Regular ArticleSuicidal and Death Ideation in Older Primary Care Patients With Depression, Anxiety, and At-Risk Alcohol Use
Section snippets
METHODS
The PRISMe Study (Primary Care Research in Substance Abuse and Mental Health for the Elderly) is a multisite, randomized comparative trial examining two models of care for older persons with depression, anxiety, and at-risk alcohol consumption. The overall goal of the study is to compare the effects of integrated and referral models of behavioral healthcare on engagement, participation, patient outcomes, and cost. A variety of sites and culturally diverse populations are represented by the 11
RESULTS
For the total study sample of 2,240 subjects, responses to the Paykel suicide questions included the following: 1) Life not worth living: 773 (34.5%); 2) Wished you were dead: 518 (23.1%); 3) Thoughts of taking own life: 229 (10.2%); 4) Seriously considered/made plans to take life: 74 (3.3%); and 5) Made an attempt in past 12 months: 13 (0.6%). In aggregate, three groups were defined: No Ideation: 1,390 (62.1%), Death Ideation: 616 (27.5%); and Suicidal Ideation: 234 (10.4%).
Demographic
DISCUSSION
This study describes characteristics associated with suicidal and death ideation in a large sample of older primary care patients with identified psychopathology, including depression, anxiety disorder, and at-risk alcohol use. As such, our findings focus attention on the most common mental health problems that are likely to be associated with greater suicidal ideation. Our objective was to explore the association of suicidal and death ideation with demographic and clinical characteristics and
CONCLUSIONS
One in 10 older primary care patients with depression, anxiety disorder, or at-risk alcohol use experiences active suicidal ideation. Although routine screening for suicidal ideation is unlikely to be a practical, standard part of primary-care clinical practice, data describing risk factors may help healthcare providers target those most in need of more thorough clinical assessment and preventive measures. Our findings suggest that older persons who are at greatest risk of suicidal ideation
References (47)
- et al.
Suicide prevention in late life: directions for science and practice
Clin Psychol Rev
(2000) - et al.
Suicide screening in a primary care setting at a VA medical center
Psychosomatics
(1996) - et al.
Suicide in elderly depressed patients: is active vs. passive suicidal ideation a clinically valid distinction?
Am J Geriatr Psychiatry
(1996) - et al.
Structural characteristics of social networks and their relationship with social support in the elderly: who provides support?
Soc Sci Med
(1988) - et al.
Depression and health-related quality of life in ethnic minorities seeking care in general medical settings
J Affect Disord
(2000) Suicide in elderly patients
- et al.
The role of competing demands in the treatment provided primary care patients with major depression
Arch Fam Med
(2000) - et al.
Suicidal ideation among older primary care patients
J Am Geriatr Soc
(1996) - et al.
Suicide in elders
Ann N Y Acad Sci
(2001) - et al.
High-risk management guidelines for elderly suicidal patients in primary care settings
Int J Geriatr Psychiatry
(2001)
Epidemiology and psychiatric morbidity of suicidal ideation among the elderly
Crisis
Life events and social support in suicide
Suicide Life Threat Behav
The effect of participation in religious activities on suicide versus natural death in adults 50 and older
J Nerv Ment Dis
Completed suicide among older patients in primary care practices: a controlled study
J Am Geriatr Soc
General Health Questionnaire (GHQ-12)
Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 Study
JAMA
Validation of a Short Orientation-Memory-Concentration Test of Cognitive Impairment
Am J Psychiatry
The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10
J Clin Psychiatry
The CES-D Scale: a self-report depression scale for research in the general population
Applied Psychological Measurement
An inventory for measuring clinical anxiety: psychometric properties
J Consult Clin Psychol
Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G)
The MOS 36-item Short-Form Health Survey (SF-36), I: conceptual framework and item selection
Med Care
Cited by (187)
A network analysis of suicidal ideation, depressive symptoms, and subjective well-being in a community population
2021, Journal of Psychiatric ResearchSuicidal behaviour in older age: A systematic review of risk factors associated to suicide attempts and completed suicides
2021, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Conversely, personality disorders and psychoses were poorly correlated to suicide attempts in older age (De Leo et al., 2001). Depressive and anxiety disorders appeared to have the major load on suicide attempts in older age (Bartels et al., 2002). Mental illness in the form of depression was predominant among the younger females (68 % of cases) and the older males (75 % of cases) (Nowers, 1993).
Passive and active suicidal ideation in Swedish 85-year-olds: Time trends 1986–2015
2021, Journal of Affective DisordersA narrative review examining intersections of identity in older adult suicidality
2021, Aggression and Violent BehaviorViolence, older adults, and serious mental illness
2021, Aggression and Violent BehaviorCitation Excerpt :Furthermore, there may not be nursing home units available in certain areas for adults with SMI who also exhibit aggressive behaviors (Lane, 2011). Although suicidal ideation in older adults with major depressive disorder has been well researched (Bartels et al., 2002), there is a modicum of literature on attempted suicide in the elderly with SMI (Chiu, Lam, Pang, Leung, & Wong, 1996). Some literature suggests that individuals with SMI are at greater risk for suicide than the general population (Chen et al., 2011; Conwell, Van Orden, & Caine, 2011; Douzenis et al., 2013).
The authors acknowledge the invaluable efforts of Aricca Dums, B.A., in helping to prepare this manuscript.
PRISMe Study investigators (in alphabetical order): Carolyn Aoyama (HRSA), Pat Arean (Co-PI), Steve Bartels (PI), Hongtu Chen (PI), Henry Chung (Co-PI), Marisue Cody (Co-PI), Giuseppe Costantino (PI), U. Nalla B. Durai (PI), Carroll Estes (PI), Susan Cooley (VA), Jack Fitzpatrick (Co-PI), Brian Goodman (Co-PI), Trevor Hadley (Co-PI), Tim Howell (Co-PI), Ira Katz (Co-PI), Joanne Kirchner (PI), Dean Krahn (PI), Sue Levkoff (PI), Karen Linkins (Co-PI), Maria Llorente (PI), Jim Maxwell (Co-PI), Keith Miles (Co-PI), Robert Molokie (Co-PI), Jack McIntyre (PI), Betsy McDonel Herr (SAMHSA), Mike Nazar (Co-PI), Ed Olsen (VA), David Oslin (PI), Tom Oxman (Co-PI), Andy Pomerantz (Co-PI), Louise Quijano (Co-PI), Melissa Rael (SAMHSA), Pat Sabry (SAMHSA), Bill Van Stone (VA), Heidi Syropoulos (Co-PI), Paul Wohlford (SAMHSA), Cynthia Zubritsky (PI).
The PRISMe Study is a collaborative research study funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Veterans Affairs (VA), and the Health Resources and Services Administration (HRSA).