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Biomedical subjects

P R Duberstein

Publications and source records attributed to P R Duberstein.

At least 19 recordsLinked to original sources
PubMed2004

Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain.

BACKGROUND: Mental disorders amplify suicide risk across the lifecourse, but most people with mental disorder do not take their own lives. Few controlled studies have examined the contribution of stressors to suicide risk. METHOD: A case-control design was used to compare 86 suicides and 86 controls aged 50 years and older, matched on age, gender, race and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. RESULTS: Perceived physical illness, family discord and employment change amplified suicide risk after controlling for sociodemographic covariates and mental disorders that developed > or = 1 year prior to death/interview. Only the effect of physical illness (OR 6.24, 95% CI 1.28-51.284) persisted after controlling for all active mental disorders. CONCLUSIONS: Interventions to decrease the likelihood of financial stress and to help families manage discord and severe physical illness may effectively reduce suicides among middle-aged and older adults.

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PubMed2004

Poor social integration and suicide: fact or artifact? A case-control study.

BACKGROUND: Sociological studies have shown that poor social integration confers suicide risk. It is not known whether poor integration amplifies risk after adjusting statistically for the effects of mental disorders and employment status. METHOD: A case-control design was used to compare 86 suicides and 86 living controls 50 years of age and older, matched on age, gender, race, and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. Social integration was defined in reference to two broad levels of analysis: family (e.g. sibship status, childrearing status) and social/ community (e.g. social interaction, religious participation, community involvement). RESULTS: Bivariate analyses showed that suicides were less likely to be married, have children, or live with family. They were less likely to engage in religious practice or community activities and they had lower levels of social interaction. A trimmed logistic regression model showed that marital status, social interaction and religious involvement were all associated with suicide even after statistical adjusting for the effects of affective disorder and employment status. Adding substance abuse to the model eliminated the effects of religious involvement. CONCLUSIONS: The association between family and social/community indicators of poor social integration and suicide is robust and largely independent of the presence of mental disorders. Findings could be used to enhance screening instruments and identify problem behaviors, such as low levels of social interaction, which could be targeted for intervention.

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PubMed2001

The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. II. Life events, social support and suicidal behavior.

OBJECTIVE: To investigate the validity of proxy respondent reports of stressful life events, social support and suicidal behavior among individuals who attempted suicide. METHOD: Subjects were 80 psychiatric in-patients admitted following a suicide attempt. Data based on structured interviews with proxy respondents were compared with data based on interviews with subjects (gold standard). RESULTS: Specificity was higher than sensitivity across life event categories, and agreement was substantial for public and observable events (e.g. parent's death) but lower for more ambiguous events. Proxies were good judges of subject reports of frequency of social interaction but not perceived emotional support. Proxies were good judges of past history of suicide attempts and level of suicidal intent. CONCLUSION: Results support proxy-based data on suicidal behavior and certain aspects of social support and stressful life events in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.

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PubMed2001

The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses.

OBJECTIVE: To investigate the validity of best-estimate methodology for making psychiatric diagnoses among individuals who attempted suicide. METHOD: Subjects were 80 patients admitted for treatment following a suicide attempt. Psychiatric diagnoses based on structured interviews with subjects were compared with diagnoses made based on interviews with proxy respondents. In both cases, interview information was supplemented with pre-admission psychiatric and medical records to inform diagnoses. RESULTS: Diagnostic agreement, based on kappa coefficients, was substantial for major depression and bipolar disorders, and moderate for non-affective psychoses, organic mood and anxiety disorders. Agreement was substantial for substance dependence but poor for substance abuse disorders. CONCLUSION: Results support best-estimate methodology for making mood and substance dependence diagnoses in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.

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PubMed2001

Profile of discrete emotions in affective disorders in older primary care patients.

PURPOSE: This research examined whether the frequencies of specific emotions are associated with major and minor depression in older primary care patients. DESIGN AND METHODS: Older primary care patients (N = 146), prescreened with a depression questionnaire, completed a diagnostic interview and an emotions questionnaire. RESULTS: Controlling for age, sex, and other psychiatric and medical illnesses, major depressives differed from nondepressed controls in nine emotions; minor depressives differed from controls in four emotions. Major depressives differed from the controls more in sadness, joy, and interest--but not anger, fear, or guilt--than in comparison sets of emotions. Minor depressives differed from the controls more in sadness and inner-directed hostility--but not guilt, anger, fear, joy, or interest--than in comparison sets of emotions. IMPLICATIONS: The frequencies of discrete emotions are differentially associated with major and minor depression; future research is needed to determine their specific diagnostic and treatment implications.

Age Factors↗
PubMed2001

Suicide in elders.

Older persons in the United States are at higher risk for suicide than any other segment of the population. The epidemiology and risk factors for suicide in later life and the most promising approaches to its prevention are reviewed. Available data suggest that psychiatric and physical illnesses, functional impairment, personality traits of neuroticism and low openness to experience, and social isolation are important correlates of late-life suicide. Affective illness is the risk factor with the strongest association. As treatable conditions in most cases, mood disorders are critical targets for preventive interventions. Because 70% of older adults who committed suicide saw their primary care provider within 30 days of death, the primary care setting is an important venue for intervention. Mood disorders are common in primary care practice, but often go undiagnosed and inadequately treated. One important approach to late-life suicide prevention, therefore, is to optimize the ability of primary care providers to diagnose and treat late-life mood disorders and suicidality effectively. Other elders at high risk have no active relationship to primary care. Strategies designed to identify this group and provide them with preventive services through outreach to the community have shown promise as late-life suicide prevention measures as well.

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PubMed2001

Violence, alcohol, and completed suicide: a case-control study.

OBJECTIVE: Violent behavior may represent a risk factor for suicide. The authors tested the hypothesis that violent behavior in the last year of life is associated with completed suicide, even after controlling for alcohol use disorders. METHOD: The authors analyzed data from the 1993 National Mortality Followback Survey, a nationally representative survey conducted by telephone interview with decedents' next of kin. Data on 753 victims of suicide were compared with data on 2,115 accident victims. Decedents ranged in age from 20 to 64. Dichotomous measures of violent behavior in the past year and history of alcohol misuse were derived by using the four-item CAGE questionnaire. Multiple logistic regression was used to evaluate the interactions of violent behavior with alcohol misuse, gender, and age, respectively, in predicting suicide versus accidental death. Education and race were included as covariates. RESULTS: Violent behavior in the last year of life was a significant predictor of suicide; the relationship was especially strong in individuals with no history of alcohol misuse, those who were younger, and women. CONCLUSIONS: Violent behavior distinguished suicide victims from accident victims, and this finding is not attributable to alcohol use disorders alone. Given that violent behavior increases the risk of suicide, violence prevention initiatives may serve to decrease the risk of suicide as well.

Accidents↗
PubMed2001

Personality correlates of hopelessness in depressed inpatients 50 years of age and older.

In this study we examined the relationship between scores on the Beck Hopelessness Scale and the personality traits that constitute the Five-Factor Model in a sample of 77 depressed inpatients, 50 years of age and older. Multiple regression analyses showed that Hopelessness is related to low Extraversion domain scores, and to specific facets of both Extraversion (low positive emotions) and Neuroticism (low self-consciousness, high impulsiveness). Efforts to tie Hopelessness with the motivational, affective, and interpersonal constructs subsumed under Extraversion are warranted.

Affective Symptoms↗
PubMed2001

Are closed-minded people more open to the idea of killing themselves?

This article summarizes the author's work on Openness to Experience (a personality trait) and suicidal behavior. It appears that people who obtain low scores on an inventory measuring Openness to Experience are less likely to report suicidal ideation but more likely to take their own lives. How can this apparent discrepancy be reconciled? Based on the premise that the expression of suicidal ideation can have adaptive consequences (e.g., by mobilizing family and treatment providers), it is hypothesized that people with major depression who are low in Openness may be at increased risk for completed suicide in part because they are less likely to feel, or report feeling, suicidal.

Adaptation, Psychological↗
PubMed2001

Psychological vulnerability to completed suicide: a review of empirical studies.

Retrospective research shows that close to 90 percent of suicides have a diagnosable psychiatric disorder; however, only a small proportion of individuals with psychopathology take their own lives. This article reviews the empirical literature on psychological vulnerability to completed suicide. A search of the MEDLINE and PsycINFO databases yielded 46 cohort or case-control studies that used standardized or structured assessments of psychological dimensions. Five constructs have been consistently associated with completed suicide: impulsivity/aggression, depression, anxiety, hopelessness, and self-consciousness/social disengagement. Current knowledge of psychological vulnerability to completed suicide could inform social and neurobiological research, and thereby deepen understanding of suicide while potentially bridging these areas of study.

Case-Control Studies↗
PubMed2000

A presurgical psychosocial intervention for breast cancer patients. psychological distress and the immune response.

OBJECTIVE: The present study evaluated the feasibility and potential immunological benefit of a presurgical intervention for breast cancer patients. METHODS: Forty-one newly diagnosed breast cancer patients were randomized into control (standard care) and intervention groups. In addition to standard care, intervention group members received a two-session psychosocial intervention. Blood was drawn at three timepoints: (1) at preintervention; (2) at postintervention/presurgery; and (3) at postsurgery. RESULTS: Examination of the immunological data revealed evidence of suppression of interferon-gamma (IFN-gamma) in the control group over time, but not in the intervention group. Secondary findings related to psychological assessment generally paralleled the IFN-gamma results. CONCLUSION: The relevance and applicability of these findings to future breast cancer intervention research is detailed.

Adult↗
PubMed2000

Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older.

Completed suicide may be the most preventable lethal complication of depressive disorders in older adults. Identification of risk factors for suicidal behavior has therefore become a major public health priority. Using data collected on 81 depressed patients 50 years of age and older, we report analyses designed to determine the associations between the personality traits that constitute the Five Factor Model of personality and measures of suicidal behavior and ideation. We hypothesized that low Extraversion would be associated with a lifetime history of attempted suicide, and high Neuroticism would be associated with suicidal ideation. Results were generally consistent with the hypotheses. We also observed a relationship between Openness to Experience and suicidal ideation. These findings suggest that longstanding patterns of behaving, thinking, and feeling contribute to suicidal behavior and thoughts in older adults and highlight the need to consider personality traits in crafting and targeting prevention strategies.

Adult↗
PubMed2000

The effect of participation in religious activities on suicide versus natural death in adults 50 and older.

This study tests the hypothesis that older persons dying by suicide, compared with natural death, are less likely to have participated in religious activities. Data from the 1993 National Mortality Followback Survey were used to compare the frequency of participation in religious activities of 584 suicides to those of 4279 natural deaths occurring among women and men ages 50 and older. Adjusting for sex, race, marital status, age, and frequency of social contact, the odds for having never participated in religious activities are greater among suicide victims, compared with natural deaths. Participation in religious activities does appear to reduce the odds of the occurrence of suicide. This effect remains even after controlling for the frequency of social contact. The identification of specific factors contributing to this intrinsic benefit of religious participation requires further investigation.

Age Factors↗
PubMed2000

Domestic violence, separation, and suicide in young men with early onset alcoholism: reanalyses of Murphy's data.

Partner violence and partner separation at the time of completed suicide were investigated in 42 male alcoholics originally described by Murphy (1992). Half of the men had domestic violence histories. Partner-violent men were younger, had an earlier age of onset of alcoholism, and were more likely to be separated from their partner at the time of death than partner-nonviolent men. Loss of a close personal relationship, often a domestic partner, is common during the last year of life among alcoholic men completing suicide. Domestic violence appears to typify many of their domestic relationships, particularly among younger men and men with early onset alcoholism.

Age of Onset↗
PubMed1999

Age-related patterns of factors associated with completed suicide in men with alcohol dependence.

Seven factors associated with completed suicide among male alcoholics were investigated to determine if victims of differing ages would show different patterns of factors. Data on 56 male alcoholic suicide victims were collected post-mortem. Subjects were divided into three age groups: 21-34, 35-49, and > or = 50 years. Consistent with the hypotheses, unemployment and recent loss due to separation from a domestic partner were more likely with younger age, and serious medical problems and mood disorders were associated with increased age. There were no differences on other presumed risk factors among the age groups. Results suggest that factors associated with suicide may cluster in male alcoholics of differing ages, with implications for risk recognition and intervention.

Adult↗
PubMed1999

Cerebrovascular risk factors and depression in older primary care patients: testing a vascular brain disease model of depression.

The authors examined whether cerebrovascular risk factors (CVRFs) are associated with depressive diagnoses and symptoms in 303 primary-care patients age >/=60 years, as would be consistent with a small-vessel brain disease model of later-life depression. CVRFs were not significantly independently associated with major, minor, or subsyndromal depression, late-onset major depression, or overall depressive symptom severity. These data did not support the notion that a small-vessel brain disease model of depression might apply to the majority of older persons with depressive symptoms and syndromes in primary-care settings. Future work should include longitudinal study with larger sample sizes.

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PubMed1999

Effects of group treatment for women with a history of childhood sexual abuse.

OBJECTIVE: Empirical support for the effectiveness of group therapies for women with a history of childhood sexual abuse is scant. This study examined the feasibility of conducting abuse-focused research and group treatment on a short-term unit and evaluated the effectiveness of the Women's Safety in Recovery group. METHODS: Eighty-six women with a history of childhood sexual abuse participated in treatment as usual (N=38) or in the Women's Safety in Recovery group (N=48). The latter group met three times weekly for one hour, focusing on patients' current safety and self-care. Participants completed the Symptom Checklist-Revised at baseline, discharge, and six-month follow-up. Patients rated their experience in treatment at discharge and six-month follow-up, and therapists rated patients' treatment experiences at discharge. The feasibility of the treatment group was measured by enrollment rates, group attendance, and attrition. RESULTS: Eighty-two percent of eligible patients agreed to enroll in the study. Women's Safety in Recovery participants attended an average of ten group meetings. Seventy percent of enrollees completed discharge assessments, and of these, 82 percent completed the six-month follow-up. Compared with treatment-as-usual patients, Women's Safety in Recovery participants reported greater symptom improvement and reported that their childhood sexual abuse issues had been more thoroughly addressed. These differences were present at discharge and at six-month follow-up. Therapists also perceived that abuse issues of these participants had been more thoroughly addressed. CONCLUSIONS: Women's Safety in Recovery participants reported significant reductions in distress compared with those receiving treatment as usual. The abuse-focused research program and the Women's Safety in Recovery group proved feasible, despite attrition.

Adaptation, Psychological↗