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Marnin J Heisel

Publications and source records attributed to Marnin J Heisel.

13 recordsLinked to original sources
PubMed2007

Future orientation moderates the relationship between functional status and suicide ideation in depressed adults.

Functional impairment might amplify suicide risk in later life. A positive view of the future may reduce this risk. We tested the hypothesis that hopelessness and positive future orientation moderate the association between functional status and suicide ideation in a sample of 136 patients, 55 years of age or older, in treatment for depression. Future orientation moderated the association between functional status and suicide ideation; hopelessness did not. Although prospective research is needed to test more rigorously the hypothesized protective role of positive future orientation, our data suggest that treatments designed to enhance future orientation might decrease suicide risk.

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PubMed2006

Planning of suicide attempts among depressed inpatients ages 50 and over.

BACKGROUND: Suicidal behavior is heterogeneous; suicide attempts can be impulsive (lower planned) or reflect forethought and preparation (higher planned). Lower planned and higher planned attempts may have different correlates that require different prevention strategies. Based on a model of suicide planning relevant to middle-aged and older adults, we tested the following hypotheses: physical illness burden, decreased functional capacity, hopelessness, and living alone are associated with suicide attempts that are more extensively planned; lower cognitive functioning is associated with suicide attempts that are more impulsive. METHODS: Subjects were 117 inpatients ages 50 and over diagnosed with major depression based on semi-structured clinical research interviews, the medical record, plus other records when available. All subjects had attempted suicide within 1 month of admission. The degree of planning prior to the suicide attempt was quantified using Beck's Suicide Intent Scale. Multivariate linear regression analysis identified correlates of planning. RESULTS: As hypothesized, lower cognitive functioning was associated with lower levels of planning. Contrary to the hypothesis, impaired physical self-care was associated with lower (not higher) planning. Results pertaining to living alone were equivocal. LIMITATIONS: The study was limited by the cross-sectional research design and unclear generalizability to completed suicide or to racial/ethnic minorities. CONCLUSIONS: Depressed patients with lower cognitive functioning and impairments in physical self-care may be especially vulnerable to impulsive suicidal behavior. The potential role of living alone in higher planned suicidal acts requires further investigation.

Activities of Daily Living↗
PubMed2006

Future orientation and suicide ideation and attempts in depressed adults ages 50 and over.

OBJECTIVE: The objective of this study was to test the hypothesis that future orientation is associated with lower levels of suicide ideation and lower likelihood of suicide attempt in a sample of patients in treatment for major depression. METHODS: Two hundred two participants (116 female, 57%) ages 50-88 years were recruited from inpatient and outpatient settings. All were diagnosed with major depression using a structured diagnostic interview. Suicide ideation was assessed with the Scale for Suicide Ideation (both current and worst point ratings), and a measure of future orientation was created to assess future expectancies. The authors predicted that greater future orientation would be associated with less current and worst point suicide ideation, and would distinguish current and lifetime suicide attempters from nonattempters. Hypotheses were tested using multivariate logistic regression and linear regression analyses that accounted for age, gender, hopelessness, and depression. RESULTS: As hypothesized, higher future orientation scores were associated with lower current suicidal ideation, less intense suicidal ideation at its worst point, and lower probability of a history of attempted suicide after accounting for covariates. Future orientation was not associated with current attempt status. CONCLUSIONS: Future orientation holds promise as a cognitive variable associated with decreased suicide risk; a better understanding of its putative protective role is needed. Treatments designed to enhance future orientation might decrease suicide risk.

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PubMed2006

The development and initial validation of the geriatric suicide ideation scale.

OBJECTIVE: The authors report on the development and initial validation of the Geriatric Suicide Ideation Scale (GSIS), a new multidimensional measure of suicide ideation and related factors in older adults. METHODS: Study 1 involved development of an initial 66-item measure, administration to a heterogeneous sample of 172 adults 65 years or older, assessment of the measure's factor structure, and subsequent scale reduction and correlation with social desirability. Study 2 involved validation of the reduced scale with a new sample of 107 older adults and psychometric assessment of the measure's reliability and initial validity. RESULTS: Factor analysis indicated a four-factor structure for the GSIS, with subscales assessing Suicide Ideation, Death Ideation, Loss of Personal and Social Worth, and Perceived Meaning in Life. Psychometric analyses with a new sample indicated strong internal consistency and test-retest reliability. Construct and criterion validity for the GSIS and its subscales were demonstrated by positive associations with measures of depression, hopelessness, and self-reported health problems, and negative associations with life satisfaction and psychological well-being. The 10-item Suicide Ideation subscale also differentiated psychiatric patients from nonpatients. CONCLUSIONS: The GSIS is a psychometrically sound measure of late-life suicide ideation. Findings support the use of its subscales as standalone measures of late-life suicide risk and psychological resilience.

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PubMed2006

Suicide and its prevention among older adults.

OBJECTIVE: To review the research on the epidemiology, risk and resiliency, assessment, treatment, and prevention of late-life suicide. METHOD: I reviewed mortality statistics. I searched MEDLINE and PsycINFO databases for research on suicide risk and resiliency and for randomized controlled trials with suicidal outcomes. I also reviewed mental health outreach and suicide prevention initiatives. RESULTS: Approximately 12/100,000 individuals aged 65 years or over die by suicide in Canada annually. Suicide is most prevalent among older white men; risk is associated with suicidal ideation or behaviour, mental illness, personality vulnerability, medical illness, losses and poor social supports, functional impairment, and low resiliency. Novel measures to assess late-life suicide features are under development. Few randomized treatment trials exist with at-risk older adults. CONCLUSIONS: Research is needed on risk and resiliency and clinical assessment and interventions for at-risk older adults. Collaborative outreach strategies might aid suicide prevention.

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PubMed2005

Personality and reports of suicide ideation among depressed adults 50 years of age or older.

BACKGROUND: Accuracy in patient reports of suicide ideation is a concern in clinical assessment, given that some patients deny suicide ideation even when suicidal. Despite this concern, there is little research on the psychological processes driving reported suicide ideation in at-risk patients. METHODS: A cross-sectional design was used to examine the association of personality and suicide ideation in a clinical sample of 134 depressed adults 50 years and older. Patients completed a structured diagnostic interview, an interviewer-rated measure of current suicide ideation and self-report measures of personality (NEO-Personality Inventory Revised; NEO-PI-R) and hopelessness. The main outcome variable in logistic regression analyses was suicide ideator status; covariates included comorbid psychopathology, hopelessness and physical illness burden. Predictors were Neuroticism and Openness to Experience (OTE) scores on the NEO-PI-R. RESULTS: Elevated OTE and neuroticism were associated with suicide ideation in unadjusted analyses; OTE was also associated with suicide ideation in adjusted regression analyses. LIMITATIONS: This study used a cross-sectional methodology with depressed patients 50 years or older; it is possible that patients' depression severity may have influenced their responses to personality measures. Prospective studies of personality vulnerability to future suicide ideation are warranted. CONCLUSIONS: Elevated neuroticism increases the likelihood of reporting suicide ideation, just as it may enhance risk for suicidal behavior and death by suicide. The pattern for openness is markedly different. Although elevated openness increases the likelihood of reporting suicide ideation, previous research has shown that it may decrease risk of death by suicide, suggesting that the personality-mediated expression of suicide ideation may be adaptive in certain contexts. In contrast, low levels of openness may mute reports of suicide ideation in at-risk patients and confer risk for poor outcomes by potentially undermining clinician vigilance.

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PubMed2005

A psychometric analysis of the Geriatric Hopelessness Scale (GHS): towards improving assessment of the construct.

BACKGROUND: Hopelessness increases vulnerability to late-life depression and risk for suicide. The present study examined the psychometric properties of the Geriatric Hopelessness Scale (GHS; Fry, 1984) among a heterogeneous sample of older adults and its association with depression and suicide ideation. METHODS: Seventy-eight adults 65 years or older recruited from psychiatric, medical, residential, and community were administered the study measures. We examined the item-response characteristics, factor structure, and reliability of the GHS, its construct validity by way of associations with depression, hopelessness, and suicide ideation, and criterion validity in terms of differentiating psychiatric patients from non-psychiatric participants. RESULTS: The GHS had poor item-response characteristics but acceptable internal consistency and construct validity. A factor analysis yielded three internally consistent factors assessing Fatalistic, Interpersonal, and Spiritual Hopelessness. An 11-item GHS-Suicide Risk subscale was identified with acceptable internal consistency, significant association with measures of hopelessness, depression, and suicide ideation, and that differentiated psychiatric patients from non-psychiatric participants. LIMITATIONS: This study had a relatively small sample size, included a high proportion of female respondents (79%), and a relatively low proportion of patients in mental health care (17%). CONCLUSIONS: The GHS had acceptable reliability and construct validity, but poor item-response characteristics and criterion validity with respect to differentiating psychiatric patients from non-psychiatric participants. Use of shortened GHS measures may improve upon the limitations of the full scale, and may be preferable when seeking to identify older adults at risk for suicide.

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PubMed2005

Psychometric properties of the 15-item geriatric depression scale in functionally impaired, cognitively intact, community-dwelling elderly primary care patients.

OBJECTIVES: To examine the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15), a brief depression screening measure. DESIGN: Cross-sectional. SETTING: Nineteen counties in western New York, West Virginia, and Ohio. PARTICIPANTS: Nine hundred sixty functionally impaired, cognitively intact, community-dwelling primary care patients aged 65 and older. MEASUREMENTS: The GDS-15, major depression as measured using the Mini-International Neuropsychiatric Interview, depressed mood, life satisfaction, suicidal ideation, and reported suicide attempts. RESULTS: Exploratory factor analyses suggested a two-factor structure for the GDS-15 in this category of patients, with component subscales assessing depression and positive affect. Cronbach alpha coefficients provide evidence for moderate, although acceptable, internal consistency reliability. Significant associations between the GDS-15 and measures of depressed mood, life satisfaction, and suicidal ideation demonstrated construct validity, whereas acceptable sensitivity and specificity to discriminate between depressed and nondepressed patients demonstrated criterion validity. Internal consistency reliability and construct validity did not differ significantly between patients with low and high functional impairment. A significant weakness of the scale is its low correlation with suicide attempt status. CONCLUSION: In general, this study provides evidence of impressive psychometric properties of the GDS-15 when administered to a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.

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PubMed2005

Does the geriatric depression scale (GDS) distinguish between older adults with high versus low levels of suicidal ideation?

OBJECTIVE: The Geriatric Depression Scale (GDS) is a common screening measure for late-life depression, but it does not directly assess thoughts of death or suicide. The present study asked whether 30-item (GDS) and 15-item (GDS-SF) GDS scales differentiate older adults with high versus low levels of suicidal ideation. METHODS: This cross-sectional study included a sample of 105 adults age 65 or older recruited from medical and psychiatric inpatient and outpatient practices, nursing and retirement residences, and community-based seniors' programs. RESULTS: GDS scores were associated positively with self-report and clinician-administered measures of suicidal ideation. Fifteen of 30 GDS items and 7 of 15 GDS-SF items distinguished groups high or low in self-reported suicidal ideation. Receiver Operating Characteristic curve analyses indicated criterion validity for the GDS measures with respect to suicidal ideation at cut-off scores of 12 for the GDS and 6 for the GDS-SF. Five internally consistent GDS items were identified that were highly associated with suicidal ideation, assessing hopelessness, worthlessness, emptiness, an absence of happiness, and absence of the perception that it is "wonderful to be alive." CONCLUSION: Long and short forms of the GDS may be used to screen older patients at risk for suicide. Clinicians using the GDS for this purpose are advised to further assess suicide risk with measures designed specifically to assess presence and severity of suicidal ideation.

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PubMed2005

Is suicide ideation a surrogate endpoint for geriatric suicide?

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention , and ideation . Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide ( n = 6); those not supporting this hypothesis ( n = 1); and those providing insufficient information to test the hypothesis ( n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed.

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PubMed2004

Social, demographic, and clinical factors related to disruptive behaviour in hospital.

OBJECTIVE: This study addresses 2 issues: first, whether the diagnosis of borderline personality disorder (BPD) or borderline traits differentiates adult patients who demonstrate disruptive behaviour during hospitalization from those patients who do not; and second, whether other clinical variables can be assessed during the emergency visit to differentiate patients who are likely to show disruptive behaviour in hospital from those who are not. METHOD: We completed a case-control, chart-based, retrospective analysis of patients consecutively admitted to an inpatient psychiatric service. We assembled 44 subjects who demonstrated evidence of disruptive behaviour during inpatient hospitalization. These subjects were matched with 61 control subjects admitted during the same time period. Potential participants were excluded if they had a diagnosis of schizophrenia, psychotic disorders, delirium, or dementia or if they had a diagnosis receiving a psychotic specifier. RESULTS: Univariate analyses revealed that patients with disruptive behaviour were significantly more likely to have been diagnosed with BPD or borderline traits than the comparison group (32.6% vs 13.4%; chi2 = 4.45, df 1; P < 0.05). According to stepwise logistic regression analysis, 4 variables significantly contributed to the final model (R2 = 0.37, P < 0.001) predicting disruptive behaviours with the following odds ratios (ORs): Axis III infectious diseases (OR 7.63; 95% CI, 1.41 to 41.67), Axis IV housing problems (OR 3.58; 95% CI, 1.21 to 10.64), history of suicidal behaviours (OR 3.46; 95% CI, 1.24 to 9.71), and problems with primary supports (OR 0.12; 95% CI, 0.03 to 0.46). This last variable was related to a reduced risk of disruptive behaviours in hospital. CONCLUSIONS: Patients at risk for disruptive behaviour during psychiatric hospitalization are characterized by a history of suicidal or impulsive-aggressive behaviour and social disadvantage.

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PubMedDate not supplied

Cognitive functioning and geriatric suicide ideation: testing a mediational model.

The authors evaluated a structural model of the relationship between cognitive functioning and geriatric suicide ideation, mediated by Depression/Hopelessness, a latent construct characterized by a combination of the two. A heterogeneous sample of 90 elderly participants completed the Geriatric Suicide Ideation Scale, a new, multidimensional self-report measure of suicide ideation in seniors, and measures of cognitive functioning, depression, and both global and social forms of hopelessness. The results demonstrated significant associations between suicide ideation and the various predictor variables. The results of structural-equation modeling supported the proposed mediational model, indicating that the Depression/Hopelessness construct mediates the relationship between cognitive functioning and suicide ideation among older persons. These findings have implications for the conceptualization and treatment of potentially suicidal elderly persons.

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