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Y Conwell

Publications and source records attributed to Y Conwell.

At least 55 records · Page 3Linked to original sources
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.

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PubMed1997

Diagnosis and treatment of depression in late life. Consensus statement update.

OBJECTIVE: To reexamine the conclusions of the 1991 National Institutes of Health Consensus Panel on Diagnosis and Treatment of Depression in Late Life in light of current scientific evidence. PARTICIPANTS: Participants included National Institutes of Health staff and experts drawn from the Planning Committee and presenters of the 1991 Consensus Development Conference. EVIDENCE: Participants summarized relevant data from the world scientific literature on the original questions posed for the conference. PROCESS: Participants reviewed the original consensus statement and identified areas for update. The list of issues was circulated to all participants and amended to reflect group agreement. Selected participants prepared first drafts of the consensus update for each issue. All drafts were read by all participants and were amended and edited to reflect group consensus. CONCLUSIONS: The review concluded that, although the initial consensus statement still holds, there is important new information in a number of areas. These areas include the onset and course of late-life depression; comorbidity and disability; sex and hormonal issues; newer medications, psychotherapies, and approaches to long-term treatment; impact of depression on health services and health care resource use; late-life depression as a risk factor for suicide; and the importance of the heterogeneous forms of depression. Depression in older people remains a significant public health problem. The burden of unrecognized or inadequately treated depression is substantial. Efficacious treatments are available. Aggressive approaches to recognition, diagnosis, and treatment are warranted to minimize suffering, improve overall functioning and quality of life, and limit inappropriate use of health care resources.

Age Factors↗
PubMed1997

Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale.

BACKGROUND: Later-life depressive disorders are a major public health problem in primary care settings. A validated screening instrument might aid in the recognition of depression. However, available findings from younger patients may not generalize to older persons, and existing studies of screening instruments in older patient samples have suffered substantial methodological limitations. METHODS: One hundred thirty patients 60 years or older attending 3 primary care internists' practices participated in the study. Two screening scales were used: the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Geriatric Depression Scale (GDS). The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Third Edition, Revised, was used to establish "gold standard" diagnoses including major and minor depressive disorders. Receiver operating curve analysis was used to determine each scale's operating characteristics. RESULTS: Both the CES-D and the GDS had excellent properties in screening for major depression. The optimum cutoff point for the CES-D was 21, yielding a sensitivity of 92% and a specificity of 87%. The optimum cutoff point for the GDS was 10, yielding a sensitivity of 100% and a specificity of 84%. A shorter version of the GDS had a sensitivity of 92% and a specificity of 81% using a cutoff point of 5. All scales lost accuracy when used to detect minor depression or the presence of any depressive diagnosis. CONCLUSIONS: The CES-D and the GDS have excellent properties for use as screening instruments for major depression in older primary care patients. Because the GDS's yes or no format may ease administration, primary care clinicians should consider its routine use in their practices.

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PubMed1997

Late-life suicide and depression in the primary care setting.

Late-life depression and suicidal behavior in the primary care setting is a significant public health concern. The prevalence of depression in this population is substantial, yet rates of detection and treatment are far from adequate. Untreated depression has significant consequences with regard to morbidity and mortality. Although suicide is a relatively low-base-rate behavior, a substantial proportion of late-life suicides have contact with their primary care provider prior to their death; thus this offers an avenue for suicide prevention. There is a growing knowledge base concerning what constitutes barriers to the recognition and treatment of late-life depression as well as what constitutes useful screening tools and treatments for the depressed elderly. Important new findings with regard to the functional effects of subsyndromal depression, possible subtypes of late-life depression, the clinical utility of SSRIs and psychotherapeutic interventions, and innovative and collaborative models of care hold promise for advancing the science and practice of treating late-life depression.

Age Factors↗
PubMed1997

Ruminative thinking in older inpatients with major depression.

Ruminative thinking, the tendency to dwell on particular ideas or themes, can be a prominent part of the phenomenology of major depression, but it rarely has been the focus of empirical research. We attempted to replicate (in adult psychiatric inpatients age > or = 50 years with DSM-III-R major depression) the previously published finding that ruminative thinking was associated with melancholia and with psychosis. In our sample, these associations were not present. In addition, we explored the relationships of ruminative thinking to specific areas of thought content (e.g., suicidal ideation, somatic worry), cognitive function and overall functional status; ruminative thinking was not associated with suicidal ideation, but was associated with greater somatic worry and with poorer functional status, although these associations were not independent of overall depressive severity. A substantial proportion of subjects were unable to complete the cognitive measures; ruminative thinking was independently associated with inability to complete these tasks. We conclude that ruminative thinking is a meaningful and common clinical phenomenon among severely depressed older inpatients. Further investigations in inpatients and other populations examining its relationships to other phenomenology, to course and outcome, and to putative underlying mechanisms of depression are warranted.

Adult↗
PubMed1997

Management of suicidal behavior in the elderly.

Suicidal behavior in older people is more often lethal than in any other age group. Social isolation, losses and physical illness, a past history of suicide attempts, and psychiatric illness are risk factors with implications for prevention of late life suicide. Preliminary indications are that community outreach to elders at risk and educational programs for primary care providers on the identification and treatment of late life depression are effective at lowering suicide rates.

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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

Age of onset and medical illness in older depressed inpatients.

Age of onset of depressive episodes may serve as a useful marker of pathogenetic heterogeneity in late-life depression. Medical illness may play an important role in the pathogenesis of depression in the elderly, but its relationship to age of onset has not been carefully examined. We prospectively studied 110 older inpatients with DSM-III-R major depression. Using multiple regression techniques, we found that medical illness was not independently associated with age of onset. Independent predictors of older age of onset were age, male sex, absence of substance abuse history, and absence of melancholia. Our discussion reconsiders the usefulness of age of onset as a primary research variable for elucidating heterogeneity in late-life depression.

Activities of Daily Living↗
PubMed1995

Suicide and aging. I: Patterns of psychiatric diagnosis.

Rates of suicide differ markedly as a function of age and gender. In a great majority of countries that report suicide statistics, rates are higher in the elderly than in younger age groups. Few data are available to determine whether this age-related pattern of rates is reflected in a differential prevalence of other factors known to be associated with increased suicide risk. Using the psychological autopsy method, researchers have established the distribution of psychiatric diagnoses in samples of adolescents, young adults, and elders who have committed suicide, and in victims across the life course in community-based populations. Review of those studies reveals that affective disorders, substance use disorders, and their comorbidity are common in completed suicides of all ages. Although methodologic issues and cohort and period effects limit the conclusions that can be drawn, comparison by age within and between studies further suggests that depressive illness is more common and substance abuse less prevalent in later-life victims. That the aging process itself (biological, psychological, and social) may account for the observed pattern has important implications for further research and the design of intervention strategies. There is a need for more coordinated and comprehensive study of psychopathological correlates of suicide across the life course in a broad range of cultures.

Adult↗
PubMed1995

Suicide and aging. II: The psychobiological interface.

There is an accumulating body of research suggesting that suicidal behavior may be associated with abnormalities of the central serotonin system. Other monoaminergic, peptidergic, and neuroendocrine systems have been implicated as well. A review of studies that examine neurobiological variables in postmortem tissue of suicide victims and controls reveals that investigators in most instances have viewed age as a confound to be controlled rather than considering it as a variable of interest. However, the close associations between aging and increased suicide rates, and the knowledge that the functional integrity of many of these same systems changes with normal and abnormal aging processes, raise the possibility that biological aging contributes to suicide risk, and that the underlying neurobiology of suicide in the elderly differs from that of younger people. The few available studies that did examine the association of age with neurobiological measures indicate directions for future research into the role that aging may play in determining the biological bases of suicide risk.

Adolescent↗
PubMed1995

Dementia.

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PubMed1995

Nutrition.

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Adult↗
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.

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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.

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