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Biomedical subjects

P R Duberstein

Publications and source records attributed to P R Duberstein.

At least 37 records · Page 2Linked to original sources
PubMed1999

Age and suicidal ideation in older depressed inpatients.

Age-related patterns of symptom presentation may complicate the recognition of suicide risk. The authors sought to determine whether there is a relationship between age and reported suicidal ideation in depressed suicide attempters (DSAs) and depressed nonattempters (DNs) 50 years of age and over. Regression analyses revealed that increasing age is significantly associated with the absence of suicidal ideation in both DSAs and DNs. Because of their lower rates of depressed mood and suicidal ideation, the depressions of older adults may more readily escape detection. Preventive or treatment measures initiated after the onset of the suicidal state may be insufficient, and other preventive strategies ought to be considered.

Age Factors↗
PubMed1999

Attempted suicide in older depressed patients: effect of cognitive functioning.

The authors explored cognitive functioning and suicidal behavior in older depressed patients. Inpatients age 50 years or older (N=103) with major depression, 45 of whom had attempted suicide, were evaluated within 1 week of their hospital admission. Measures of suicidal behavior included suicide attempter status, the Suicide Intent Scale (SIS), ratings of method used (violent/nonviolent), and seriousness of injuries sustained (lethality). The Mini-Mental State Exam (MMSE) score measured cognitive impairment; covariates were age, gender, and living arrangement. The MMSE score was not associated with suicide attempter status, but for attempters, MMSE score showed a positive association with SIS score, but not method or lethality. Findings suggest that although cognitive disturbance may be associated with less-deliberate acts among older depressed suicide attempters, it does not appear to influence the potential lethality of their behavior.

Aged↗
PubMed1998

Medical illness burden, trait neuroticism, and depression in older primary care patients.

OBJECTIVE: The authors tested the hypotheses that medical illness burden is independently associated with depression and that this association is moderated by neuroticism. METHOD: Multiple regression techniques were used to determine the independent associations of medical burden and neuroticism with depression in a group of 196 subjects, 60 years of age and older, recruited from primary care settings. RESULTS: Medical burden and neuroticism were independently associated with major depression, depressive symptoms, and psychiatric dysfunction. CONCLUSIONS: These findings support models in which medical disorders may contribute directly to depression. At the same time, the role of neuroticism in later-life depression warrants further study.

Aged↗
PubMed1998

Women's safety in recovery: group therapy for patients with a history of childhood sexual abuse.

The literature on group therapies for women with histories of childhood sexual abuse has focused on outpatient treatments. A model of group treatment for inpatients and partial hospital patients is described here. "Women's Safety in Recovery" is a first-stage trauma recovery group that promotes mastery of current life stressors and prevents regression through the use of psychoeducation about abuse effects, the practice of problem-solving skills, and supportive, topic-focused discussion. The group is structured in three one-week modules that patients can begin or leave at any time.

Adaptation, Psychological↗
PubMed1998

Age differences in behaviors leading to completed suicide.

The authors described retrospectively the premorbid self destructive behaviors of suicide victims to determine whether these behaviors differ with age. One hundred forty one suicide victims, age 21-92 years, were studied by psychological autopsy. Older age was significantly associated with more determined and planful self-destructive acts, less violent methods, and fewer warnings of suicidal intent. Age differences in the behaviors leading to suicide indicate that intervention in the midst of a suicidal crisis may be less effective in elderly persons than in younger people. Primary prevention should be the focus of efforts to decrease suicide rates in late life.

Adult↗
PubMed1998

Suicide in widowed persons. A psychological autopsy comparison of recently and remotely bereaved older subjects.

Using the psychological autopsy method, the authors sought to determine whether widowed people who commit suicide more than 4 years after their spouse's death (n = 21) can be clinically distinguished from those who commit suicide after a shorter period of widowhood (n = 14). The latter had a higher rate of psychiatric treatment (P = 0.018), early loss/separation (P = 0.03), and a nonsignificantly higher rate of lifetime substance abuse (P = 0.07). Spousal bereavement increases the likelihood of physician visits, so the recently widowed represent a population for whom interventions may be readily implemented. Clinicians should monitor suicide risk in their recently widowed patients, especially those with psychiatric, substance abuse, and/or early loss/separation histories.

Aged↗
PubMed1997

Suicide and alcoholism. Distinguishing alcoholic patients with and without comorbid drug abuse.

Psychological autopsy data were used to test the hypothesis that alcoholic patients with comorbid drug use disorders who committed suicide (A + D; n = 26) are distinguishable from alcoholic suicide victims without a comorbid drug use disorder (A; n = 35). Dependent variables included demographics, suicidal behavior; psychiatric symptoms, and medical illness burden. The A group were older, white, and tended to be living alone. Analyses that controlled for age and sex indicated that As were more likely to have had a comorbid major depression and less likely to tell someone they were contemplating suicide. Scores on a measure of illness burden increased with age among the A group but not the A + D group, though the latter were more likely to be under a physician's care with increasing age. These differences should be considered when designing preventive measures.

Adult↗
PubMed1996

Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study.

OBJECTIVE: Psychiatric illness is a potent risk factor for suicide, rates of which differ markedly with age. The purpose of this study was to examine whether the psychiatric diagnoses of suicide victims vary predictably with age. METHOD: DSM-III-R axis I diagnoses of 141 persons aged 21 to 92 years who had completed suicide were established by the psychological autopsy method. Multiple logistic regression analyses were used to determine whether age, gender, or their interaction predicted the presence of specific disorders. RESULTS: One or more axis I conditions were diagnosable in 90.1% of the suicide victims. Substance use disorders were most frequent, followed by mood disorders and primary psychotic illness. Younger age at death was a significant predictor of substance abuse or dependence and primary psychoses, while older age predicted major mood disorders. Comorbidity of substance use and mood disorders was common. Among victims with substance abuse or dependence, older age at death predicted major depression; among victims with mood disorders, younger age at death predicted comorbid substance abuse or dependence. CONCLUSIONS: The distribution of psychiatric illnesses in suicide victims differs across the life course. Age-related patterns of addictive and psychotic disorders echo their prevalence in the general population. In contrast, the relationship between age and mood disorders among suicide victims is distinctly different from that of the general population. These findings suggest that risk for suicide increases with age in individuals with major affective illness. Depressed elderly men are particular targets for suicide prevention strategies.

Adult↗
PubMed1995

Openness to experience and completed suicide across the second half of life.

Personality data gathered in a psychological autopsy study indicate that completed suicides obtain higher neuroticism scores than age- and gender-matched controls. Older suicide victims obtained lower openness to experience (OTE) scores than both younger suicide victims and normal controls. Although the role of neuroticism and negative affect in psychopathology has been discussed extensively, OTE has been accorded relatively little attention in the psychiatric literature. The apparent role of OTE in completed suicide warrants its closer examination. In this article, I offer the testable hypotheses that persons low in OTE are at risk for taking their own lives because their affective dampening, cognitive certainty, diminished behavioral repertoire, and rigidly defined self-concept have decreased their capacity to adapt to the expectable age-associated changes in role, health, and function that accumulate over time. Concrete thinking and excessive focus on proximal, low-level goals place them at risk for descending into states of suicidal meaninglessness in times of stress or crisis. This state of awareness increases the desirability of suicide as an action-oriented solution to the stressors of aging. Other lines of investigation are suggested. These include research on OTE and the neurobiology of suicidal behavior; OTE and gender differences in suicidal behavior; and clinical intervention designed to increase the degree to which one is open to experience.

Adolescent↗
PubMed1995

Prevention of late life suicide: when, where, why and how.

Suicide in late life is discussed from the perspective of four guidelines derived from preventive medicine; preventive efforts (1) are beneficial in proportion both to the prevalence and severity of a disease, (2) must consider how the outcome might affect individuals and society as a whole, (3) should take into account biological, psychological and social dimensions, (4) can only be effective if important and 'alterable' risk factors are identified. Possible risk factors for late life suicide which may be altered include social isolation, stressful circumstances, and affective disorder. Primary prevention may involve outreach programs to decrease social isolation, secondary prevention may include education of primary care physicians, and tertiary prevention may, in patients with severe affective disorder, include hospitalization and aggressive somatic therapies.

Aged↗
PubMed1995

Attitudes of older people toward suicide and assisted suicide: an analysis of Gallup Poll findings.

OBJECTIVES: To describe the older population's attitudes toward suicide and assisted suicide, and to determine whether lenient attitudes are associated with known demographic and psychosocial risk factors for completed suicide. DESIGN: Telephone survey conducted by the Gallup Organization in November 1992. PARTICIPANTS: A sample of 802 adults in the United States (541 women and 261 men) aged 60 years and older. MEASUREMENTS: The dependent variables, attitudes toward suicide, were assessed with five attitude statements. Participants rated their agreement with each statement on 4-point Likert-type scales, subsequently dichotomized for use in univariate analyses and logistic regressions. The independent variables included income and demographic and psychosocial risk factors for suicide: age, gender, race, marital status, religiousness, self-rated health, and satisfaction with family relationships. RESULTS: The majority of respondents did not express lenient attitudes. In comparison with survey findings of physicians and the general population, a relatively smaller percentage (41%) of these older respondents believe that physician-assisted suicide should be legalized. Agreement with one or more of the attitudes presented was associated with age, gender, race, marital status, and religiousness in univariate analyses (P < .05), and race, religiousness (P < .001), gender, self-rated health, and satisfaction with family relations (P < .08) in logistic regressions. CONCLUSIONS: The hypothesized relations between risk factors for suicide and lenient attitudes toward suicide were supported. Although none of the risk factors was associated with all five attitudes, in combination the results suggested that a common set of variables predict both lenient attitudes toward suicide and suicidal behavior. Future research is necessary to determine the role of depression and other factors that may mediate the observed relationships and to determine whether the presence of specific, strongly held attitudes sanctioning suicide in an older person signals the need to assess suicide risk.

Aged↗
PubMed1995

Attitudes toward self-determined death: a survey of primary care physicians.

OBJECTIVE: To survey physicians to determine whether sociodemographic and practice-related variables are predictive of their attitudes toward suicide. DESIGN: Mailed questionnnaire survey. SETTING: Monroe County, New York. PARTICIPANTS: A 50 percent random sample of practicing primary care physicians. Of 186 potential respondents, 114 (61.3%) physicians returned questionnaires. MEASUREMENT: In addition to age and gender, independent variables included medical specialty, practice composition defined in terms of patient age, and textbook knowledge of depression and suicide. The dependent variable, attitude toward suicide, was measured using four standard opinion survey questions and six items based on a case vignette. Dependent variables were rated on a Likert-type scale and subsequently dichotomized for use in logistic regression analysis. RESULTS: Approximately 61 percent of the respondents believe that suicide can be rational under certain circumstances, 51 percent believe that physicians should not assist suicides under any circumstances, and 31 percent support legalization of assisted suicide under certain circumstances. Regression analyses revealed that gender was a significant predictor for three of the ten attitude items. Medical specialty, clinical and epidemiological knowledge of depression and suicide, and physician age significantly predicted one attitude item. CONCLUSIONS: These results suggest that physicians' attitudes toward suicide are multidetermined. Although gender, age, medical specialty, and knowledge of depression and suicide predict certain attitudes, the logistic regression analyses were not highly successful in predicting respondents' attitudes. Given the power of physicians to command public attention and to influence public and legal opinion, it is vital that future research continue to explore the determinants of physicians' attitudes toward self-determined death.

Adult↗
PubMed1993

Interpersonal stressors, substance abuse, and suicide.

In contrast to suicide in depression, suicide associated with alcoholism and substance dependence may be preceded more often by interpersonal loss and conflict 6 weeks prior to death. We used psychological autopsy methodology in an effort to clarify and extend these findings using a more comprehensive typology of interpersonal stressors. Subjects included 57 suicide victims with diagnoses of alcohol/substance dependence (A/SD; N = 30) and mood/anxiety disorders (M/AD; N = 27). Consistent with previous studies, a substantial majority of the A/SD suicide victims were confronted with interpersonal stressors in the 6 weeks prior to death. Our investigation extends previous findings by indicating that a) A/SD suicide victims are confronted with a broader range of interpersonal stressors than M/AD suicide completers and b) the types of interpersonal stressors experienced by A/SD subjects in the weeks prior to suicide involve conflicts/arguments and attachment disruptions.

Adult↗
PubMed1993

Rorschach oral imagery, attachment style, and interpersonal relatedness.

Data on a college sample (n = 198) were used to examine the hypothesized relationship between Rorschach orality and self-reported attachment style. The number of Rorschach Human responses was also examined. High orals were more often classified as insecure than low orals. Within the low-oral group, however, subjects who produced no oral responses were more likely to be classified as insecure than subjects who produced one oral response, 78% versus 35%; p < .005. This implies that there is heterogeneity within the low-oral group. Neither orality nor attachment security was meaningfully related to the number of Human responses provided, but the Human responses provided by insecure (vs. secure) subjects more frequently evidenced themes of struggle. We concluded that (a) there is a subgroup of low orals who are not interpersonally secure but who, instead, are insecure and interpersonally anxious; and (b) unlike the quality of the Human response, the number of Human responses may not reflect preoccupations with themes of dependency, attachment, and interpersonal relatedness.

Journal Article↗
PubMed1992

Parental idealization and the absence of Rorschach oral imagery.

Although the attitudes, behaviors, and pathologies associated with the oral personality have been examined extensively and are well-described (Masling, 1986), the absence of Rorschach oral imagery has not been studied. Based on previous research, we hypothesized that undergraduate subjects who do not provide any oral responses idealize at least one of their parents. This hypothesis was tested by asking subjects to describe their parents (Blatt, Wein, Chevron, & Quilan, 1979). Indeed, subjects who do not report perceiving any Rorschach oral imagery are more likely than subjects who do report oral imagery to engage in parental idealization. The results are discussed in the context of previous research on dependency and attachment.

Journal Article↗
PubMed1991

Subliminal psychodynamic activation, food consumption, and self-confidence.

The subliminal psychodynamic activation (SPA) method was used to study the effects of a message related to loss and separation on the behavior of anaclitic and control subjects in a sample of male college students (N = 148). In the subliminal condition (4 ms exposure time), subjects shown the experimental message "Mommy is Leaving Me" ate significantly fewer crackers than those exposed to the neutral message "Mona is Loaning It" (p = .04). Subjects subliminally exposed to the experimental message reported less confidence in their interpersonal attractiveness than those subliminally shown the neutral stimulus (p = .05). These findings, which support the hypothesis that semantic analyses are performed unconsciously, are discussed in the context of recent research on both the SPA paradigm and the anaclitic personality.

Adult↗