This study suggests that primary care physicians are capable of recognizing suicidal ideation but are less willing to treat it if the patient is older and retired. Future research needs to determine etiologic factors for this age bias.

This study examined the role that hopelessness plays in geriatric suicidal ideation. Sixty institutionalized elderly males were recruited. Multiple regression analyses revealed that while hopelessness was strongly related to suicidal ideation, the relationship between hopelessness and suicidal ideation was dependent on level of depression. Participants who reported moderate or higher levels of depressive symptoms were more likely to have suicidal ideation with increasing hopelessness, whereas hopelessness had little effect on level of ideation at mild or lower depressive symptom levels. Unlike previous studies in younger adults, hopelessness did not predict suicidal ideation better than depressive symptoms, although the relationship between depression and suicidal ideation was stronger within higher levels of hopelessness. These findings highlight the importance of considering depression and hopelessness simultaneously when assessing and treating geriatric suicidal ideation.

Cognitive factors such as perceptions of poor health and negative expectancies toward the future may mediate relationships between health variables, depressive symptoms, and suicidal ideation. In this study of risk factors associated with late life suicidal ideation, thirty older psychiatric inpatients were interviewed using standardized instruments. Self-reported symptoms of hopelessness, perceived health, and depression, as well as number of impaired medical illness systems were examined in relation to presence of suicidal thoughts. Several aspects of a cognitive model of suicide were supported using partial correlation and regression analyses. First, patients who were more depressed and suicidal had more negative cognitions than those who were less depressed and not suicidal. Second, depressive symptoms were strongly related to suicidal thoughts even after controlling for the patients' number of impaired illness systems. Third, cognitive factors versus health factors were shown to influence the relationship between depression and suicidal ideation. These findings emphasize the importance of cognitive biases in geriatric suicidal ideation.

No abstract

As a means of adapting to managed care, the psychiatry department at Wake Forest University developed a managed behavioral health organization (MBHO) to manage the care of enrollees in QualChoice, the health maintenance organization of the Wake Forest University Baptist Medical Center. Before the academic MBHO was created, care was managed by a for-profit MBHO. In this case study, financial and utilization data were obtained from both MBHOs and from QualChoice. The data confirm that the academic MBHO was able to offer competitive rates for its services. It also was able to increase enrollees' use of the medical center's own providers and facilities by making more referrals than were made by the for-profit MBHO. Developing a managed behavioral health organization can allow academic psychiatry departments, either individually or as consortia, to preserve the patient base they require for teaching, research, and financial stability.