Older adults have the highest risk of death by suicide in the United States. Improving our understanding of the factors that lead to increased risk of suicide in older adults will greatly inform our ability to prevent suicide in this high-risk group. Two studies were conducted to test the effect of perceived burdensomeness, a component of the interpersonal-psychological theory of suicide (Joiner, 2005), on suicide ideation in older adults. Further, gender was examined as a moderator of this association to determine if perceived burdensomeness exerted a greater influence on suicide ideation in males. The results of these studies suggest that perceived burdensomeness accounts for significant variance in suicide ideation, even after predictors such as depressive symptoms, hopelessness, and functional impairment are controlled. Gender did not moderate the association. The implications of these findings for treatment of older adults with suicide ideation and elevated suicide risk are discussed.
"The acquired capability for lethal self-injury is hypothesised to develop through exposure and thus habituation to painful and/or fearsome experiences, and is posited by the theory to be necessary to overcome powerful internal self-preservation pressures (Joiner et al., 2009) (see Fig. 1). The predictions of the Interpersonal- Psychological Theory have been tested in an adult sample (Joiner et al., 2009), and by several other population-based and clinical research studies (Van Orden et al., 2008; Cukrowicz et al., 2011; You et al., 2011). "
[Show abstract][Hide abstract] ABSTRACT: The Interpersonal-Psychological Theory of Suicide (IPTS) has been supported by recent research. However, the nature of the models׳ three major constructs - perceived burdensomeness, thwarted belongingness and acquired capability - requires further investigation. In this paper, we test a number of hypotheses about the predictors and correlates of the IPTS constructs. Participants aged 32-38 from an Australian population-based longitudinal cohort study (n=1167) were assessed. IPTS constructs were measured by items from the Interpersonal Needs Questionnaire (INQ) and Acquired Capability for Suicide Scale (ACSS), alongside demographic and additional measures, measured concurrently or approximately 8 years earlier. Cross-sectional analyses evaluating the IPTS supported earlier work. Mental health was significantly related to all three IPTS constructs, but depression and anxiety caseness were associated only with perceived burdensomeness. Various social support measures were differentially associated with the three constructs. Stressful events and lifetime traumas had robust independent associations with acquired capability for suicide only. The IPTS model provides a useful framework for conceptualising suicide risk. The findings highlight the importance of perceived social support in suicide risk, identify the importance of personality and other factors as new avenues of research, and provide some validation for the independence of the constructs.
Psychiatry Research 05/2014; 219(2). DOI:10.1016/j.psychres.2014.05.029 · 2.47 Impact Factor
"We are unsure as to why the elevation in risk was restricted to adults aged below 60 years of age. 'Perceived burdensomeness' has been proposed as an important contributing factor for suicidal behaviour among older age people in general . Although we found no evidence of higher risk of self-harm in elderly men or women diagnosed with the assessed physical illnesses, it may be that the same mechanism impacts strongly among people who experience major physical disorders and associated disability at a premature age. "
[Show abstract][Hide abstract] ABSTRACT: To examine self-harm risk across the adult age range in patients diagnosed with various physical illnesses using the General Practice Research Database - a broadly representative sample of all people registered with a family practice in the United Kingdom.
We conducted a large nested case-control study sampled from the whole primary care cohort. During 2001-2008 we studied 2306 cases of self-harm and 46,120 age and gender-matched controls without such an episode recorded. Relative risks were estimated against reference patients with none of the examined physical illnesses. Additionally, we assessed confounding by recorded depression, effect modification by gender and multi-morbidity effects.
Risk was significantly elevated in relation to any of the physical illnesses (male OR 1.35, 95% CI 1.18-1.54; female OR 1.62, 95% CI 1.40-1.86). For both genders combined, risk was raised with each specific illness. Effects sizes were consistently larger in women. Adjustment for recorded depression explained much of the elevated risk, but not so in women with asthma, back pain, diabetes, epilepsy or hypertension. Raised risk was seen in younger adults and during middle age, but not among older people. There was a dose-response relationship with increasing number of physical illnesses, and in women this was independent of depression.
Heightened risk was seen with a variety of physical illnesses. The findings indicate a need for tackling psychological distress and reducing self-harm risk in physically ill patients who attend primary healthcare services for non-psychiatric reasons, particularly so for women and younger and middle aged adults.
Journal of psychosomatic research 08/2012; 73(2):92-7. DOI:10.1016/j.jpsychores.2012.05.010 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine the relation between functional impairment, self-rated health, and depressive symptoms. Independently, self-rated health and functional impairment each contribute to depressive symptoms; however, it remains unknown how these variables are related to depression in combination. It was hypothesized that self-rated health would moderate the relation between functional impairment and depressive symptoms in a sample of older adults.
A community sample of adults aged 60 and above was recruited from primary care clinics (n = 106); 98 of these participants had usable data. Participants completed self-report questionnaires that assessed depressive symptoms, functional impairment, and self-rated physical health.
Self-rated health moderated the relation between functional impairment and depressive symptoms. For participants with poor self-rated health, greater functional impairment was associated with greater depressive symptoms.
It appears that patient perceptions of health may be protective against depressive symptoms for those with functional impairment.
Aging and Mental Health 07/2011; 16(3):281-7. DOI:10.1080/13607863.2011.598847 · 1.75 Impact Factor
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