Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions

Lutz, Julie; Orden, Kimberly A. Van; Bruce, Martha L.; Conwell, Yeates

doi:10.1016/j.jagp.2021.01.137

Cited by 22 publications

(9 citation statements)

References 108 publications

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“…However, when nurses identified people who would benefit from group activities, or even a particular type of group activities, they encouraged them to participate. Social disconnectedness is associated with a greater risk of late-life suicide ( 45 , 46 ). However, we were able to find only one study that had used increased community participation to minimize social isolation ( 47 ), and these results need to be replicated in other intervention studies.…”

Section: Discussionmentioning

confidence: 99%

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison

Sakashita

Oyama

2022

Front. Public Health

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Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study aimed to examine the effect on suicide rates of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them. We also wished to consider any different effects by sex. A literature search used PubMed and PsycINFO to identify systematic reviews of interventions in this age group. From the reference lists of these articles, we identified controlled studies assessing the impact of a multilayered program on suicide incidence among older adults. We were particularly interested in initiatives linking different kinds of prevention interventions. We found three relevant systematic reviews, and from these, we identified nine eligible studies. These included seven non-randomized controlled studies from rural areas in Japan (average eligible population: 3,087, 59% women, average duration: 8 years). We also found two cohort studies. The first was from a semi-urban area in Padua, Italy (18,600 service users, 84% women, duration: 11 years). The second was from urban Hong Kong, with 351 participants (57% women) over a 2-year follow-up period. We used a narrative synthesis of these studies to identify five different multilayered programs with different forms of connections or linkages between layers. Two studies/programs (Italy and Hong Kong) involved selective and indicated prevention interventions. One study/program (Yuri, Japan) included universal and selective prevention interventions, and the final six studies (two programs in northern Japan) involved linkages between all three layers. We also found that these linkages could be either formal or informal. Formal linkages were professional referrals between levels. Informal linkages included advice from professionals and self-referrals. Several of the studies noted that during the program, the service users developed relationships with services or providers, which may have facilitated movements between levels. All five programs were associated with reduced suicide incidence among women in the target groups or communities. Two programs were also associated with a reduction among men. The study authors speculated that women were more likely to accept services than men, and that the care provided in some studies did less to address issues that are more likely to affect men, such as suicidal impulsivity. We therefore suggest that it is important to build relationships between levels, especially between selective and indicated prevention interventions, but that these can be both formal and informal. Additionally, to reach older men, it may be important to create systematic methods to involve mental health professionals in the indicated prevention intervention. Universal interventions, especially in conjunction with systematically linked indicated and selective interventions, can help to disseminate the benefits across the community.

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Section: Discussionmentioning

confidence: 99%

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison

Sakashita

Oyama

2022

Front. Public Health

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“…Executive dysfunction is a predictor of poor response of depression to pharmacotherapy [ 42 ] and may interfere with problem-solving and the performance of treatment assignments during psychotherapy. Similarly, the study did not assess loneliness, social isolation, bereavement, role transitions, interpersonal conflicts, thwarted belongingness, and other interpersonal factors that had been associated with suicidality [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, two trajectories best described the presence of suicidal ideation during psychotherapy of older adults with major depression. While many predictors of suicidal ideation have been reported [ 43 ], the convergence of machine learning findings identified three potent predictors (hopelessness, neuroticism, and general self-efficacy) that should not be missed in the assessment of depressed older adults starting psychotherapy. Identifying these predictors early can shape the therapists’ strategy by including interventions targeting hopelessness, emotional reactivity related to neuroticism, and low self-efficacy and improve the course of suicidal ideation in depressed older adults.…”

Section: Discussionmentioning

confidence: 99%

Modifiable predictors of suicidal ideation during psychotherapy for late-life major depression. A machine learning approach

et al. 2021

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This study aimed to identify subgroups of depressed older adults with distinct trajectories of suicidal ideation during brief psychotherapy and to detect modifiable predictors of membership to the trajectories of suicidal ideation. Latent growth mixed models were used to identify trajectories of the presence of suicidal ideation in participants to a randomized controlled trial comparing Problem Solving Therapy with “Engage” therapy in older adults with major depression over 9 weeks. Predictors of membership to trajectories of suicidal ideation were identified by the convergence of four machine learning models, i.e., least absolute shrinkage and selection operator logistic regression, random forest, gradient boosting machine, and classification tree. The course of suicidal ideation was best captured by two trajectories, a favorable and an unfavorable trajectory comprising 173 and 76 participants respectively. Members of the favorable trajectory had no suicidal ideation by week 8. In contrast, members of the unfavorable trajectory had a 60% probability of suicidal ideation by treatment end. Convergent findings of the four machine learning models identified hopelessness, neuroticism, and low general self-efficacy as the strongest predictors of membership to the unfavorable trajectory of suicidal ideation during psychotherapy. Assessment of suicide risk should include hopelessness, neuroticism, and general self-efficacy as they are predictors of an unfavorable course of suicidal ideation in depressed older adults receiving psychotherapy. Psychotherapeutic interventions exist for hopelessness, emotional reactivity related to neuroticism, and low self-efficacy, and if used during therapy, may improve the course of suicidal ideation.

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“…An area of particular significance when it comes to prevention efforts for older adults is suicide prevention. Among some older adults, social disconnection and suicide are significant public health concerns (Lutz et al, 2021). Specifically, transitions in care, such as admission to a nursing home, can be a time of heightened risk for suicidal ideation (e.g., Temkin-Greener et al, 2020).…”

Section: Prevention and Health Promotionmentioning

confidence: 99%

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

Lind¹,

Poon²,

Birdsall³

2022

Clinical Psychology: Science and Practice

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To address the shortage in geriatric behavioral health professionals, it is crucial for more psychologists to become competent in working with older adults. This article will provide an overview of foundational geropsychology knowledge regarding intervention, consultation, and related services. We will begin by reviewing general and specialized psychological interventions with older adults, as well as adaptations based on aging-related changes and diverse care settings. Next, we will review health and medical factors that can impact service delivery. We will highlight characteristics of different treatment settings and interdisciplinary collaboration in providing consultation services, as well as services such as health promotion and illness prevention. We will summarize administrative best practices when psychologists work with older clients, including documentation of medical necessity for psychological services, billing, and reimbursement procedures compliant with state and federal laws and regulations. Finally, we will end with a discussion of ethical and legal considerations such as informed consent, confidentiality, substitute or end-of-life decision-making and potential conflicts of interest, diminished capacities, and elder abuse and neglect. Public Health Significance StatementGiven the growing population of older adults aged 65 and older, there is a need for psychologists who are competent to provide psychological services to older adults. Psychologists who find themselves working with older adults are encouraged to enhance their knowledge and competencies specific to diverse older adult populations and treatment settings to ensure high quality care of older clients. The authors hope that information provided within this article will serve as a guide to providing foundational knowledge competencies related to providing interventions and consultation services with older adult clients.

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Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions

Cited by 22 publications

References 108 publications

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison

Modifiable predictors of suicidal ideation during psychotherapy for late-life major depression. A machine learning approach

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

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