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Y Conwell

Publications and source records attributed to Y Conwell.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1995

Older age and the underreporting of depressive symptoms.

OBJECTIVE: To determine whether older age is associated with a decrease in self-reported depressive symptoms, independent of examiner-rated symptoms, in inpatients with major depression. DESIGN: Survey study. SETTING: Inpatient psychiatric units at a university medical center. PATIENTS: Eligible subjects were those over 20 years of age with a primary diagnosis of DSM-III-R major depression. Participation was sought from all subjects over 60 years of age and from every second or every third younger subject, depending on rater availability. Of 137 eligible subjects, 97 completed all study measures. MEASUREMENTS: The Beck Depression Inventory (BDI), as a measure of self-reported depressive symptoms, was the dependent variable. The Hamilton Rating Scale for Depression (Ham-D) was used to assess examiner-rated symptoms. MAIN RESULTS: Older age (P = .03) was associated negatively and examiner-rated depressive symptoms (P = .0001) were associated positively with BDI score. Other variables, including gender, education, age of depression onset, and medical illness burden, were not independently associated with BDI. Examination of depressive symptom subtotals (psychologic/affective vs. somatic/neurovegetative) revealed that only the self-reported psychologic/affective subtotal was significantly associated with age (P = .0018). CONCLUSIONS: Some older patients with clinically significant depression underreport their symptoms. When asking older patients about depressive symptoms, clinicians should view negative responses only within larger clinical contexts and should obtain information from other sources as needed. Similar concerns must temper interpretation of research that relies on subject self-report to study depression in late life.

Age Factors↗
PubMed1994

Adrenal weight and morphology in victims of completed suicide.

Several lines of evidence have implicated hypothalamic-pituitary-adrenal (HPA) axis dysfunction in major depression and suicidal behavior. In the present study, the weight and morphology of postmortem adrenal glands were compared between suicide victims and sudden death, nonpsychiatric controls. The mean adrenal weight of the combined left and right glands was significantly higher in the suicide group; this difference was accounted for specifically by increases in left adrenal weight of suicides compared with the control group. There was a positive correlation between adrenal weight and total cortical thickness in both left and right glands, providing direct evidence that increased adrenal weight in suicide victims is due to cortical hypertrophy. The finding of left-right adrenal weight asymmetry in suicides is consistent with the hypothesis of abnormal lateralized input from higher control centers of the HPA axis.

Adolescent↗
PubMed1994

Physician-assisted suicide: a mental health perspective.

Despite their wealth of relevant clinical and research experience, mental health professionals have contributed relatively little to the active and ongoing debate about physicians assisting in the suicide of their patients. Methodologies developed for the study of completed suicide, the knowledge they have revealed, and the complex questions that remain unanswered, all must be considered. Similarly, psychiatry's extensive contributions to our understanding of the doctor-patient relationship, fundamental to the practice of psychodynamically informed treatments, have been almost completely ignored. Mental health care providers have much to contribute to, and should become actively involved in, this important public health and policy debate.

Attitude to Death↗
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

Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale.

OBJECTIVE: To further validate an objective measure of physical illness burden, the Cumulative Illness Rating Scale (CIRS). DESIGN: Survey with correlation of CIRS ratings made from physician interviews and review of medical records with post-mortem ratings made independently at tissue autopsy. SUBJECTS: Victims of completed suicide investigated by both psychological and tissue autopsy (n = 72). RESULTS: CIRS ratings made by examination of tissue at autopsy were highly predictive of analogous ratings based on historical data, accounting for 75% of the variance in CIRS scores. Taking autopsy findings as the gold standard of objective health assessment, historical ratings tend to underestimate physical illness at high levels of tissue pathology and to overestimate burden at lower levels. CONCLUSIONS: The CIRS score, when derived from all available sources of medical information, is a valid objective measure of physical illness burden and has broad applicability to research in geriatrics.

Adult↗
PubMed1993

Depressive symptoms, medical illness, and functional status in depressed psychiatric inpatients.

OBJECTIVE: There is evidence that both psychiatric (especially affective) and medical illnesses contribute to physical disability. However, the differential contributions of specific psychiatric disorders and of medical pathology to functional status in psychiatric populations have not been studied. The authors therefore examined the contributions of depressive symptoms and medical illness to functional disability in depressed inpatients. METHOD: This prospective investigation included 109 psychiatric inpatients with DSM-III-R major depression. Regression techniques were used to examine the contribution of demographic variables (age, sex, education), depressive symptom severity (Hamilton Rating Scale for Depression score), psychiatric function (Global Assessment of Functioning Scale score), organ system pathology (Cumulative Illness Rating Scale score), and medical disability (Karnofsky Performance Status Scale score) to overall functional status (Instrumental Activities of Daily Living and Physical Self-Maintenance scores). These relationships were also examined in older and younger subgroups. RESULTS: Greater age, female sex, and illness factors all contributed to poorer functional status. Of the illness factors, psychiatric pathology contributed more to low functional status than did medical illness. The predictive power came specifically from the functionally based measures of psychiatric and medical illness; a quantitative measure of symptoms (Hamilton depression scale) or organ pathology (Cumulative Illness Rating Scale) did not significantly predict overall functional status. CONCLUSIONS: Clinicians and researchers should recognize that symptomatic and functional assessments tap related but different domains and that both psychiatric and medical illnesses contribute to overall disability.

Activities of Daily Living↗
PubMed1992

Suicide attempts in elderly psychiatric inpatients.

OBJECTIVE: To describe the psychopathological characteristics of elderly suicide attempters admitted to an inpatient psychiatric unit. DESIGN: Retrospective chart review. PATIENTS: All 168 patients age 60 years and over treated on the adult psychiatric inpatient unit of Yale-New Haven Hospital from 1979 to 1984. Twenty-five made a suicide attempt. MAIN OUTCOME MEASURES: Presence and severity of suicide attempts were rated and compared with demographic, clinical, and functional data. RESULTS: (1) Eighty percent of the attempters had a major depressive syndrome; (2) among patients with affective disorders, presence of an attempt was significantly associated with a later age of onset; (3) patients who had made more severe attempts were more likely to be diagnosed as psychotic depression, although this trend was not significant; (4) substance abuse and dementia were uncommon diagnoses; (5) symptomatic and functional outcome of hospitalization was as favorable for the attempters as for the entire elderly cohort. CONCLUSIONS: Affective illness, especially late-onset major depression, was the major association with suicide attempts.

Affective Disorders, Psychotic↗