Biomedical subjects

Paul R Duberstein

Publications and source records attributed to Paul R Duberstein.

At least 19 recordsLinked to original sources

PubMed2007

Future orientation moderates the relationship between functional status and suicide ideation in depressed adults.

Functional impairment might amplify suicide risk in later life. A positive view of the future may reduce this risk. We tested the hypothesis that hopelessness and positive future orientation moderate the association between functional status and suicide ideation in a sample of 136 patients, 55 years of age or older, in treatment for depression. Future orientation moderated the association between functional status and suicide ideation; hopelessness did not. Although prospective research is needed to test more rigorously the hypothesized protective role of positive future orientation, our data suggest that treatments designed to enhance future orientation might decrease suicide risk.

Aged↗

PubMed2006

Planning of suicide attempts among depressed inpatients ages 50 and over.

BACKGROUND: Suicidal behavior is heterogeneous; suicide attempts can be impulsive (lower planned) or reflect forethought and preparation (higher planned). Lower planned and higher planned attempts may have different correlates that require different prevention strategies. Based on a model of suicide planning relevant to middle-aged and older adults, we tested the following hypotheses: physical illness burden, decreased functional capacity, hopelessness, and living alone are associated with suicide attempts that are more extensively planned; lower cognitive functioning is associated with suicide attempts that are more impulsive. METHODS: Subjects were 117 inpatients ages 50 and over diagnosed with major depression based on semi-structured clinical research interviews, the medical record, plus other records when available. All subjects had attempted suicide within 1 month of admission. The degree of planning prior to the suicide attempt was quantified using Beck's Suicide Intent Scale. Multivariate linear regression analysis identified correlates of planning. RESULTS: As hypothesized, lower cognitive functioning was associated with lower levels of planning. Contrary to the hypothesis, impaired physical self-care was associated with lower (not higher) planning. Results pertaining to living alone were equivocal. LIMITATIONS: The study was limited by the cross-sectional research design and unclear generalizability to completed suicide or to racial/ethnic minorities. CONCLUSIONS: Depressed patients with lower cognitive functioning and impairments in physical self-care may be especially vulnerable to impulsive suicidal behavior. The potential role of living alone in higher planned suicidal acts requires further investigation.

Activities of Daily Living↗

PubMed2006

Personality and perceived health in older adults: the five factor model in primary care.

Responses to specific questions tapping perceived health are associated with morbidity, mortality, and the use of health services, yet there has been little research on their personality correlates. We examined the associations between Five Factor Model personality traits and responses to four items extracted from the Medical Outcomes Study Short Form-36 in 266 primary care patients who were 65 years of age or older. Multivariate analyses controlling for age, gender, depressive symptoms, and physical disease burden showed that having a higher Neuroticism score was associated with worse perceived health in response to all items except "I am as healthy as anybody I know." Having a lower Extraversion score was associated with worse perceived health in response to the item "I expect my health to get worse." We discuss implications for understanding personality influences on morbidity, mortality, and health services utilization.

Aged↗

PubMed2006

Future orientation and suicide ideation and attempts in depressed adults ages 50 and over.

OBJECTIVE: The objective of this study was to test the hypothesis that future orientation is associated with lower levels of suicide ideation and lower likelihood of suicide attempt in a sample of patients in treatment for major depression. METHODS: Two hundred two participants (116 female, 57%) ages 50-88 years were recruited from inpatient and outpatient settings. All were diagnosed with major depression using a structured diagnostic interview. Suicide ideation was assessed with the Scale for Suicide Ideation (both current and worst point ratings), and a measure of future orientation was created to assess future expectancies. The authors predicted that greater future orientation would be associated with less current and worst point suicide ideation, and would distinguish current and lifetime suicide attempters from nonattempters. Hypotheses were tested using multivariate logistic regression and linear regression analyses that accounted for age, gender, hopelessness, and depression. RESULTS: As hypothesized, higher future orientation scores were associated with lower current suicidal ideation, less intense suicidal ideation at its worst point, and lower probability of a history of attempted suicide after accounting for covariates. Future orientation was not associated with current attempt status. CONCLUSIONS: Future orientation holds promise as a cognitive variable associated with decreased suicide risk; a better understanding of its putative protective role is needed. Treatments designed to enhance future orientation might decrease suicide risk.

Aged↗

PubMed2006

Personality and the association of pain and depression.

OBJECTIVES: The objectives of this study were to test the hypotheses that pain is associated with depression independent of personality and that neuroticism moderates this association. METHOD: Multiple regression analyses were conducted in a group of 404 older primary care patients assessed with validated measures. RESULTS: Bodily pain was independently associated with depression. Neuroticism moderated the associations between pain and both depressive symptom severity and major depression, albeit not independent of overall medical burden; the relationships were stronger in subjects with lower neuroticism scores. CONCLUSIONS: The association of bodily pain with depression may be greater in those previously at lower risk on account of low neuroticism.

Aged↗

PubMed2006

Childhood sexual abuse and depressive symptom severity: the role of neuroticism.

This study examined neuroticism's role in the association between childhood sexual abuse and severity of depressive symptoms in a sample of 105 psychiatric patients 50 years of age and older diagnosed with major depressive disorder. As hypothesized, men and women who reported histories of childhood sexual abuse had more severe depressive symptoms than those without abuse histories. Further, neuroticism partially accounted for the association between severe childhood sexual abuse and depressive symptom severity. Self-consciousness, a facet of neuroticism conceptually related to shame, also partially accounted for that relationship. These findings suggest that neuroticism may be one way in which childhood sexual abuse contributes to depressive symptoms in later life. Prospective studies are needed.

Affective Symptoms↗

PubMed2006

Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy.

OBJECTIVE: To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed. METHOD: Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia). A total of 5,328 older adults received pharmacotherapy or psychotherapy in these studies. RESULTS: Clinician-rated depression scores improved, on average, by 0.80 standard deviation (SD) units; self-rated depression scores improved by 0.76 SD units. Clinician-rated depression improved by 0.69 SD units in pharmacotherapeutic studies and by 1.09 SD units in psychotherapeutic studies. Self-rated depression improved by 0.62 SD units and 0.83 SD units, respectively. An interesting finding was the stronger improvements in clinician-rated depression among control subjects participating in medication studies, compared to those in psychotherapeutic studies. CONCLUSIONS: Available treatments for depression work, with effect sizes that are moderate to large. Comparisons of psychotherapy and pharmacotherapy must be interpreted with caution, in part because medication studies are more likely to use a credible active placebo, which may lead to smaller adjusted effect sizes in medication studies. Given that psychotherapy and pharmacotherapy did not show strong differences in effect sizes, treatment choice should be based on other criteria, such as contraindications, treatment access, or patient preferences.

Aged↗

PubMed2005

Personality and reports of suicide ideation among depressed adults 50 years of age or older.

BACKGROUND: Accuracy in patient reports of suicide ideation is a concern in clinical assessment, given that some patients deny suicide ideation even when suicidal. Despite this concern, there is little research on the psychological processes driving reported suicide ideation in at-risk patients. METHODS: A cross-sectional design was used to examine the association of personality and suicide ideation in a clinical sample of 134 depressed adults 50 years and older. Patients completed a structured diagnostic interview, an interviewer-rated measure of current suicide ideation and self-report measures of personality (NEO-Personality Inventory Revised; NEO-PI-R) and hopelessness. The main outcome variable in logistic regression analyses was suicide ideator status; covariates included comorbid psychopathology, hopelessness and physical illness burden. Predictors were Neuroticism and Openness to Experience (OTE) scores on the NEO-PI-R. RESULTS: Elevated OTE and neuroticism were associated with suicide ideation in unadjusted analyses; OTE was also associated with suicide ideation in adjusted regression analyses. LIMITATIONS: This study used a cross-sectional methodology with depressed patients 50 years or older; it is possible that patients' depression severity may have influenced their responses to personality measures. Prospective studies of personality vulnerability to future suicide ideation are warranted. CONCLUSIONS: Elevated neuroticism increases the likelihood of reporting suicide ideation, just as it may enhance risk for suicidal behavior and death by suicide. The pattern for openness is markedly different. Although elevated openness increases the likelihood of reporting suicide ideation, previous research has shown that it may decrease risk of death by suicide, suggesting that the personality-mediated expression of suicide ideation may be adaptive in certain contexts. In contrast, low levels of openness may mute reports of suicide ideation in at-risk patients and confer risk for poor outcomes by potentially undermining clinician vigilance.

Aged↗

PubMed2005

Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues.

The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues.

Communication↗

PubMed2005

Cross-sectional age differences in personality among medicare patients aged 65 to 100.

1,084 older Medicare recipients were orally administered the NEO Five-Factor Inventory (NEO-FFI; P. T. Costa & R. R. McCrae, 1992). Participants were assigned to groups based on gender and age (65-79 or 80-100). An analysis of covariance showed that women had significantly higher Neuroticism, Openness, and Agreeableness scores; that older participants were significantly higher in Agreeableness; and that age differences in Agreeableness were significantly greater in men than in women. With the exception of Agreeableness, this study provides no evidence for age differences among those in the last decades of life.

Age Factors↗

PubMed2005

Does the geriatric depression scale (GDS) distinguish between older adults with high versus low levels of suicidal ideation?

OBJECTIVE: The Geriatric Depression Scale (GDS) is a common screening measure for late-life depression, but it does not directly assess thoughts of death or suicide. The present study asked whether 30-item (GDS) and 15-item (GDS-SF) GDS scales differentiate older adults with high versus low levels of suicidal ideation. METHODS: This cross-sectional study included a sample of 105 adults age 65 or older recruited from medical and psychiatric inpatient and outpatient practices, nursing and retirement residences, and community-based seniors' programs. RESULTS: GDS scores were associated positively with self-report and clinician-administered measures of suicidal ideation. Fifteen of 30 GDS items and 7 of 15 GDS-SF items distinguished groups high or low in self-reported suicidal ideation. Receiver Operating Characteristic curve analyses indicated criterion validity for the GDS measures with respect to suicidal ideation at cut-off scores of 12 for the GDS and 6 for the GDS-SF. Five internally consistent GDS items were identified that were highly associated with suicidal ideation, assessing hopelessness, worthlessness, emptiness, an absence of happiness, and absence of the perception that it is "wonderful to be alive." CONCLUSION: Long and short forms of the GDS may be used to screen older patients at risk for suicide. Clinicians using the GDS for this purpose are advised to further assess suicide risk with measures designed specifically to assess presence and severity of suicidal ideation.

Aged↗

PubMed2005

Attempted suicide in elderly Chinese persons: a multi-group, controlled study.

OBJECTIVE: Attempted suicide in later life is under-researched despite its public health significance. In this study, the authors delineated the characteristics of elderly suicide attempters in a representative Chinese sample by comparing them with suicide completers and comparison subjects age 65 years or over who were randomly selected from the community. METHODS: There were 224 subjects in this study: 66 suicide attempters, 67 suicide completers, and 91 comparison subjects from the community. Using a case-control design and standardized measuring instruments, authors examined the risk and protective factors associated with attempted suicide, making direct comparisons with the community-comparison subjects and suicide completers. RESULTS: A current diagnosis of major depression was associated with a nearly 60-fold increased risk for attempted suicide, and a population attributable risk (PAR) of 67%. Other risk factors included past suicide attempts, poorer function of self-care, arthritis, and specific personality dispositions, particularly low Conscientiousness. Co-residence with children decreased risk. Although the profiles of suicide attempters and completers were similar, they could be distinguished by suicide intent, recent life events (particularly hospitalization), functional competence, religious denomination, and personality characteristics. CONCLUSIONS: A high degree of clinical vigilance and multidisciplinary collaboration are required in the management of elderly suicide attempters. The treatment of depression should form a crucial part of the prevention program. Features that distinguish suicide completers from suicide attempters may also carry implications for the secondary prevention of suicide in elderly persons.

Aged↗

PubMed2005

Health locus of control and perceived risk for breast cancer in healthy women.

Although early detection is closely linked to survival of breast cancer, many women do not adhere to recommended screening guidelines. One of the most studied factors that contribute to women's screening behavior is their perceived risk of developing breast cancer. In this study, the authors examined contributions of general health locus of control and breast cancer-specific control to understanding perceived risk. Sixty-six healthy women with and without family histories of breast cancer participated in the study. The following were the central findings: (1) internal locus of control and breast cancer-specific control predicted perceived risk, as measured by the certainty of remaining free of breast cancer, and (2) breast cancer-specific control mediated the relationship between internal locus of control and perceived risk. Findings suggest that significant relations between health locus of control and perceived risk variables may be overlooked in the absence of situation-specific measures.

Adult↗

PubMed2004

Information needs and decision-making processes in older cancer patients.

The paper provides an overview of age-differences in patients' preferences for participation in cancer treatment decision-making and factors that relate to these age-differences. On average, older cancer patients prefer to receive less information about their illness and treatment and assume a less active role in making treatment decisions. They are also less likely to collect and analyze all relevant information in order to make an optimal decision. Observed age-differences are, in part, explained by age-associated cognitive decline. Age-differences are, on average, small to moderate, and most older patients prefer to be well-informed. Nonetheless, only a minority of them wishes to play an active role in decision-making. Given their lower preference for active participation in decision-making, older adults may show less positive psychological effects of active participation, but this question warrants research. Implications for working with older cancer patients are discussed.

Age Factors↗

PubMed2004

Predisposing and precipitating factors for suicide among alcoholics: empirical review and conceptual integration.

Alcohol dependence is a potent risk factor for suicide. Accordingly, alcoholics should be targeted in suicide prevention efforts. This article reviews the literature on suicide among alcoholics and provides a model that may inform research, clinical work, and prevention efforts. In this model, we propose that aggression/impulsivity, severe alcoholism, negative affect, and hopelessness are key predisposing factors for suicide among alcoholics. We propose that major depressive episodes and stressful life events, particularly interpersonal difficulties, are key precipitating factors. We also integrate these constructs in a model that proposes that many acts of suicide among alcoholics may be viewed as acts of reactive aggression executed in the midst of distress over a lost or threatened relationship. Empirical evidence for the model is discussed along with its limitations. The next generation of research on alcoholism and suicide should include a focus on the interpersonal anlage of suicide in this population.

Alcohol Drinking↗

PubMed2004

Risk factors for suicide in blacks and whites: an analysis of data from the 1993 National Mortality Followback Survey.

OBJECTIVE: Data on risk factors for suicide in blacks in the United States are needed, given the dramatic increase in the black suicide rate from 1980 to 1997. The 1993 National Mortality Followback Survey represented an unprecedented opportunity to identify risk factors for suicide in blacks and to determine whether race differences (black versus white) in risk factors exist. METHOD: Multiple logistic regression analyses were used to compare cases of suicide (150 suicides in blacks and 1,279 suicides in whites) with cases of accidental deaths (737 cases in blacks and 3,458 cases in whites). Predictors of interest were 18 items tapping four domains: antisocial behavior, substance use/abuse, depressive symptoms, and psychotic symptoms. RESULTS: Four items distinguished suicides from accidental deaths in both black and whites: death ideation, suicidal ideation, bizarre behavior, and making violent threats. Items in two of the four domains discriminated risk for suicide in whites more strongly than in blacks: reports of community complaints and problem drinking. No variable conferred greater risk for suicide in blacks than in whites. CONCLUSIONS: The current study underscores the need for examination of race differences in risk factors for suicide. It is also essential to examine variables that were unavailable in the National Mortality Followback Survey data set, particularly racism, perceived discrimination, and feelings of alienation from the dominant culture.

Accidents↗

PubMed2004

NEO-PI-R neuroticism scores in substance-dependent outpatients: internal consistency and self-partner agreement.

We evaluated internal consistency reliabilities and self-partner agreement on Revised NEO Personality Inventory (Costa & McCrae, 1992) Neuroticism (N) domain and facet scores (anxiety, angry hostility, depression, self-consciousness, impulsiveness, vulnerability) in a sample of 48 substance-dependent outpatients. Low internal consistency was seen for self-rated impulsiveness (alpha =.36). Agreement between self and partner reports was low for impulsiveness (.22) and vulnerability (.24) and was modest for the remaining facets of N (.31 to.34) and the N domain score (.31).

Adult↗

PubMed2004

The association of irritability and impulsivity with suicidal ideation among 15- to 20-year-old males.

Information on the association of impulsivity and measures of aggression with suicidal ideation in adolescents and young adults is limited. Data were gathered from a community sample of 625 adolescent and young adult males. Analyses were based on multivariate generalized estimating equations. Impulsivity and irritability were associated strongly with suicidal ideation after accounting for alcohol dependence and other aggression-related constructs including psychopathy. Given that irritable, impulsive adolescent males appear to contemplate suicidal behavior, their heightened suicide risk may be anticipated and mitigated.

Adolescent↗