Biomedical subjects

Y Conwell

Publications and source records attributed to Y Conwell.

At least 37 records · Page 2Linked to original sources

PubMed2000

Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older.

Completed suicide may be the most preventable lethal complication of depressive disorders in older adults. Identification of risk factors for suicidal behavior has therefore become a major public health priority. Using data collected on 81 depressed patients 50 years of age and older, we report analyses designed to determine the associations between the personality traits that constitute the Five Factor Model of personality and measures of suicidal behavior and ideation. We hypothesized that low Extraversion would be associated with a lifetime history of attempted suicide, and high Neuroticism would be associated with suicidal ideation. Results were generally consistent with the hypotheses. We also observed a relationship between Openness to Experience and suicidal ideation. These findings suggest that longstanding patterns of behaving, thinking, and feeling contribute to suicidal behavior and thoughts in older adults and highlight the need to consider personality traits in crafting and targeting prevention strategies.

Adult↗

PubMed2000

The effect of participation in religious activities on suicide versus natural death in adults 50 and older.

This study tests the hypothesis that older persons dying by suicide, compared with natural death, are less likely to have participated in religious activities. Data from the 1993 National Mortality Followback Survey were used to compare the frequency of participation in religious activities of 584 suicides to those of 4279 natural deaths occurring among women and men ages 50 and older. Adjusting for sex, race, marital status, age, and frequency of social contact, the odds for having never participated in religious activities are greater among suicide victims, compared with natural deaths. Participation in religious activities does appear to reduce the odds of the occurrence of suicide. This effect remains even after controlling for the frequency of social contact. The identification of specific factors contributing to this intrinsic benefit of religious participation requires further investigation.

Age Factors↗

PubMed2000

Completed suicide among older patients in primary care practices: a controlled study.

OBJECTIVE: To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not. DESIGN: A case-control study using data collected by psychological autopsies of suicides and prospective patient interviews for controls. SETTING: Primary care practices in Monroe County, NY. PARTICIPANTS: Forty-two suicides aged 60 years and older who visited a primary care provider within 30 days of death and 196 patients aged 60 years and older from a group practice of general internal medicine (n = 115) or family medicine (n = 81). MEASUREMENTS: Psychiatric diagnosis; depressive symptom severity; physical health and function; psychiatric treatment history. RESULTS: Completed suicides had more depressive illness (P = .001), physical illness burden (P = .0002), and functional limitations (P = .0001) than controls and were more likely to be prescribed antidepressants (P = .004), anxiolytic agents (P = .0001), and narcotic analgesics (P = .022). Among depressed subjects, affective symptom severity (P< .0001) and emotional dysfunction (P<.0001) distinguished suicide completers. However, physical health, overall function, and treatments received did not differ between groups. CONCLUSIONS: The primary care setting is an important venue for late life suicide prevention. Primary care providers should be well prepared to diagnose and treat depression in their older patients. Additional research is needed concerning the interactions of physical health, functional status, and depressive symptoms in determining suicide risk.

Activities of Daily Living↗

PubMed2000

Cerebrovascular risk factors and 1-year depression outcome in older primary care patients.

OBJECTIVE: A model in which cerebrovascular disease contributes to the pathogenesis of depression in later life was the basis of the authors' hypothesis that cerebrovascular risk factors at intake are independently associated with depression at 1-year follow-up. METHOD: The subjects were 247 patients aged 60 years or older in primary care practices. The study measures were completed at intake and 1-year follow-up. Multiple regression techniques were used to determine the independent association of initial cerebrovascular risk factors with depressive symptoms and diagnoses at 1 year. RESULTS: The authors found that the severity of initial cumulative cerebrovascular risk factors was significantly independently associated with 1-year depressive symptoms and diagnoses, but not after also controlling for overall medical burden. CONCLUSIONS: The results lend some support to the cerebrovascular model of depression.

Age Factors↗

PubMed2000

A neuropsychological comparison of depressed suicide attempters and nonattempters.

The neuropsychological performance of 18 older inpatients with major depression who were admitted following a suicide attempt was compared with that of 29 older depressed inpatients who had never attempted suicide. There was an interactive effect of age and group on the Trail Making Test, part B, such that attempters showed greater performance declines with age. No other differences were detected between groups on a range of neuropsychological tasks. These findings are discussed in the context of the methodological limitations of previous studies and the need for future research to better elucidate the nature of the relationships between age, cognitive functioning, and suicidal behavior.

Age Factors↗

PubMed2000

Method choice, intent, and gender in completed suicide.

Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.

Adult↗

PubMed2000

Domestic violence, separation, and suicide in young men with early onset alcoholism: reanalyses of Murphy's data.

Partner violence and partner separation at the time of completed suicide were investigated in 42 male alcoholics originally described by Murphy (1992). Half of the men had domestic violence histories. Partner-violent men were younger, had an earlier age of onset of alcoholism, and were more likely to be separated from their partner at the time of death than partner-nonviolent men. Loss of a close personal relationship, often a domestic partner, is common during the last year of life among alcoholic men completing suicide. Domestic violence appears to typify many of their domestic relationships, particularly among younger men and men with early onset alcoholism.

Age of Onset↗

PubMed2000

Family matters: a social system perspective on physician-assisted suicide and the older adult.

Physician-assisted suicide is one of the most controversial issues facing health care providers today, provoking contentious debate that spans medical, psychological, legal, religious, and moral realms. Despite the wealth of theories and opinions proffered, most of this work focuses on concepts of individual competence and autonomy, with little or no attention paid to the dynamics of family or other psychosocial systems likely to affect an individual's decision to ask for assistance in ending his or her life. Moreover, concepts such as "autonomy" typically are examined from a legal perspective without consideration of the late-life developmental themes confronting older adults and their families, that is, the stages of life cycle transition and the predictable family stresses that typically accompany serious illness.

Aged↗

PubMed1999

Age-related patterns of factors associated with completed suicide in men with alcohol dependence.

Seven factors associated with completed suicide among male alcoholics were investigated to determine if victims of differing ages would show different patterns of factors. Data on 56 male alcoholic suicide victims were collected post-mortem. Subjects were divided into three age groups: 21-34, 35-49, and > or = 50 years. Consistent with the hypotheses, unemployment and recent loss due to separation from a domestic partner were more likely with younger age, and serious medical problems and mood disorders were associated with increased age. There were no differences on other presumed risk factors among the age groups. Results suggest that factors associated with suicide may cluster in male alcoholics of differing ages, with implications for risk recognition and intervention.

Adult↗

PubMed1999

Studies of suicide in later life: methodologic considerations and research directions.

Later-life suicide is a tragedy that occurs worldwide. Often it is preventable. Here, the authors summarize an international workshop where they review four research approaches to studying putative risk factors: epidemiologic studies of suicidal behaviors, clinic-based follow-up studies, studies of suicide attempters, and psychological autopsy studies. They provide brief descriptions of the approaches, examples of questions best addressed by each approach, and their weaknesses and limitations; they also recommend promising areas for future research and propose opportunities for research that could be conducted cross-nationally.

Aged↗

PubMed1999

Cerebrovascular risk factors and depression in older primary care patients: testing a vascular brain disease model of depression.

The authors examined whether cerebrovascular risk factors (CVRFs) are associated with depressive diagnoses and symptoms in 303 primary-care patients age >/=60 years, as would be consistent with a small-vessel brain disease model of later-life depression. CVRFs were not significantly independently associated with major, minor, or subsyndromal depression, late-onset major depression, or overall depressive symptom severity. These data did not support the notion that a small-vessel brain disease model of depression might apply to the majority of older persons with depressive symptoms and syndromes in primary-care settings. Future work should include longitudinal study with larger sample sizes.

Aged↗

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

Reasons for living in a clinical sample of adolescents.

The psychometric properties and validity of the Reasons for Living (RFL) Inventory were examined in a sample of psychiatrically hospitalized adolescents (n = 253), aged 13 to 18 years, identified as suicide ideators, suicide attempters, and psychiatric controls. Confirmatory factor analysis suggested that the original RFL factors did not provide a good fit; exploratory factor analysis identified five factors, of which three were identical with the original RFL factors. Factor scores differentiated suicidal from non-suicidal adolescents and attempters from ideators. Correlational analyses indicated that RFL factors were associated with suicidal ideation, depression, and hopelessness, and predicted unique variance in suicidal ideation over that accounted for by depression and hopelessness. Our findings provide support for the RFL as a sound measure for clinical and research assessment in adolescents.

Adolescent↗

PubMed1998

Quantitative and qualitative differences in the verbal learning performance of elderly depressives and healthy controls.

We compared the verbal learning and memory performance of 57 inpatients with unipolar major depression and 30 nondepressed control participants using the California Verbal Learning Test. The effect of age within this elderly sample was also examined, controlling for sex, educational attainment, and estimated level of intelligence. Except for verbal retention, the depressive had deficits in most aspects of performance, including cued and uncued recall and delayed recognition memory. As well, there were interactions between depression effects and age effects on some measures such that depressives' performance declined more rapidly with age than did the performance of controls. The results are discussed in the context of recent contradictory reports about the integrity of learning and memory functions in late-life depression. We conclude that there is consistent evidence, from this and other studies, that elderly depressed inpatients have significant deficits in a range of explicit verbal learning functions.

Adolescent↗

PubMed1998

High levels of hopelessness persist in geriatric patients with remitted depression and a history of attempted suicide.

OBJECTIVE: To determine whether a high level of hopelessness after treatment of a depressive episode is an indicator of a history of lifetime suicide attempts in older people. DESIGN: Groups of suicide attempters, suicidal ideators, and nonsuicidal patients were compared via analysis of variance with respect to levels of hopelessness, depression, anxiety, and global functioning before and after treatment of depression. SETTING: An outpatient research clinic providing two treatment protocols of late-life mood disorders. PARTICIPANTS: A total of 107 consecutive outpatients (mean age 67) with major depression who responded to treatment. MEASUREMENTS: Levels of hopelessness, severity of depression, anxiety, and global functioning were compared across the three groups at the beginning of treatment and at remission. RESULTS: After remission there were no differences between the three groups in depression severity, anxiety, and global functioning. Hopelessness remained significantly higher in the attempter group than among ideators or nonsuicidal patients. CONCLUSIONS: Suicide attempts, the most important risk factor for subsequent suicide, are associated with persistent, high levels of hopelessness following remission of depression in late-life patients. These findings suggest that treatments designed specifically to lower hopelessness (such as cognitive, behavioral or interpersonal therapy) may be effective in reducing suicide risk.

Aged↗

PubMed1998

Cerebrovascular risk factors and later-life major depression. Testing a small-vessel brain disease model.

The topic of vascular depression has received increasing prominence as a putative etiology of depression in later life. The authors examined one aspect of this model by comparing the burden of systemic cerebrovascular risk factors (CVRFs) in 130 psychiatric inpatients with major depression and 64 normal control (NC) subjects, all age > or = 50 years. Depressed subjects did not differ statistically from NCs on cumulative CVRF scores. Diabetes mellitus and atrial fibrillation were both associated with depression, but only atrial fibrillation retained an independent association after medical disability was statistically controlled. Among the depressed subjects, CVRF scores were not significantly associated with overall symptom severity, psychiatric disability, age at onset of depression, melancholic subtype, or psychotic depression. These data did not support the notion that a linear model of small-vessel disease might apply to the great majority of older inpatients with major depression.

Aged↗

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↗