[Show abstract][Hide abstract] ABSTRACT: Objectives: To investigate the roles of Reasons for Living (RFL) and Meaning in Life (MIL) in potentially promoting mental health and well-being and protecting against suicide ideation among community-residing older adults and to investigate the psychometric properties of the Reasons for Living Scale-Older Adult Version (RFL-OA).
Method: Of 173 older adults initially recruited into a longitudinal study on late-life suicide ideation, 109 completed the RFL-OA and measures of cognitive and physical functioning and positive and negative psychological factors at a two-year follow-up assessment. We tested a model in which RFL and MIL protect against suicide ideation, controlling for demographic and clinical factors. We also assessed the psychometric properties of the RFL-OA in community-residing older adults, investigating its internal consistency and its convergent (MIL, perceived social support, and life satisfaction), divergent (loneliness, depressive symptom severity, and suicide ideation), and discriminant validity (cognitive and physical functioning).
Results: RFL-OA scores explained significant variance in suicide ideation, controlling for age, sex, depressive symptom severity, and loneliness. MIL explained significant unique variance in suicide ideation, controlling for these factors and RFL, and MIL significantly mediated the association between RFL and suicide ideation. Psychometric analyses indicated strong internal consistency (α=.94), convergent, divergent, and discriminant validity for the RFL-OA relative to positive and negative psychological factors and cognitive and physical functioning.
Conclusion: These findings add to a growing body of literature suggesting merit in investigating positive psychological factors together with negative factors when assessing suicide risk and planning psychological services for older adults.
Aging and Mental Health 08/2015; DOI:10.1080/13607863.2015.1078279 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults.
We recruited 173 voluntary participants, 65 years and older, into a 2+ year longitudinal study of the onset or exacerbation of depressive symptoms and suicide ideation. We assessed the internal consistency of the GSIS and its four component subscales, and its shorter and longer duration test-retest reliability, convergent (depression, social hopelessness, and loneliness), divergent (psychological well-being, life satisfaction, perceived social support, and self-rated health), discriminant (basic and instrumental activities of daily living and social desirability), criterion (history of suicide behavior), and predictive validity (future suicide ideation).
The GSIS demonstrated strong test-retest reliability and internal consistency. Baseline GSIS scores were significantly positively associated with suicide risk factors, negatively associated with potential resiliency factors, and not associated with functional impairment or social desirability. GSIS scores significantly differentiated between participants with as compared to those without a history of suicide behavior. Baseline GSIS scores significantly predicted suicide ideation at a 2+ year follow-up assessment.
Findings suggest strong measurement characteristics for the GSIS with community-residing older adults, including impressive consistency over time. These results are consistent with research attesting to the empirical and pragmatic strengths of this measure. These findings have implications for the monitoring of suicide risk when aiming to enhance mental health and well-being and prevent suicide in later life.
Aging and Mental Health 08/2015; DOI:10.1080/13607863.2015.1072798 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although perfectionism is recognized as a factor that is linked with suicide, we maintain that the role of perfectionism as an amplifier of the risk of suicide has been underestimated due to several factors. In the current article, contemporary research on the role of perfectionism in suicide is reviewed and summarized. Several themes are addressed, including: (a) consistent evidence linking suicide ideation with chronic exposure to external pressures to be perfect (i.e., socially prescribed perfectionism); (b) the roles of perfectionistic self-presentation and self-concealment in suicides that occur without warning; and (c) how perfectionism contributes to lethal suicide behaviors. We also summarize data showing consistent links between perfectionism and hopelessness and discuss the need for a person-centered approach that recognizes the heightened risk for perfectionists who also tend to experience hopelessness, psychache, life stress, overgeneralization, and a form of emotional perfectionism that restricts the willingness to disclose suicidal urges and intentions. It is concluded that when formulating clinical guidelines for suicide risk assessment and intervention and public health approaches to suicide prevention, there is an urgent need for an expanded conceptualization of perfectionism as an individual and societal risk factor. We also discuss why it is essential to design preventive programs tailored to key personality features with specific components that should enhance resilience and reduce levels of risk among perfectionists who hide behind a mask of apparent invulnerability.
Review of General Psychology 09/2014; 18(3):156-172. DOI:10.1037/gpr0000011 · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neuroticism and extraversion are potentially important markers of personality vulnerability to suicide. Whereas previous studies have examined these traits independently, we examined their combined effects. Data were collected from family members and/or friends of individuals 18 years or older who died by suicide (n = 64) in rural China and from age-, sex-, and geographically matched controls (n = 64). Personality was assessed with the NEO-Five Factor Inventory. Individuals with a personality style characterized by high neuroticism and low extraversion were at 3.07 (95% confidence interval [CI], 1.44-6.55) times greater risk for suicide than were individuals without this personality style; in contrast, a style characterized by low neuroticism and high extraversion conferred decreased suicide risk (odds ratio, 0.41; 95% CI, 1.44-6.55). We conclude that it may be clinically inadequate to conceptualize neuroticism, by itself, as a risk marker for suicide. However, when the negative affect characteristic of neuroticism is combined with the joylessness, pessimism, and hopelessness characteristic of low extraversion, risk for suicide is elevated.
The Journal of nervous and mental disease 07/2012; 200(7):598-602. DOI:10.1097/NMD.0b013e31825bfb53 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate whether living alone is significantly associated with expression of suicide ideation among mood-disordered mental health patients and whether degree of family connectedness moderates the association between living alone and expression of suicide ideation.
Cross-sectional survey design.
Inpatient and outpatient mental health services in Rochester, New York.
A total of 130-mood-disordered inpatients and outpatients 50 years and older.
Patients completed a demographics form, an interviewer-rated measure of current suicide ideation (Scale for Suicide Ideation), and a self-report measure of family connectedness derived from the Reasons for Living Scale-Older Adult version.
Patients who reported greater family connectedness were significantly less likely to report suicide ideation; this protective effect was strongest for those living with others (Wald χ(2)[df = 1] = 3.987, p = 0.046, OR = 0.905; 95% CI = 0.821-0.998). A significant main effect of family connectedness on suicide ideation suggested that having a stronger connection to family members decreased the likelihood of reporting suicide ideation (Wald χ(2)[df = 1] = 9.730, p = 0.002, OR = 0.852; 95% CI = 0.771-0.942).
These results suggest potential value in assessing the quality of interpersonal relationships when conducting a suicide risk assessment among depressed middle-aged and older adults.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 11/2011; 20(8):717-23. DOI:10.1097/JGP.0b013e31822ccd79 · 4.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess whether social supports (proxies) can detect the presence of suicide ideation in a clinical sample of depressed adults 50 years of age or older, and to additionally assess the potential impact of depression symptom severity on patient-proxy concordance in reports of patient suicide ideation.
Cross-sectional data were collected regarding Axis I diagnoses, severity of depressive symptoms, and suicide ideation in a clinical sample of 109 patients 50 years of age and older. Patients were administered study measures by trained interviewers. Patients' social supports completed proxy measures of these same variables. We assessed concordance in self- and proxy-reported suicide ideation, employing global suicide ideation items derived from depression scales and more fine-grained suicide ideation items drawn from multi-item suicide ideation measures. We investigated patient-proxy concordance regarding the presence of patient suicide ideation.
Patients who endorsed suicide ideation and were concordantly seen by their social supports to be suicidal reported significantly greater depressive symptom severity than patients concordantly reported to be nonsuicidal. Patients' social supports reported significantly less depressive symptom severity in patients who endorsed suicide ideation yet who did not appear to be suicidal to them.
Our findings suggest that family and friends can broadly ascertain the presence of suicide ideation in depressed middle-aged and older adults, yet in doing so may largely be responding to their broad perceptions of depressive symptom severity in patients and not specifically to the presence of suicidal thoughts.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 04/2011; 56(4):219-26. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The capacity of friends and family member informants to make judgments about the presence of a mood disorder history in an older primary care patient has theoretical, clinical, and public health significance. This study examined the accuracy of informant-reported mood disorder diagnoses in a sample of primary care patients aged 65 years or older. We hypothesized that the accuracy (sensitivity and specificity) of informant reports would vary with the patient's personality.
Hypotheses were tested in 191 dyads consisting of patients and their friends or relatives (informants) recruited from primary care settings. Gold-standard mood disorder diagnoses were established at consensus conferences based on a review of medical charts and data collected in a structured interview with the patient. Patients completed an assessment battery that included the NEO-Five Factor Inventory.
Sensitivity and specificity of informant-derived mood disorder diagnoses were related to patient personality. Sensitivity of informant-derived lifetime mood disorder diagnoses was compromised by higher Extraversion and higher Agreeableness. Specificity of informant-derived lifetime mood disorder diagnoses was compromised by lower Agreeableness and higher Conscientiousness.
Patient personality has implications for the accuracy of mood disorder histories provided by friends and family members. Given that false negatives can have grave consequences, we recommend that practitioners be particularly vigilant when interpreting collateral information about their extraverted, agreeable patients.
International Psychogeriatrics 09/2010; 23(4):634-43. DOI:10.1017/S1041610210001808 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients' initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring.
[Show abstract][Hide abstract] ABSTRACT: Older adults have high rates of suicide and typically seek care in primary medical practices. Older adults often do not directly or spontaneously report thoughts of suicide, which can impede suicide prevention efforts. Therefore, the use of additional approaches to suicide risk detection is needed, including the use of screening tools. The objective of this study was to assess whether brief screens for depression have acceptable operating characteristics in identifying suicide ideation among older primary care patients and to examine potential sex differences in the screen's accuracy.
We administered the 15-item Geriatric Depression Scale (GDS), which includes a 5-item GDS subscale (GDS-SI) designed to screen for suicide ideation, to a cross-sectional cohort of 626 primary care patients (235 men, 391 women) 65 years of age or older in the Northeastern United States. We assessed presence of suicide ideation with items from the Hamilton Rating Scale for Depression and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Patients expressing suicide ideation (n = 69) scored higher on the GDS and GDS-SI than those who did not (n = 557). A GDS cut score of 4 maximized sensitivity (0.754) and specificity (0.815), producing an area under the curve of 0.844 (P < .001) and positive and negative predictive values of 0.335 and 0.964, respectively. Optimal cut scores were 5 for men and 3 for women. A GDS-SI cut score of 1 was optimal for the total sample and for both men and women.
The GDS and GDS-SI accurately identify older patients with suicide ideation. Research is needed to examine their acceptability and barriers to routine use in primary care.
The Journal of the American Board of Family Medicine 03/2010; 23(2):260-9. DOI:10.3122/jabfm.2010.02.080163 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Alexithymia is a characteristic style of thinking and feeling involving deficits in the recognition of emotions. It is associated with depression onset and severity in younger adults, but researchers have not yet examined the association between alexithymia and depression severity in clinically depressed older adults.
One hundred thirty-four patients aged 50 years or older with a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I mood disorder and currently receiving mental health treatment.
Alexithymia was measured using the Toronto Alexithymia Scale-20, a 20-item measure with subscales assessing difficulty identifying feelings, difficulty describing feelings (DDF), and externally oriented thinking. Depression symptom severity was measured using the Beck Depression Inventory, Second Edition (BDI-II).
Total alexithymia scores were independently related to depressive symptom severity after controlling for demographics, cognitive functioning, and illness burden. DIF and DDF subscale scores were also independently associated with BDI-II scores.
The association between alexithymia and depression symptom severity could be attributed to difficulties in recognizing and describing negative emotions and resulting delays in seeking mental health treatment. Future research should focus on modifiable risk factors related to difficulties identifying and describing feelings.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 01/2010; 18(1):51-6. DOI:10.1097/JGP.0b013e3181bd1bfe · 4.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide.
Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in one's life, and current mental status and physical functioning.
Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach's alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior.
These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.
The Gerontologist 07/2009; 49(6):736-45. DOI:10.1093/geront/gnp052 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report preliminary findings of the first ever study testing a 16-week course of Interpersonal Psychotherapy (IPT) modified for older outpatients at elevated risk for suicide. Participants were referred from inpatient and outpatient medicine and mental health services. Psychotherapy sessions took place in a therapist's office in a teaching hospital. Twelve adults 60 years or older (M=70.5, SD=6.1) with current thoughts of suicide (suicide ideation) or a wish to die (death ideation) or with recent self-injurious behavior were recruited into weekly sessions of IPT; one was subsequently excluded due to severe cognitive impairment. Participants completed measures of suicide ideation, death ideation, and depressive symptom severity at pre-treatment, mid-treatment, post-treatment, and at 3-month follow-up periods, and measures of therapeutic process variables. Preliminary findings of this uncontrolled pre-post-treatment study support the feasibility of recruiting and retaining older adults at-risk for suicide into psychotherapy research and suggest that adapted IPT is tolerable and safe. Findings indicate a substantial reduction in participant suicide ideation, death ideation, and depressive symptoms; controlled trials are needed to further evaluate these findings. We discuss implications for clinical care with at-risk older adults.
Professional Psychology Research and Practice 04/2009; 40(2):156-164. DOI:10.1037/a0014731 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adults with mood disorders are at elevated risk for suicide. Psychological features such as hopelessness increase their risk for suicide ideation. Few studies have examined psychological constructs posited to lower risk for suicide ideation. The authors tested the hypothesis that reasons for living (RFL) are inversely related to suicide ideation.
This report is a secondary analysis of cross-sectional data.
Participants were recruited from the clinical services of three teaching hospitals in Rochester, NY.
The sample consisted of 125 adults 50 years or older receiving treatment for a mood disorder.
A diagnostic interview and measures of suicide ideation, depression, hopelessness, and RFL were included in the assessment battery. Dependent variables were presence and severity of suicide ideation. Data were analyzed using multivariate logistic and linear regressions.
Patients who reported higher levels of fear of suicide were less likely to report suicide ideation. The relationships between hopelessness and both the presence and severity of suicide ideation were stronger among those who reported greater levels of responsibility to family.
Clinicians working with at-risk older adults are encouraged to explore their patients' RFL. These cross-sectional findings point to the need for prospective research examining the associations among different RFL, hopelessness, and suicide ideation in depressed older adults.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2008; 16(9):736-41. DOI:10.1097/JGP.0b013e31817b609a · 4.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The psychological assessment of older adults is often challenging due to the frequent co-morbidity of mental and physical health problems, multiple medications, interactions among medications, age-related sensory and cognitive deficits, and the paucity of assessment instruments with psychometric support for use with older adults. First, psychological assessment instruments for examining five important clinical areas (suicide ideation, sleep disorders, anxiety, depression, and personality) are discussed in light of the most current research regarding their psychometric properties and suitability for use with older adults. Instruments developed specifically for older adults are distinguished from instruments developed for younger adults that have some psychometric support for their use with older adults. Second, the potential sensory deficits that could compromise assessment, factors to consider in light of these deficits, and accommodations that can be made to minimize their effects are discussed.
[Show abstract][Hide abstract] ABSTRACT: We investigated associations between suicide ideation and a set of potential risk and resiliency factors in a heterogeneous sample of 107 older adults (mean age = 81.5 years, SD = 7.7 years; range, 67 to 98 years; 76% female) recruited in community, residential, and healthcare settings. Participants completed the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006) and measures of depression, perceived physical health problems, domains of psychological well-being, perceived meaning in life, and indices of social network and of religious affiliation and observance. The main findings indicated that suicide ideation was associated positively with depression and with number of self-reported physical health problems and negatively with domains of psychological well-being including positive relations with others and self-acceptance, and with perceived meaning in life. Hierarchical multiple regression analyses indicated that the resiliency factors in general, and perceived meaning in life in particular, explained significant added variance in suicide ideation over and above measures of mental and physical health problems. These findings suggest potential value in attending to both suicide risk and resiliency when assessing late-life suicide ideation and when developing interventions for older adults at risk for suicide.
[Show abstract][Hide abstract] ABSTRACT: To identify elements of affective instability associated with an increased likelihood of impulsivity and then to determine whether these elements characterize patients with borderline personality disorder (BPD) and suicidal behaviour.
We prospectively followed 82 individuals with BPD and a history of recurrent suicidal behaviour who recorded their current mood states, impulsivity, suicide ideation, and environmental stressors (triggers) 6 times daily over 3 weeks.
Our results suggested that mood amplitude was correlated with impulsivity and that 4 subgroups defined by mean scores on mood amplitude and negative mood intensity significantly differed in the number of suicidal behaviours reported in the last year.
A subgroup of BPD patients appears to be at elevated risk for suicidal behaviour based on high mood amplitude and mean negative mood intensity. Clinicians might target this group for monitoring and interventions to reduce the likelihood of suicidal behaviour.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 03/2008; 53(2):112-6. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A deeper understanding of the influences on self-reported mood symptoms could inform the debate about the utility of self-report instruments and enhance the assessment and treatment of affective disorders. We tested the hypotheses that higher Neuroticism is associated with the over-reporting of affective symptoms and lower Openness to Experience is associated with the under-reporting of affective symptoms.
Subjects were 134 inpatients of ages 50 and over diagnosed with a mood disorder. Personality was assessed with the Revised NEO Personality Inventory. Self-reported depression was assessed with the Beck Depression Inventory-II; observer-rated depression was assessed via the Hamilton Depression Rating Scale. Symptom-reporting was defined as the ratio of self-reported to observer-rated symptoms.
As hypothesized, multivariate linear regression analyses revealed that high Neuroticism contributed to patients' over-reporting of mood symptoms. Contrary to the hypothesis, low Openness was associated with high ratios of self-reported to observer-rated mood symptoms.
Cross-sectional design and unclear generalizability to racial/ethnic minorities.
Traits are important correlaters of self-reported vs. observer-rated symptoms in patients with affective disorders. To the extent that economic imperatives and other pressures impel greater reliance on self-report data in mental health research and services, there will be a corresponding need for prospective research on the determinants and clinical implications of discrepancies between self-reports and observer ratings.
[Show abstract][Hide abstract] ABSTRACT: Narcissistic personality (NP) has been implicated as a potential vulnerability factor for late-life suicide. The present study investigated whether NP increases vulnerability to suicidal ideation and behavior among geriatric depression day-hospital patients.
Using a retrospective database analysis, the authors examined demographic data, diagnostic information, and scores on self-report (Geriatric Depression Scale [GDS]) and clinician-rated depression measures (Hamilton Rating Scale for Depression [HAM-D]), for 608 geriatric psychiatry patients 65 years or older.
Of the 538 patients meeting study inclusion criteria, 20 had NP, defined as either narcissistic personality disorder (n = 13) or narcissistic personality traits (n = 7). Patients with NP were rated significantly higher on the HAM-D suicide item than those without NP, controlling for age, sex, depression (GDS), and cognitive functioning.
Findings suggest that NP may be a clinical marker of elevated suicide risk among depressed older adults. Clinicians are advised to assess the presence of self-pathology and its potential impact upon psychological functioning in depressed older patients, and to incorporate discussions of life transitions into therapeutic work with those at-risk for suicide.
American Journal of Geriatric Psychiatry 10/2007; 15(9):734-41. DOI:10.1097/JGP.0b013e3180487caa · 4.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Narcissistic personality (NP) has been implicated as a potential vulnerability factor for late-life suicide. The present study investigated whether NP increases vulnerability to suicidal ideation and behavior among geriatric depression day-hospital patients.
Methods: Using a retrospective database analysis, the authors examined demographic data, diagnostic information, and scores on self-report (Geriatric Depression Scale [GDS]) and clinician-rated depression measures (Hamilton Rating Scale for Depression [HAM-D]), for 608 geriatric psychiatry patients 65 years or older.
Results: Of the 538 patients meeting study inclusion criteria, 20 had NP, defined as either narcissistic personality disorder (n = 13) or narcissistic personality traits (n = 7). Patients with NP were rated significantly higher on the HAM-D suicide item than those without NP, controlling for age, sex, depression (GDS), and cognitive functioning.
Conclusion: Findings suggest that NP may be a clinical marker of elevated suicide risk among depressed older adults. Clinicians are advised to assess the presence of self-pathology and its potential impact upon psychological functioning in depressed older patients, and to incorporate discussions of life transitions into therapeutic work with those at-risk for suicide.
American Journal of Geriatric Psychiatry 08/2007; 15(9):734-741. DOI:10.1097/01.JGP.0000260853.63533.7d · 4.24 Impact Factor