and age interactions in relation to mortality among individuals with and without life weariness and suicidal thoughts. Methods A longitudinal cohort study on a national, representative sample of individuals aged 60+ years was conducted within the Swedish National Study of Aging and Care study. The sample included 7213 individuals, who provided information about life weariness and suicidal thoughts through an item derived from the Montgomery-Åsberg Depression Rating Scale. Data were analysed with multivariate Cox proportional hazards models, adjusted for potential confounders. Results At baseline, 12.5% of the participants (14.6% of females and 9.5% of males) reported life weariness and suicidal thoughts. During the 16-year follow-up, a mean survival time was 11.5 years (standard deviation (SD) 5.6), and 3804 individuals died (59.5% females and 40.5% males). Individuals with life weariness and suicidal thoughts had half the survival rate compared with those without such thoughts (24.5% vs. 50.6%), with a mean survival time of 8.4 years (SD 5.7) versus 12.0 years (SD 5.4). The multi-adjusted hazard ratio of mortality for those reporting life weariness and suicidal thoughts was 1.44 (95% confidence interval, 1.30–1.59), with the population attributable risk at 11.1%. In the models, being male or female 80+ years showed the highest multi-adjusted hazard ratio of long-term mortality (ref. female 60–69 years). Conclusions The findings suggested that life weariness and suicidal thoughts were risk factors for long-term mortality, when controlled for sex and age interactions that were found to strongly predict long-term mortality. These findings have practical implications in prevention of mortality, emphasising the importance of screening, identifying, and intercepting older men and women with signs of life weariness and suicidal thoughts. Trial registration Not applicable.
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Affiliation(s)
- Cecilia Fagerström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Anna-Karin Welmer
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
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Jonson M, Sigström R, Mellqvist Fässberg M, Wetterberg H, Rydén L, Rydberg Sterner T, Hedna K, Lagerlöf Nilsson U, Skoog I, Waern M. Passive and active suicidal ideation in Swedish 85-year-olds: Time trends 1986-2015. J Affect Disord 2021; 290:300-307. [PMID: 34020204 DOI: 10.1016/j.jad.2021.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/20/2021] [Accepted: 04/25/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Older adults have high suicide rates. We investigated potential time trends in the prevalence of passive and active suicidal ideation in 85-year-olds. Further, we examined factors associated with such ideation in this age group. METHODS Population-based samples of 85-year-olds were interviewed in 1986 (N = 347), 2008 (N = 426) and 2015 (N = 320). Past-month passive/active suicidal ideation was evaluated with the Paykel questions. RESULTS Reporting any type of passive or active suicidal ideation was less common in 2008 (7.3%, p < 0.001) and 2015 (7.2%, p < 0.001) compared to 1986 (16.4%). The change was driven by decreases in passive ideation. Passive/active suicidal ideation was associated with higher MADRS score (OR: 1.2, 95% CI: 1.1-1.2, p < 0.001), institution residence (OR: 3.9, 95% CI: 1.7-8.9, p = 0.001) and feelings of loneliness (OR: 2.7, 95% CI: 1.4-5.2, p = 0.003). When stratified by sex, it was associated with institution residence (OR: 3.7, 95% CI: 1.4-9.9, p = 0.008) and feelings of loneliness (OR: 3.0, 95% CI: 1.4-6.3, p = 0.005) in women. In men, we observed a tenfold higher risk in those without partners (OR: 9.8, 95% CI: 2.9-33.5, p < 0.001). LIMITATIONS While differential three-year mortality was not observed in 1986, mortality was higher among non-participants in 2008 and 2015. This might have inflated cohort differences in passive/active suicidal ideation. CONCLUSION An initial decrease in the prevalence of passive/active suicidal ideation in 85-year-olds was observed but this positive trend did not persist. Results underline that preventive strategies targeting loneliness and focusing on institutional settings are needed, as are interventions for men without partners.
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Affiliation(s)
- Mattias Jonson
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Affective Clinic, Gothenburg, Sweden.
| | - Robert Sigström
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Clinic of Cognition and Old Age Psychiatry, Gothenburg, Sweden
| | - Madeleine Mellqvist Fässberg
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Hanna Wetterberg
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lina Rydén
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Khedidja Hedna
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Statistikkonsulterna Jostat & Mr Sample AB, Gothenburg, Sweden
| | - Ulrika Lagerlöf Nilsson
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Department of Historical Studies, Faculty of Humanities, University of Gothenburg, Sweden
| | - Ingmar Skoog
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Clinic of Cognition and Old Age Psychiatry, Gothenburg, Sweden
| | - Margda Waern
- Center for Ageing and Health (Age Cap), Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden; Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Demmin DL, Silverstein SM. Visual Impairment and Mental Health: Unmet Needs and Treatment Options. Clin Ophthalmol 2020; 14:4229-4251. [PMID: 33299297 PMCID: PMC7721280 DOI: 10.2147/opth.s258783] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined. Patients and methods A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted. Results Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability. Conclusion In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.
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Affiliation(s)
- Docia L Demmin
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester, Rochester, NY, USA
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Minayo MCDS, Figueiredo AEB, Mangas RMDN. Study of scientific publications (2002-2017) on suicidal ideation, suicide attempts and self-neglect of elderly people hospitalized in Long-Term Care Establishments. CIENCIA & SAUDE COLETIVA 2019; 24:1393-1404. [PMID: 31066841 DOI: 10.1590/1413-81232018244.01422019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/29/2018] [Indexed: 11/22/2022] Open
Abstract
This is a study on scientific work on the ideation, suicide attempt and self-neglect of elderly residents in LTCEs from 2002 to 2017. Documents were retrieved from the following sources: BVS/SP, SciELO, Scopus, PubMed and Web of Science, with the following descriptors: suicide attempt, suicidal ideation, self-neglect, elderly, long-term care establishment, and their correspondents in Portuguese, Spanish and French. Twenty-six papers on the subject were found. There is a consensus among the authors, whose texts are analyzed here, concerning the factors that lead the elderly to suicidal behavior: depression, illness and pain, complicated and traumatic mourning, anxiety and despair after recovery from depressive episode, poor living conditions, death of close relatives, friends, family conflicts, family history of self-inflicted events. The protection factors found are religiosity, optimistic lifestyle, satisfaction with life and investment in the autonomy and power of relationships and communication and monitored drug therapy for mental disorders such as depression.
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Affiliation(s)
- Maria Cecília de Souza Minayo
- Departamento de Estudos de Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700. 21040-361 Manguinhos Rio de Janeiro RJ Brasil.
| | - Ana Elisa Bastos Figueiredo
- Departamento de Estudos de Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700. 21040-361 Manguinhos Rio de Janeiro RJ Brasil.
| | - Raimunda Matilde do Nascimento Mangas
- Departamento de Estudos de Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700. 21040-361 Manguinhos Rio de Janeiro RJ Brasil.
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Grover S, Sahoo S, Avasthi A, Lakdawala B, Dan A, Nebhinani N, Dutt A, Tiwari S, Gania A, Subramanyam A, Kedare J, Suthar N. Prevalence of suicidality and its correlates in geriatric depression: A multicentric study under the aegis of the Indian Association for Geriatric Mental Health. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_35_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Khazem LR, Anestis MD. Do physical disabilities differentiate between suicidal ideation and attempts? An examination within the lens of the ideation to action framework of suicide. J Clin Psychol 2018; 75:681-695. [DOI: 10.1002/jclp.22735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Lauren R. Khazem
- Department of Psychology, The University of Southern Mississippi; Hattiesburg Mississippi
| | - Michael D. Anestis
- Department of Psychology, The University of Southern Mississippi; Hattiesburg Mississippi
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Tuvesson H, Hellström A, Sjöberg L, Sjölund BM, Nordell E, Fagerström C. Life weariness and suicidal thoughts in late life: a national study in Sweden. Aging Ment Health 2018; 22:1365-1371. [PMID: 28685600 DOI: 10.1080/13607863.2017.1348484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. METHOD Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery-Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. RESULTS Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. CONCLUSION This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.
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Affiliation(s)
- Hanna Tuvesson
- a Department of Health , Blekinge Institute of Technology , Karlskrona , Sweden
| | - A Hellström
- b Department of Health and Caring Sciences , Linnaeus University , Kalmar , Sweden
| | - L Sjöberg
- c Aging Research Center , Department of Neurobiology, Care Sciences and Society , Karolinska Institutet and Stockholm University , Stockholm , Sweden
| | - B-M Sjölund
- c Aging Research Center , Department of Neurobiology, Care Sciences and Society , Karolinska Institutet and Stockholm University , Stockholm , Sweden.,d Faculty of Health and Occupational Studies , University of Gävle , Gävle , Sweden
| | - E Nordell
- e Department of Geriatric Medicine , Skåne University Hospital , Malmö , Sweden
| | - C Fagerström
- f Blekinge Centre of Competence , Blekinge County Hospital , Karlskrona , Sweden
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Sousa GSD, Perrelli JGA, Botelho ES. Nursing diagnosis for Risk of Suicide in elderly: integrative review. Rev Gaucha Enferm 2018; 39:e20170120. [PMID: 30088601 DOI: 10.1590/1983-1447.2018.2017-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/06/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the specialized literature regarding the risk factors in nursing diagnosis for suicide risks in elderly. METHOD This is an integrative literature review carried out during June 2015 in the following databases with no time limit: MEDLINE, PsycINFO and CINAHL. RESULTS A total of 80 full papers were analyzed. It was suggested the inclusion of 23 risk factors in NANDA-I taxonomy: apathy; unrest; low self esteem; carelessness with medication; Inability to ask for help; Inability to express feelings; suicidal plan; rigidity; functional disability; visual problems; sadness; hostility; anxiety; failure; frustration; unhappiness; dishonor; frequent visits to a physician with unclear symptoms; social deprivation; social devaluation; psychological violence; Interfamilial violence; and financial violence. CONCLUSION The risks for suicide presented in NANDA-I taxonomy need to be refined and adapted to the elderly reality. Furthermore, a review is also recommended for the risk factors not included in this classification.
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Affiliation(s)
- Girliani Silva de Sousa
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento. Recife, Pernambuco, Brasil
| | | | - Everton Sougey Botelho
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento. Recife, Pernambuco, Brasil
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Matschke J, Sehner S, Gallinat J, Siegers J, Murroni M, Püschel K, Glatzel M. No difference in the prevalence of Alzheimer-type neurodegenerative changes in the brains of suicides when compared with controls: an explorative neuropathologic study. Eur Arch Psychiatry Clin Neurosci 2018; 268:509-517. [PMID: 29383449 DOI: 10.1007/s00406-018-0876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/24/2018] [Indexed: 12/25/2022]
Abstract
Suicide ranks among the leading causes of death for individuals of all ages with highest rates in the elderly. The cause of suicide is considered a multifactorial phenomenon. A variety of neurodegenerative diseases, notably Alzheimer's disease, or, more recently, tauopathies as frontotemporal lobar degeneration or chronic traumatic encephalopathy, has been suggested as risk factor for suicide. Accordingly, we hypothesized that neurodegenerative changes typical of these diseases should be more prevalent in the brains of suicides when compared with controls. Suicides from the German federal state of Hamburg (n = 162) were compared with age- and sex-matched controls who died of other cause. Neuropathological assessment included semiquantitative analysis of neuritic plaques and neurofibrillary tangles visualized with silver stains; in addition, quantitative immunohistochemical analysis of β-amyloid load and counts of tau-positive neurofibrillary tangles and neuropil threads was done. Univariate analysis and multivariable conditional logistic regression models did not show an effect of any parameter associated with the odds of committing suicide. On the contrary, after stratification for age, older suicide victims (over 48 years) showed lower β-amyloid loads when compared to controls in the univariate analysis (suicides: 4.7 ± 12.9; controls: 9.9 ± 20.9; p = 0.031; r = - 0.17). In conclusion, neuropathological characteristics of Alzheimer's disease and common tauopathies associated with age seem to be of limited relevance for suicides. However, intact cognition when planning and carrying out complex acts may be of importance in the context of suicide.
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Affiliation(s)
- Jakob Matschke
- Forensic Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Julia Siegers
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Melanie Murroni
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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The Relationship Between Difficulties in Daily Living and Suicidal Ideation Among Older Adults: Results From a Population-Based Survey in Shandong. J Nerv Ment Dis 2018; 206:211-216. [PMID: 29394192 PMCID: PMC5841859 DOI: 10.1097/nmd.0000000000000794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To date, few studies have examined the association between difficulties in activities of daily living (ADL) and suicidal ideation (SI) among the seniors in China. This study aims to explore this association among older adults in China. A total of 3313 older people (60+) were included in this study, and questionnaires were administered by face-to-face interview. In total, 4.2% of the participants reported SI. The mean score of ADL among older adults with SI (21.06 ± 10.92) was much higher than that in those without SI (16.13 ± 5.60). Multivariate analyses showed that some specific domains of ADL including using transport, medical care, and household activities were associated with SI even after we controlled the psychological conditions. An association was observed between difficulties in daily living and SI among older adults in China. Psychological interventions should be taken to prevent potential risk of suicide targeting the seniors with certain disabilities.
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Lutz J, Fiske A. Functional disability and suicidal behavior in middle-aged and older adults: A systematic critical review. J Affect Disord 2018; 227:260-271. [PMID: 29107819 DOI: 10.1016/j.jad.2017.10.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Middle-aged and older adults have elevated rates of suicide around the globe, but there is a paucity of knowledge about risk factors for suicide in these age groups. One possible risk factor may be functional disability, which is more common at later ages. METHODS The current systematic critical review examined findings regarding the associations between functional disability and suicidal behavior (suicidal ideation, suicide attempts, and death by suicide) in middle-aged and older adults (i.e. age 50 and older). RESULTS Forty-five studies were found that examined these associations. The majority of studies supported a significant association between functional disability and suicidal ideation. In addition, findings to date strongly suggest that depression serves as a mediator of the association between functional disability and suicidal ideation, though most studies did not directly test for mediation. LIMITATIONS Firm conclusions regarding suicide attempts and death by suicide, as well as mediation, cannot be drawn due to a relative lack of research in these areas. CONCLUSIONS The association between functional disability and suicidal behavior suggests an important area for prevention and intervention among middle-aged and older adults, but additional research is necessary to clarify the specifics of these associations and examine appropriate intervention strategies. Important future directions for research in this area include the direct comparison of associations of risk factors with different types of suicidal behavior, greater use of longitudinal data with multiple time points, and further examination of potential mediators and moderators of the association between functional disability and suicidal behavior.
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Affiliation(s)
- Julie Lutz
- West Virginia University, Department of Psychology, Morgantown, WV, United States.
| | - Amy Fiske
- West Virginia University, Department of Psychology, Morgantown, WV, United States; West Virginia University Injury Control Research Center, Morgantown, WV, United States
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Abstract
Despite the fact that suicide and its prevention continues to be a priority area for health care in the UK, suicide in the elderly remains a neglected subject receiving little interest and research attention. The Green Paper Our Healthier Nation (Secretary of State for Health, 1998) maintained the concept of setting targets for suicide reduction originally proposed in The Health of the Nation strategy. The new target proposes that by the year 2010 the death rate from suicide and undetermined injury will be reduced by at least a further sixth (17%) from the baseline of 1996. The setting of such targets has always been a contentious issue among many psychiatrists, who have concerns that they may be used as a quality measure of psychiatric services, especially as some consider that social influences predominate over health care issues. The subsequent debate has focused on targeting specific at-risk groups, notably severely mentally ill young men, Asian women and those who deliberately harm themselves.
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Stolz E, Mayerl H, Gasser-Steiner P, Freidl W. Attitudes towards assisted suicide and euthanasia among care-dependent older adults (50+) in Austria: the role of socio-demographics, religiosity, physical illness, psychological distress, and social isolation. BMC Med Ethics 2017; 18:71. [PMID: 29212490 PMCID: PMC5719645 DOI: 10.1186/s12910-017-0233-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. METHODS A nationwide cross-sectional survey among older care allowance recipients (50+) in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. RESULTS About a quarter (24.8-26.0%) of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to (hypothetically) make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. CONCLUSIONS Positive attitudes towards and will to (hypothetically) use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the (near) future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Peter Gasser-Steiner
- Department of Sociology, University of Graz, Universitätsstraße 15/IV, 8010, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria.
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Abstract
OBJECTIVES This study examines how living arrangements are associated with suicidal ideation for older adults in South Korea, which has the highest suicide rate among OECD countries, and a particularly high suicide rate for older persons. METHODS Analyzing a sample of 5795 women and 3758 men aged 65 and older from a nationwide representative cross-sectional data-set, we examined how many older adults think about suicide over a one-year period, why they think about suicide, and whether living arrangements are associated with suicidal ideation. RESULTS About 1 out of 12 respondents in our sample reported suicidal ideation. While women and men did not differ in the prevalence of suicidal ideation, women attributed their suicidal feelings to health problems, while men attributed theirs to economic difficulties. Logistic regression results indicated that living arrangements are associated with suicidal ideation for men but not women. Older men living with a spouse were less likely to have suicidal ideation than older men with other living arrangements (i.e., living alone, living with children without spouse, living with spouse, and others). CONCLUSIONS Our results highlight the importance of living arrangements to older men's suicidal ideation. We discuss gender differences in the implications of living arrangements to suicidal ideation within the context of Confucian culture.
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Affiliation(s)
- Jibum Kim
- a Department of Sociology , Sungkyunkwan University , Seoul , South Korea
| | - Yun-Suk Lee
- b Department of Urban Sociology , University of Seoul , Seoul , South Korea
| | - Jinkook Lee
- c University of Southern California and RAND
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van Wijngaarden E, Leget C, Goossensen A. Disconnectedness from the here-and-now: a phenomenological perspective as a counteract on the medicalisation of death wishes in elderly people. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:265-273. [PMID: 26833466 DOI: 10.1007/s11019-016-9687-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
When elderly people are ideating on manners to end their lives, because they feel life is over and no longer worth living, it is important to understand their lived experiences, thoughts and behaviour in order to appropriately align care, support and policy to the needs of these people. In the literature, the wish to die in elderly people is often understood from a medical, psychopathological paradigm, referred to as cognitive impairment, depressive disorder, pathological bereavement, and suicidality. In this paper, we evaluate this dominant paradigm by considering three serious limitations, namely: (1) the risk of epistemic transformation; (2) the risk of reduction; and (3) the risk of obscuring the social and cultural embeddedness. Drawing on insights from our empirical-phenomenological research on the issue of elderly and the self-chosen death, this paper argues for a phenomenological perspective to counteract the medicalisation of death wishes in elderly people.
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Affiliation(s)
- Els van Wijngaarden
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands.
| | - Carlo Leget
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands
| | - Anne Goossensen
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands
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Suicidal ideation and behavior assessment in dementia studies: An Internet survey. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 2:60-68. [PMID: 29067294 PMCID: PMC5644276 DOI: 10.1016/j.trci.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction The AARR task force on suicidal ideation and behavior (SI/SB) in dementia conducted an online survey on the extent of SI/SB in individuals diagnosed with mild cognitive impairment (MCI) or dementia who were participating in clinical trials. Methods Investigators with experience in conducting SI/SB assessments in clinical trial subjects with MCI or dementia were invited to complete a global 19-item online survey. Results A total of 204 evaluable responses were collected with the majority from North America and Europe (83.4%) and the remainder from Asia, Latin America, and Mideast/Africa. The mean (SD) number of subjects personally assessed by the respondents in the past year with MCI, mild-moderate dementia, or severe dementia was 12.8 (26.2), 31.2 (39.6), and 10.1 (34.7), respectively. The mean number of subjects in each diagnostic group with suicidal ideation (SI), suicidal behavior (SB), or completed suicide (CS) was on average quite low (0.3 to 1.1 for SI, 0.1 to 0.2 for SB, and 0.0 to 0.2 for CS). Confidence in subject self-reports of SI/SB over different time periods declined with increasing severity of cognitive impairment and with increasing duration of the recall time period assessed. Of respondents, 56% and 75% had low confidence in self-ratings of SI/SB from subjects with severe dementia over the past 24 hours and the past week to 1 month, respectively. Ratings of the reliability of information collected on SI/SB also decreased with increasing severity of cognitive impairment. Approximately 70% of respondents rated the reliability of the information they obtained from all sources (patient, caregiver, and others) for subjects with MCI as high, but only about half (42.0% to 55.3%) and less than a quarter (17.4% to 24.3%) rated the reliability of information obtained for subjects with mild to moderate dementia or severe dementia as high, respectively. Discussion These results support the usefulness of prospective SI/SB assessments in MCI and mild dementia, raise questions about the reliability of assessments in moderate dementia, and confirm their lack of clinical utility in severe dementia. The results highlight the need for development of validated assessment instruments adapted to the stage of cognitive decline of the patients under study and may be the most effective in the earliest stages of the disease.
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Alphs L, Brashear HR, Chappell P, Conwell Y, Dubrava S, Khin NA, Kozauer N, Hartley DM, Miller DS, Schindler RJ, Siemers ER, Stewart M, Yaffe K. Considerations for the assessment of suicidal ideation and behavior in older adults with cognitive decline and dementia. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 2:48-59. [PMID: 29067293 PMCID: PMC5644272 DOI: 10.1016/j.trci.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Better understanding of suicide risk and its management in older adults with cognitive impairment and/or dementia remain significant unmet public health needs. Urgency to address them derives from concern that CNS treatments for dementia may impact suicide risk. Regulatory guidances requiring assessment of emergent suicidal ideation and behavior (SI/SB) at every clinical trial visit emphasize the need for understanding their prevalence. Methods The literature regarding SI/SB in older persons with cognitive impairment or dementia was reviewed by an Alzheimer's Association Taskforce with emphasis on epidemiology, classification, assessment, and regulatory requirements. Results Gaps in our knowledge were identified, challenges discussed and recommendations for future work provided. Discussion Currently available SI/SB data from geriatric persons with dementia do not provide adequate understanding of its epidemiology, identification, assessment, or management. The growing public health burden of this population requires greater attention from clinicians and researchers on tactics and assessment tools to meet these needs.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - H Robert Brashear
- Janssen Alzheimer Immunotherapy & Research & Development, LLC, South San Francisco, CA, USA
| | | | | | | | - Ni A Khin
- Division of Psychiatry Products, Food and Drug Administration, Silver Spring, MD, USA.,Division of Clinical Compliance Evaluation, FDA, Silver Spring, MD, USA
| | - Nicholas Kozauer
- Division of Neurology Products, Food and Drug Administration, Silver Spring, MD, USA
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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] [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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Abstract
BACKGROUND Concerns about suicide risk in people with dementia have been increasing in recent years along with a discourse about rational suicide and assisted suicide. METHODS A systematic narrative literature review of suicidal behavior and assisted suicide in persons with dementia. RESULTS Most studies that have examined the spectrum of suicidal ideation, attempted suicide and suicide in dementia have methodological limitations but the overall suicide risk does not appear to be increased. When suicidal behavior does occur, common themes include the presence of psychiatric comorbidity, mainly depression; occurrence early in the dementia course with preserved insight and capacity; and an increased risk in younger people. The emerging discourse on rational and assisted suicide has been spurred by early and pre-symptomatic diagnosis and poses a number of ethical challenges for clinicians including the role of proxy decision-makers. CONCLUSIONS Although dementia might not confer a significant overall risk for suicidal behavior, clinicians still need to consider the potential for suicide in vulnerable individuals particularly early in the dementia course.
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Suicidal ideation among individuals with dysvascular lower extremity amputation. Arch Phys Med Rehabil 2015; 96:1404-10. [PMID: 25883037 DOI: 10.1016/j.apmr.2015.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the estimated prevalence and correlates of suicidal ideation (SI) among individuals 1 year after a first lower extremity amputation (LEA). DESIGN Cohort survey. SETTING Four medical centers. PARTICIPANTS A referred sample of patients (N=239), primarily men, undergoing their first LEA because of complications of diabetes mellitus or peripheral arterial disease, were screened for participation between 2005 and 2008. Of these patients, 136 (57%) met study criteria and 87 (64%) enrolled; 70 (80.5%) of the enrolled patients had complete data regarding SI at 12-month follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES SI, demographic/health information, depressive symptoms, mobility, independence in activities of daily living (ADL), satisfaction with mobility and ADL, medical comorbidities, social support, self-efficacy. RESULTS At 12 months postamputation, 11 subjects (15.71%) reported SI; of these, 3 (27.3%) screened negative for depression. Lower mobility, lower satisfaction with mobility, greater impairment in ADL, lower satisfaction with ADL, lower self-efficacy, and depressive symptoms were all correlated with the presence of SI at a univariate level; of these, only depressive symptoms remained significantly associated with SI in a multivariable model. CONCLUSIONS SI was common among those with recent LEA. Several aspects of an amputee's clinical presentation, such as physical functioning, satisfaction with functioning, and self-efficacy, were associated with SI, although depression severity was the best risk marker. A subset of the sample endorsed SI in the absence of a positive depression screen. Brief screening for depression that includes assessment of SI is recommended.
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The Relationships Between Functional Limitation, Depression, Suicidal Ideation, and Coping in Older Korean Immigrants. J Immigr Minor Health 2015; 17:1643-53. [DOI: 10.1007/s10903-015-0204-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rim TH, Lee CS, Lee SC, Chung B, Kim SS. Influence of visual acuity on suicidal ideation, suicide attempts and depression in South Korea. Br J Ophthalmol 2015; 99:1112-9. [DOI: 10.1136/bjophthalmol-2014-306518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/03/2015] [Indexed: 11/03/2022]
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Raijmakers NJH, van der Heide A, Kouwenhoven PSC, van Thiel GJMW, van Delden JJM, Rietjens JAC. Assistance in dying for older people without a serious medical condition who have a wish to die: a national cross-sectional survey. JOURNAL OF MEDICAL ETHICS 2015; 41:145-150. [PMID: 24335917 DOI: 10.1136/medethics-2012-101304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The Dutch euthanasia law regulates physician assistance in dying for patients who are suffering unbearably from a medical condition. We studied the attitudes of the Dutch population to assistance in dying for older persons who have a wish to die without the presence of a serious medical condition. METHODS A cross-sectional survey was conducted among a random sample of the Dutch public (response rate 78%, n=1960), using statements and vignettes about attitudes to assistance in dying for older persons who are tired of living. RESULTS A minority of 26% agreed with a vignette in which a physician warrants the request for physician-assisted suicide of an older person who is tired of living without having a serious medical condition. Furthermore, 21% agreed with the statement 'In my opinion euthanasia should be allowed for persons who are tired of living without having a serious disease'. People supporting euthanasia for older persons who are tired of living were more likely than opponents to be highly educated (OR 1.6; 95% CI 1.1 to 2.3), to be non-religious (OR 1.7; 95% CI 1.3 to 2.3), to have little trust in physicians (OR 1.6; 95% CI 1.2 to 2.2), and to prefer to make their own healthcare decisions (OR 1.7; 95% CI 1.3 to 2.3). CONCLUSIONS Although it is lower than the level of support for assistance in dying for patients whose suffering is rooted in a serious medical condition, our finding that a substantial minority of the general public supports physician assistance in dying for older people who are tired of living implies that this topic may need to be taken seriously in the debate about end-of-life decision-making.
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Affiliation(s)
- Natasja J H Raijmakers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pauline S C Kouwenhoven
- Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Johannes J M van Delden
- Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van Wijngaarden E, Leget C, Goossensen A. Experiences and Motivations Underlying Wishes to Die in Older People Who Are Tired of Living: A Research Area in its Infancy. OMEGA-JOURNAL OF DEATH AND DYING 2014; 69:191-216. [DOI: 10.2190/om.69.2.f] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The wish to die in older people who are tired of living and the possibilities to organize death are currently being discussed within the debate on self-determination and physician-assisted suicide. Until now insight into the experiences and thoughts of people who are tired of life but not suffering from a severe depression or a life-threatening disease is lacking. Studies focussing specifically on this topic are rare. This review provides an overview of this research area in its infancy. The existential impact of age-related loss experiences play an important role in developing a wish to die. Other influencing factors are: personal characteristics, biographical factors, social context, perceptions and values. Further research to experiences and motivations underlying these specific age-related wishes to die and the existential impact of the loss-experiences seems necessary to deepen the understanding of this group of older people and for the development of policy and good care.
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Dong Y, Huang F, Hu G, Liu Y, Zheng R, Zhang Q, Mao X. The prevalence of suicidal ideation among the elderly in China: a meta-analysis of 11 cross-sectional studies. Compr Psychiatry 2014; 55:1100-5. [PMID: 24673954 DOI: 10.1016/j.comppsych.2014.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 02/18/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the pooled prevalence of suicidal ideation among Chinese elderly aged ≥ 60 years. METHODS Two reviewers independently searched the potentially relevant studies through electronic database (PubMed-Medline, Embase, Wanfang Data, Chinese National Knowledge Infrastructure and Chongqing VIP) using key terms 'suicid', 'suicidal ideation' combined with 'aged', 'elderly' and 'old people'. All selected studies should meet the eligibility criteria in this study. Chi-square based Q test and I(2) statistic assessed the heterogeneity. Forest plots were used to display results graphically. Potential publication bias was assessed by the funnel plot and Begg's test. Prevalence rate was meta-analysed. RESULTS In total, 11 studies were included with 11,526 subjects. The prevalence of suicidal ideation among Chinese elderly ranged from 2.2% to 21.5%. The pooled prevalence of all 11 studies was 11.5% (95% CI: 8.3%-14.8%). Subgroup analyses showed the prevalence for males was 11.0%, and for the females was 15.6%. In three subgroups for age, 60-69, 70-79 and ≥ 80, the prevalence was 9.1%, 12.1% and 18.9% respectively. A slightly higher prevalence in rural areas was calculated than in urban (14.7% vs. 11.8%). In mainland China, the prevalence was 12.6%. And in Taiwan and Hongkong, the pooled prevalence was 9.2%. CONCLUSIONS The prevalence of suicidal ideation was relatively high among elderly in China, and it should attract enough attention.
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Affiliation(s)
- Yonghai Dong
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, 330029, China
| | - Fen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Guoliang Hu
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, 330029, China
| | - Yun Liu
- Cadre Wards of Neurology Medicine, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Ruizhi Zheng
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Qinghe Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiangqun Mao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, 330029, China.
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Cukrowicz KC, Duberstein PR, Vannoy SD, Lin EH, Unützer J. What factors determine disclosure of suicide ideation in adults 60 and older to a treatment provider? Suicide Life Threat Behav 2014; 44:331-7. [PMID: 24494695 DOI: 10.1111/sltb.12075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Correlates of patient disclosure of suicide ideation to a primary care or mental health provider were identified. Secondary analyses of IMPACT trial data were conducted. Of the 107 patients 60 years of age or older who endorsed thoughts of ending their life at least "a little bit" during the past month, 53 indicated they had disclosed these thoughts to a mental health or primary care provider during this period. Multiple logistic regression was used to identify predictors of disclosure to a provider. Significant predictors included poorer quality of life and prior mental health specialty treatment. Among participants endorsing thoughts of suicide, the likelihood of disclosing these thoughts to a provider was 2.96 times higher if they had a prior history of mental health specialty treatment and 1.56 times higher for every one-unit decrease in quality of life. Variation in disclosure of thoughts of suicide to a mental health or primary care provider depends, in part, on patient characteristics. Although the provision of evidence-based suicide risk assessment and guidelines could minimize unwanted variation and enhance disclosure, efforts to routinize the process of suicide risk assessment should also consider effective ways to lessen potential unintended consequences.
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Park JI, Han MI, Kim MS, Yoon MS, Ko SH, Cho HC, Chung YC. Predictors of suicidal ideation in older individuals receiving home-care services. Int J Geriatr Psychiatry 2014; 29:367-76. [PMID: 23939813 DOI: 10.1002/gps.4012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 07/17/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Despite the importance of tending to older individuals who are vulnerable to suicide, little is known about suicidal ideation in the portion of this population receiving home-care services in Asian countries. The objective of this cross-sectional study was to examine predictors of suicidal ideation in older individuals using home-care service. METHOD Participants were randomly selected from the individuals 50 years old and over using home-care services across Jeollabuk-do Province, Korea. A total of 697 subjects participated in this study. Each participant completed the short version of the Geriatric Depression Scale, the Scale for Suicidal Ideation, the Multidimensional Scale of Perceived Social Support, and the World Health Organization Disability Assessment Schedule II. RESULTS Hierarchical regression analyses revealed that depression, perceived social support, and disability were significant predictors of suicidal ideation, whereas the roles of subjective health status and fish consumption remained ambiguous in this regard. In terms of social support, we also found that less perceived social support from family members was related to higher levels of suicidal ideation. The associations between various categories of disability and suicidal ideation disappeared after controlling for depression. Our investigation of the mediating effect of depression on the relationship between disability and suicidal ideation revealed that depression was either a complete (disability related to cognition, self-care, getting along with others, and life activities) or partial (disability related to participation) mediator. CONCLUSIONS Preventive strategies focusing on depression, social support, and disability should be emphasized during encounters with older people receiving home-care services.
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Affiliation(s)
- Jong-Il Park
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
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Park SM. Health status and suicidal ideation in Korean elderly: the role of living arrangement. J Ment Health 2014; 23:94-8. [PMID: 24689664 DOI: 10.3109/09638237.2013.869569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The upward Korean suicide trend of recent years is mainly explained by a strong rise in suicide by older people. AIMS This study investigates the influence of physical and mental health factors on suicidal ideation among elderly people, who are either living alone or living with others. METHODS Cross-sectional data of 1743 older adults (≥ 65 years) who completed the 2009 Korea National Health and Nutrition Examination Survey were analysed. RESULTS The outstanding finding was that suffering a stroke was significantly associated with suicidal ideation among elderly people. A limitation in daily activities, experience of depressed feelings and high levels of stress were significantly associated with suicidal thoughts in both elderly people living alone and those living with others. CONCLUSIONS The findings highlight the need for suicide-intervention services, which particularly target high-risk elderly people. Primary care should be provided to elderly people after suffering a stroke and/or experiencing a limitation in daily activities.
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Affiliation(s)
- Sang-Mi Park
- Department of Health Administration, Hanyang Women's University , Seoul , Republic of Korea
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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] [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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Chou KL. Chronic fatigue and affective disorders in older adults: evidence from the 2007 British National Psychiatric Morbidity Survey. J Affect Disord 2013; 145:331-5. [PMID: 22940497 DOI: 10.1016/j.jad.2012.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although chronic fatigue is common in old age, the association between chronic fatigue and common affective disorders is largely unknown. AIMS To fill this research gap, the present study aims to determine the relationship between chronic fatigue and common psychiatric disorders among older adults aged 65 and older. METHOD A national representative sample of 1793 England community-dwelling respondents aged 65 and above was assessed in the 2007 Adult Psychiatric Morbidity Survey (APMS) using the Revised Clinical Interview Schedule to measure chronic fatigue and common psychiatric disorders. Demographic characteristics, medical conditions, and four health-related variables based on the Short Form 12 were also measured. RESULTS The prevalence of chronic fatigue was 18.6%. Bivariate analyses revealed that chronic fatigue was more common among women and non-white ethnicities. In addition, chronic fatigue was significantly related to depression, mixed anxiety and depressive disorder, and generalized anxiety disorder after adjusting for demographic variables, medical conditions, and four other health-related variables. CONCLUSION The prevalence rate of chronic fatigue in our sample is higher than a previous study. The psychiatric comorbidity of chronic fatigue supports the notion that chronic fatigue has a strong impact on quality of life in old age.
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Affiliation(s)
- Kee-Lee Chou
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong, China.
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Gender differences in health service use for mental health reasons in community dwelling older adults with suicidal ideation. Int Psychogeriatr 2013; 25:374-81. [PMID: 23217245 DOI: 10.1017/s1041610212001895] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To ascertain gender-specific determinants of antidepressant and mental health (MH) service use associated with suicidal ideation. METHODS Data used in this study came from the ESA (Enquête sur la Santé des Aînés) survey carried out in 2005-2008 on a large sample of community-dwelling older adults (n = 2,004). Multivariate logistic regression analyses were carried out. RESULTS The two-year prevalence of suicidal ideation was 8.4% and 20.3% had persistent suicidal thoughts at one-year follow-up. In males, the prevalence of antidepressant and MH service use in respondents with suicidal ideation reached 32.2% and 48.9%, respectively. In females, the corresponding rates were 42.6% and 65.6%. Males were less likely to consult MH services than females when their MH was judged poorly. Male respondents with higher income and education were less likely to use antidepressant and MH services. However, males using benzodiazepines were more likely than females to be dispensed an antidepressant. Among respondents with suicidal ideation, gender was not associated with service use. Younger age, however, was associated with antidepressant use. CONCLUSIONS Increased promotion campaigns sensitizing men to the prodromal symptoms of depression and the need to foster access to MH care when the disorder is manageable may be needed.
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Gender differences in determinants of suicidal ideation in French-speaking community living elderly in Canada. Int Psychogeriatr 2012; 24:2019-26. [PMID: 22809829 DOI: 10.1017/s1041610212001251] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND To inform public health suicide prevention and mental health promotion campaigns, this study will carry out gender-specific analyses to ascertain the determinants of suicidal ideation or death thoughts in a large representative sample of community dwelling older adults. METHODS Data used in this study were from the ESA survey (Enquête sur la Santé des Aînés - Survey on the Health of the Elderly) on a large representative sample of community dwelling older adults (n = 2,494). Multivariate logistic regression analysis was used to study the association between suicidal ideation, mental health service, and antidepressant use and a number of clinical and socio-demographic factors. RESULTS The prevalence of suicidal ideation reached 6.3%. The findings of this study show that the presence of suicidal ideation in females is associated with younger age, single or widowed status, the reporting of daily life stressors, and chronic conditions as well as the presence of major or minor depression in the past year. In males, suicidal ideation is associated with older age, single or widowed status, and depression. Furthermore, suicidal ideation is significantly associated with antidepressant use in females but not males and this after controlling for a number of clinical factors. CONCLUSION Although no gender differences are observed between suicidal ideation and mental health service use, females with suicidal ideation are more likely to be dispensed antidepressants than males with suicidal ideation. Future research should focus on gender-specific determinants of antidepressant and mental health service use associated with suicidal ideation.
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Chiu H, Dai J, Xiang Y, Chan S, Leung T, Yu X, Hou Z, Ungvari G, Caine E. Suicidal thoughts and behaviors in older adults in rural China: a preliminary study. Int J Geriatr Psychiatry 2012; 27:1124-30. [PMID: 22252964 PMCID: PMC4733507 DOI: 10.1002/gps.2831] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 11/10/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND One purpose of this study was to examine the feasibility of conducting epidemiological survey on suicidal thoughts and behaviors (hereafter "suicidal thoughts/behaviors"; i.e., any suicidal ideation, serious ideation, planning, and attempts) among older adults in rural China. Another purpose was to investigate among older people in rural China the prevalence of suicidal thoughts/behaviors, as well as their sociodemographic and clinical correlates. METHODS A randomly selected sample of 263 subjects, 50 years or older, was recruited in a remote rural area of Southwestern China (Mianyang Region, Sichuan Province) and interviewed using structured instruments. Basic sociodemographic and clinical data were collected. RESULTS There was no refusal among approached subjects, and subjects were willing to answer questions on suicidal thoughts/behaviors. The lifetime prevalence of suicidal ideation, serious ideation, planning, and attempt was 28.9% (23.4%-34.4%), 19.7% (14.9%-24.6%), 11.4% (7.5%-15.3%), and 5.3% (2.6%-8.1%), respectively. The corresponding 12-month prevalence was 8.8% (5.3%-12.2%), 5.3% (2.6%-8.1%), 2.7% (0.7%-4.6%), and 0%, respectively. The 2-week prevalence was 3.4% (1.2%-5.6%), 2.3% (0.5%-4.1%), 2.3% (0.5%-4.1%), and 0%, respectively. Correlates of suicidal thoughts/behaviors of this group are similar to findings from other community studies, such as female gender, unmarried status, major medical conditions, insomnia, financial difficulties and lower education, depressive symptoms, recent stressful life events, greater life dissatisfaction. CONCLUSIONS Our findings suggest that larger scale epidemiological survey of suicidal thoughts/behaviors on older adults in rural China would be feasible. Suicidal thoughts/behaviors are common among older people in rural China, as seen in this preliminary study, which points to the need for further larger scale investigations.
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Affiliation(s)
- H.F.K. Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J. Dai
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China,Shenzhen Institute of Mental Health, Shenzhen, China,Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, and VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Y.T. Xiang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China,Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - S.S.M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T. Leung
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X. Yu
- Institute of Mental Health, Peking University, Beijing, China
| | - Z.J. Hou
- Sichuan College of Traditional Chinese Medicine, Mianyang, Sichuan, China
| | - G.S. Ungvari
- Graylands Hospital & School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - E.D. Caine
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, and VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
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Prevalence and correlates of suicidal thought and self-destructive behavior among an elderly hospital population in Iran. Int Psychogeriatr 2012; 24:1402-8. [PMID: 22414596 DOI: 10.1017/s1041610212000245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have examined suicidal ideation and behavior in hospitalized physically ill elderly patients, a group potentially at high risk. Our aim was to investigate the prevalence and risk factors for suicide ideation, and direct and indirect self-destructive behaviors among a sample of elderly inpatients. METHODS A cross-sectional study was conducted in 2009; 650 inpatients aged 60 years and over were screened from various medical services in teaching hospitals affiliated to Shiraz University of Medical Sciences in Iran. Suicidal ideation and behavior were measured with the Beck Scale for Suicidal Ideation (BSSI) and the Harmful Behavior Scale (HBS). Depression was measured with the Geriatric Depression Scale (GDS), medical burden with the geriatric version of the Cumulative Illness Rating Scale (CIRS-G), life events with the Paykel Life Event Scale, and social support with the Perceived Social Support Scale. RESULT Of the 650 patients screened with a mean age of 70.5 years (SD ± 7.5), 570 met inclusion criteria and of these 123 (21.6%) reported suicidal ideation on the BSSI and 80 (14.4%) had at least one self-destructive behavior included in the HBS. There was a significant correlation between suicide ideation and harmful behaviors (r = 0.503, p = 0.001). In a regression analysis, depressive symptoms, increased burden of medical conditions, marital status, history of substance use, history of traumatic life events, lack of perceived social support, and poor education were associated with both suicide ideation and harmful behavior. From demographic variables, living without a spouse and unemployment were predictors of suicidal ideation and behavior. CONCLUSION Hospitalized, physically ill elderly patients have high rates of suicidal ideation and self-destructive behavior and these vary according to psychosocial and clinical factors. The general hospital is therefore a potential site for the recognition of suicidal individuals and implementation of proximal suicide prevention strategies.
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Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. PAIN MEDICINE 2012; 13:552-61. [PMID: 22487542 DOI: 10.1111/j.1526-4637.2012.01358.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HYPOTHESIS Passive, active, and historical suicidality are associated with preference for death over disability. DESIGN Community nonpatients without pain, community patients with pain, and patients with acute and chronic pain were compared for endorsement of disability perception and preference for death over disability. Phi correlations and chi-square analyses were calculated between preference for death over disability and six suicidality items representing passive, active, and historical suicidality. Logistic regression was used to predict preference for death over disability in patients with acute and chronic pain. RESULTS For patients with acute and chronic pain, endorsement of preference for death over disability correlated significantly with all six suicidality items. The logistic regression models identified the following variables as predictors for preference for death over disability in patients with acute pain: the Behavior Health Inventory (BHI 2) family dysfunction scale, history of wanting to die, and disability perception. For patients with chronic pain, predictors were the BHI 2 Borderline scale, history of wanting to die, treated fairly by family item, frequent suicide ideation, people I trust turn on me item, and disability perception. Preference for death over disability was a statistically significant predictor in patients with chronic pain for disability perception, recent suicide ideation, having a suicidal plan, and a history of wanting to die but was not a significant predictor for any suicide items in patients with acute pain. CONCLUSION Preference for death over disability is associated with passive and active suicide ideation and historical suicidality in patients with chronic pain.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at University of Miami, Miami, Florida 33136, USA.
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Minayo MCDS, Pinto LW, Assis SGD, Cavalcante FG, Mangas RMDN. Tendência da mortalidade por suicídio na população brasileira e idosa, 1980-2006. Rev Saude Publica 2012; 46:300-9. [DOI: 10.1590/s0034-89102012000200012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2001] [Accepted: 11/12/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever a mortalidade por suicídio no Brasil, com destaque para a população idosa. MÉTODOS: Análise temporal e estudo de tendência por regressão polinomial de suicídios na população acima de dez anos no Brasil e no Estado do Rio de Janeiro de 1980 a 2006. Os dados foram extraídos do Sistema de Informações sobre Mortalidade e as taxas, calculadas segundo sexo e faixa etária, considerando-se a população residente fornecida pelo Datasus por 100 mil habitantes. Para os anos de 1980 a 1995, utilizou-se a nona revisão da Classificação Internacional de Doenças e Problemas Relacionados à Saúde, e para 1996 a 2006, a décima revisão. RESULTADOS: Crescimento significativo foi observado nas taxas de suicídio na população brasileira e no Rio de Janeiro (5,7 e 3,1 para cada 100 mil habitantes, respectivamente) em 2006. Esse incremento ocorreu pelo aumento dos suicídios na população masculina em todas as idades. A curva crescente aconteceu principalmente entre homens maiores de 60 anos. O incremento não foi estatisticamente significativo entre homens e houve decréscimo entre mulheres no Rio de Janeiro. Os principais meios de suicídio utilizados pelos homens foram enforcamento, sufocação, estrangulamento e armas de fogo. Para as mulheres, o enforcamento também ocupou a primeira posição, seguido pela ingestão de substâncias, atiramento ao fogo e precipitação de altura. A elevada taxa de indefinição dos meios ressaltou problemas na qualidade dos dados. CONCLUSÕES: Suicídios são eventos significantes na população masculina, sobretudo entre homens idosos, ao longo do tempo. No Rio de Janeiro, as taxas entre homens idosos também são maiores, mas não estatisticamente significantes. Segundo a Organização Mundial da Saúde e o Ministério da Saúde, o suicídio é passível de prevenção e existem cuidados preconizados para cada grupo etário.
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Rurup ML, Deeg DJH, Poppelaars JL, Kerkhof AJFM, Onwuteaka-Philipsen BD. Wishes to Die in Older People. CRISIS 2011; 32:194-203. [DOI: 10.1027/0227-5910/a000079] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Death thoughts and wishes occur frequently among older people. In different European countries estimates of 10%–20% have been found. Aims: To determine the prevalence and associated factors of death thoughts and wishes among older people in The Netherlands. Methods: In The Netherlands 1794 people (58–98 years) were interviewed in 2005/2006 (Longitudinal Aging Study Amsterdam). Results: 81.3% reported never having death thoughts/wishes; 15.3% reported having had such thoughts/wishes; 3.4% reported currently having a wish to die and/or a weakened wish to continue living. Of those with a current wish to die, 67% had depressive symptoms (vs. 32% of people with death thoughts/wishes ever and 9% of people who never had had death thoughts/wishes), and 20% suffered from a depressive disorder (vs. 5% if death thoughts/wishes ever; 0.3% if never death thoughts/wishes). In a multivariate analysis, a current wish to die was associated with having depressive symptoms, a depressive disorder, lower perceived mastery, financial problems, loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment. Conclusions: Practical implications for health-care professionals are that they should be aware that in certain situations older people are more likely to develop a wish to die, and that a wish to die does not necessarily mean that someone has a depressive disorder. Nevertheless, it should serve as a trigger to investigate and to treat depression if present.
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Affiliation(s)
- M. L. Rurup
- VU University Medical Center, Department of Public and Occupational Health, Amsterdam, The Netherlands
- VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - D. J. H. Deeg
- VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- VU University, Department of Psychiatry, Amsterdam, The Netherlands
| | - J. L. Poppelaars
- VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- VU University, Department of Sociology, Amsterdam, The Netherlands
| | - A. J. F. M. Kerkhof
- VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- VU University, Department of Clinical Psychology, Amsterdam, The Netherlands
| | - B. D. Onwuteaka-Philipsen
- VU University Medical Center, Department of Public and Occupational Health, Amsterdam, The Netherlands
- VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Rurup ML, Pasman HRW, Goedhart J, Deeg DJH, Kerkhof AJFM, Onwuteaka-Philipsen BD. Understanding Why Older People Develop a Wish to Die. CRISIS 2011; 32:204-16. [DOI: 10.1027/0227-5910/a000078] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Quantitative studies in several European countries showed that 10–20% of older people have or have had a wish to die. Aims: To improve our understanding of why some older people develop a wish to die. Methods: In-depth interviews with people with a wish to die (n = 31) were carried out. Through open coding and inductive analysis, we developed a conceptual framework to describe the development of death wishes. Respondents were selected from two cohort studies. Results: The wish to die had either been triggered suddenly after traumatic life events or had developed gradually after a life full of adversity, as a consequence of aging or illness, or after recurring depression. The respondents were in a situation they considered unacceptable, yet they felt they had no control to change their situation and thus progressively “gave up” trying. Recurring themes included being widowed, feeling lonely, being a victim, being dependent, and wanting to be useful. Developing thoughts about death as a positive thing or a release from problems seemed to them like a way to reclaim control. Conclusions: People who wish to die originally develop thoughts about death as a positive solution to life events or to an adverse situation, and eventually reach a balance of the wish to live and to die.
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Affiliation(s)
- M. L. Rurup
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H. R. W. Pasman
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - J. Goedhart
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - D. J. H. Deeg
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, VU University, Amsterdam, The Netherlands
| | - A. J. F. M. Kerkhof
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - B. D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Minayo MCDS, Cavalcante FG. Suicídio entre pessoas idosas: revisão da literatura. Rev Saude Publica 2010; 44:750-7. [DOI: 10.1590/s0034-89102010000400020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/07/2010] [Indexed: 11/21/2022] Open
Abstract
Foi realizada revisão da literatura sobre os principais fatores associados à ideação, tentativas e suicídio propriamente dito de pessoas idosas. Foram pesquisadas as seguintes bases de dados: MEDLINE, PsychInfo, SciELO e Biblioteca Virtual em Violência e Saúde da BIREME, referentes ao período de 1980 a 2008. Foram selecionadas e analisadas 52 referências, que mostraram forte relação entre ideação, tentativas e efetivação do ato fatal em pessoas idosas, que resulta da interação de fatores complexos: físicos, mentais, neurobiológicos e sociais. O suicídio associado à depressão em idosos é prevenível desde que a pessoa esteja devidamente tratada. Há necessidade de investimento em pesquisa no Brasil, dado o crescimento persistente das taxas de suicídio entre idosos, sobretudo do sexo masculino.
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Corna LM, Cairney J, Streiner DL. Suicide ideation in older adults: relationship to mental health problems and service use. THE GERONTOLOGIST 2010; 50:785-97. [PMID: 20566835 DOI: 10.1093/geront/gnq048] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE to assess the prevalence of suicide ideation among community-dwelling older adults and the relationship between suicide ideation, major psychiatric disorder, and mental health service use. DESIGN AND METHODS we use data from the Canadian Community Health Survey 1.2: Mental Health and Well-being (CCHS 1.2). We estimate the prevalence of suicide ideation and the prevalence of major psychiatric disorder and service use among ideators versus nonideators. In multivariate models, we consider the sociodemographic, social, and mental health correlates of suicide ideation and mental health care use. RESULTS in our sample, more than 2% of older adults reported suicide ideation in the past year and more than two thirds of these respondents did not meet the criteria for any of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders assessed in the CCHS 1.2. In multivariate models, being male, younger, or widowed, reporting lower social support and higher psychological distress increased the likelihood of suicide ideation. More than 50% of the respondents who reported suicidal thoughts did not access any type of mental health care use. IMPLICATIONS although suicide ideation is associated with depression and anxiety disorders, many older adults with suicidal thoughts do not meet the criteria for these clinical disorders. The low prevalence of service use among older adults with suicide ideation suggests the need for further inquiry into the factors associated with discussing mental health concerns with health care providers, particularly among older adults who do not meet the criteria for clinical disorder.
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Affiliation(s)
- Laurie M Corna
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada M5T 3M7.
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Bartlett H, Travers C, Cartwright C. Evaluation of a project to raise community awareness of suicide risk among older men. J Ment Health 2009. [DOI: 10.1080/09638230701506010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Scocco P, Fantoni G, Rapattoni M, de Girolamo G, Pavan L. Death ideas, suicidal thoughts, and plans among nursing home residents. J Geriatr Psychiatry Neurol 2009; 22:141-8. [PMID: 19307321 DOI: 10.1177/0891988709332937] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies have shown that suicides are at least as frequent among Nursing Home (NH) residents as they are among older people in the general population. The objective of the present study was to evaluate the prevalence of death- and/or suicidal feelings, thoughts, and plans and any attempted suicides in a random, unselected sample (N=288) of individuals aged 65-years-and-over, living in NHs located in the Veneto Region (the Italian North-East). One hundred seventy-two participants were surveyed with a response rate of 59.7%. Five sample questions were asked to investigate the presence of death- and suicidal thoughts, plans and behaviors in different time periods. Among the NH residents, 30.8% admitted having had death or suicidal thoughts or plans during the month prior to the interview. The oldest-old residents (85+y) more frequently reported death-suicide ideation. This high frequency of death and/or suicidal feelings and thoughts among older NH residents should be carefully considered when planning and implementing health care programs in these facilities.
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Abstract
BACKGROUND While dementia is more common in older people and suicide rates in many countries are higher among the elderly, there is some doubt about the association between these two phenomena. METHODS A search of the major relevant databases was carried out to examine the evidence for this possible association. RESULTS The association between dementia and suicide and also non-fatal self-harm did not appear strong but many studies have significant methodological limitations and there are few studies of suicide or self-harm in vascular, frontotemporal, Lewy body and HIV dementia where such behavior might be expected to be more common. Rates of self-harm may be increased in mild dementia and are higher before than after predictive testing for Huntington's disease. Overall, the risk of suicide in dementia appears to be the same or less than that of the age-matched general population but is increased soon after diagnosis, in patients diagnosed with dementia during hospitalization and in Huntington's disease. Putative risk factors for suicide in dementia include depression, hopelessness, mild cognitive impairment, preserved insight, younger age and failure to respond to anti-dementia drugs. Large, good quality prospective studies are needed to confirm these findings. CONCLUSIONS Further research should be undertaken to examine how rates of suicide and self-harm change during the course of the illness and vary according to the specific sub-type of dementia.
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Nazem S, Siderowf AD, Duda JE, Brown GK, Ten Have T, Stern MB, Weintraub D. Suicidal and death ideation in Parkinson's disease. Mov Disord 2009; 23:1573-9. [PMID: 18618660 DOI: 10.1002/mds.22130] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is a chronic, disabling illness affecting primarily the elderly and is associated with a high prevalence of depression. Although these are known risk factors for suicidal and death ideation, little is known about the prevalence and correlates of such ideation in PD. A convenience sample of 116 outpatients with idiopathic PD at two movement disorders centers were administered a modified Paykel Scale for suicidal and death ideation, as well as an extensive psychiatric, neuropsychological, and neurological battery. Univariate and multivariate logistic regression models were used to determine the correlates of suicidal or death ideation. Current death ideation (28%) or suicide ideation (11%) were present in 30% of the sample, and 4% had a lifetime suicide attempt. On univariate logistic regression analysis, increasing severity of depression (odds ratio = 2.92, 95% CI 2.01-4.24, P < 0.001), impulse control disorder (ICD) behaviors sometime during PD (odds ratio = 6.08, 95% CI 1.90-19.49, P = 0.002), and psychosis (odds ratio = 2.45, 95% CI 1.05-5.69, P = 0.04) were associated with either ideation. On multivariate logistic regression analysis, only increasing severity of depressive symptoms (odds ratio = 2.76, 95% CI 1.88-4.07, P < 0.001) predicted suicidal or death ideation. In conclusion, active suicidal or death ideation occurs in up to one-third of PD patients. Comorbid psychiatric disorders, more than PD-related disease variables, are associated with this ideation, highlighting the need for a comprehensive approach to the clinical care of PD patients.
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Affiliation(s)
- Sarra Nazem
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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