Passive Suicide Ideation: An Indicator of Risk Among Older Adults Seeking Aging Services?: Table 1.

Orden, Kimberly A. Van; O'Riley, Alisa; Simning, Adam; Podgorski, Carol; Richardson, T.; Conwell, Yeates

doi:10.1093/geront/gnu026

Cited by 59 publications

(41 citation statements)

References 29 publications

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“…Using a sample of older adults with elevated levels of social and functional impairment, we sought to examine if there might be a group of older adults who responded to the stresses of aging, including functional impairment, with passive suicide ideation, who were not necessarily at risk for suicide (as evidenced by a lack of active suicide ideation and a lack of depression and anxiety). Our results were largely inconsistent with the assumption that passive suicide ideation reflects normative developmental processes (i.e., coming to term with aging) because the vast majority of those who endorsed thinking life was not worth living and wishing for their death also endorsed active suicide ideation (either recently or in the past year) and/or significant depression/anxiety (Van Orden et al, 2014a). However, there was a small minority of our sample (3%) who endorsed thoughts that life was not worth living in the absence of desire for death and suicide.…”

Section: Thoughts Of Death In Later Lifecontrasting

confidence: 99%

Issues in research on aging and suicide

Orden

Conwell

2015

Aging & Mental Health

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Late-life suicide is a complex clinical and public health problem. In this article, some of the key complexities inherent in studying late-life suicide are discussed in the service of promoting high quality late-life suicide prevention science. We discuss the following research issues: the relatively greater lethality of suicidal behavior in later life (compared to younger ages); the lack of data on whether thoughts of death in later life are indicators of suicide risk; the fact that older adults do not tend to seek specialty mental health care, necessitating moving research into primary care clinics and the community; the lack of theory-based research in late-life suicide; the unclear role of cognitive impairment; and the promise of taking a “patient centered” and “participatory research” approach to late-life suicide research efforts. We believe that these perspectives are too often not capitalized upon in research on suicide prevention with older adults and that voice of the older person could contribute much to our understanding of why older adults think about and act on suicidal thoughts, as well as the most acceptable ways to reach and intervene with those at risk.

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Section: Thoughts Of Death In Later Lifecontrasting

confidence: 99%

Issues in research on aging and suicide

Orden

Conwell

2015

Aging & Mental Health

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“…It is well known that 90% of older people who take their lives suffered from a psychiatric disorder[6] with depressive disorders being the most common psychiatric diagnoses of elderly suicide victims[7]. Furthermore, late life suicidal ideation is a risk factor for suicide [4, 8, 9], and executive dysfunction[10, 11], in particular impulsivity [12-14], and impairments in risk-sensitive decision making[14, 15] are associated with greater suicidal ideation in older adults. Given that these deficits in executive function (ED) are common in depressed older adults[16] and is related to suicidal ideation[11, 17], identifying older adults with depression and ED and providing them with interventions that target executive deficits may be one way to correct the trends in death by suicide in those over the age of 65.…”

Section: Introductionmentioning

confidence: 99%

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

Gustavson

Alexopoulos

Niu

et al. 2016

The American Journal of Geriatric Psychiatry

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Objective To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, gender and additional cognitive impairment load (eg: memory impairments) were related to changes in suicidal ideation over time. Design Secondary data analysis using data from a randomized clinical trial allocating participants to PST or ST at 1:1 ratio. Raters were blind to patients' assignments. Setting University medical centers. Participants 221 people aged 65 years old and older with major depression determined by SCID diagnosis and executive dysfunction as defined by a score of 33 or less on the Initiation-Perseveration Score of the Mattis Dementia Rating Scale or Stroop Interference Task score of 25 or less. Interventions 12 weekly sessions of Problem Solving Therapy or Supportive Therapy. Main Outcome Measures The suicide item of the Hamilton Depression Rating Scale (HDRS). Results Of the 221 participants, 61% reported suicidal ideation (SI). The ST group had a lower rate of improvement in SI after 12 weeks (44.6%) than did the PST group (60.4%, Fisher's exact test p = 0.031). Logistic regression showed significantly greater reductions in SI in elders who received PST at both 12 weeks (OR = .50, Z=-2.16, p = 0.031) and 36 weeks (OR=0.5, Z=-1.96, p=0.05) after treatment. Conclusion PST is a promising intervention for older adults who are at risk for suicide.

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“…This study found that differences in suicidal ideation between intervention and usual care participants grew gradually over a year, controlling for level of baseline depression. This finding is particularly notable given the high-risk sample of home health patients with substantial psychological and medical burden, among whom suicidal ideation may be a persistent symptom (Raue et al , 2007; Van Orden et al , 2014). Indeed, 94% of participants with suicidal ideation had major or minor depression and over half of participants were taking anti-depressant medications at baseline, suggesting that comprehensive intervention, incorporating pharmacologic and psychosocial approaches, might be more effective at addressing suicidality than pharmacologic intervention alone.…”

Section: Discussionmentioning

confidence: 99%

“…Suicidal ideation (SI) is a key risk factor for suicide and represents a clinically relevant, non-normative sign of distress arising from physical, psychiatric, and/or social factors (Szanto, 1996; Van Orden et al , 2014). The prevalence of major depression among Medicare HHC patients (13.5%) is nearly twice that of older adults receiving primary care services (Bruce et al , 2002).…”

Section: Introductionmentioning

confidence: 99%

Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial

Lohman

Raue

Greenberg

et al. 2015

Int J Geriat Psychiatry

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Objectives The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. Methods Data come from the cluster-randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12 months follow-up. Suicidal ideation was measured using the Hamilton Rating Scale for Depression (HAM-D) item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed-effects models. Results A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (OR=0.51, 95% CI; 0.24-1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. Conclusion SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long-term reduction in SI among high-risk patients.

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Passive Suicide Ideation: An Indicator of Risk Among Older Adults Seeking Aging Services?: Table 1.

Cited by 59 publications

References 29 publications

Issues in research on aging and suicide

Issues in research on aging and suicide

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial

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