Biomedical subjects

Paul R Duberstein

Publications and source records attributed to Paul R Duberstein.

32 records · Page 2Linked to original sources

PubMed2003

Personality is associated with perceived health and functional status in older primary care patients.

Using data collected on 265 primary care medical patients 60 years of age and older, the authors examined the personality bases of subjective health (perceived health, functional status) after controlling for observer-rated depression and medical burden. Four hypotheses were tested: High Neuroticism is associated with poorer perceived health, low Extraversion is associated with poorer perceived health, low Openness to Experience is associated with worse functional status, and age moderates the relationships between personality and subjective health. Findings supported the notion that personality is associated with subjective health; moreover, this effect appeared to grow more pronounced with increasing age. This study underscores the conceptual and heuristic value of examining moderators of the links between personality variables and health.

Aged↗

PubMed2003

The role of drinking in suicidal ideation: analyses of Project MATCH data.

OBJECTIVE: The associations of suicidal ideation with both the intensity (drinks per drinking day) and frequency of alcohol consumption were examined in a longitudinal study of treated alcoholics. METHOD: The data are from alcohol dependent subjects (1,187 men and 374 women) enrolled in Project MATCH, a multisite clinical trial of psychosocial treatments of alcoholism. Multivariate analyses for correlated data using generalized estimating equation approaches were performed to examine correlates of suicidal ideation at study entry and at 3-, 9- and 15-month follow-up. Analyses were stratified by gender and controlled statistically for depression and alcoholism severity. RESULTS: Suicidal ideation was common among women (15.5%) and men (9.9%) entering treatment, and at least 3.6% of women and 4.2% of men reported suicidal ideation at each follow-up. There were gender patterns in suicidal ideation. In women, intensity was associated with suicidal ideation, but even nonintense drinking became associated with suicidal ideation with more frequent drinking (intensity-frequency interaction). In men, intensity was also associated with suicidal ideation, whereas frequency was unrelated. Antisocial personality disorder in men but not in women, and depression in both groups, were also linked to suicidal ideation. CONCLUSIONS: Suicidal ideation is prevalent among treated alcoholics. Drinking is strongly associated with suicidal ideation and in women even light drinking, if it occurs regularly, is associated with suicidal ideation, with implications for suicide risk-recognition and intervention.

Adult↗

PubMed2002

Risk factors for suicide in later life.

Suicide rates are higher in later life than in any other age group. The design of effective suicide prevention strategies hinges on the identification of specific, quantifiable risk factors. Methodological challenges include the lack of systematically applied terminology in suicide and risk factor research, the low base rate of suicide, and its complex, multidetermined nature. Although variables in mental, physical, and social domains have been correlated with completed suicide in older adults, controlled studies are necessary to test hypothesized risk factors. Prospective cohort and retrospective case control studies indicate that affective disorder is a powerful independent risk factor for suicide in elders. Other mental illnesses play less of a role. Physical illness and functional impairment increase risk, but their influence appears to be mediated by depression. Social ties and their disruption are significantly and independently associated with risk for suicide in later life, relationships between which may be moderated by a rigid, anxious, and obsessional personality style. Affective illness is a highly potent risk factor for suicide in later life with clear implications for the design of prevention strategies. Additional research is needed to define more precisely the interactions between emotional, physical, and social factors that determine risk for suicide in the older adult.

Aged↗

PubMedDate not supplied

Personality and attempted suicide in depressed adults 50 years of age and older: a facet level analysis.

We examined the contribution of personality traits to attempted suicide, the number of suicidal attempts, and suicidal ideation in a sample of depressed inpatients. Personality was assessed via the Revised NEO Personality Inventory (NEO-PI-R). Bivariate analyses showed that suicide attempters were more self-conscious, self-effacing, impulsive, and vulnerable to stress, and less warm, gregarious, and inclined to experience positive emotions. Multivariate regression analyses controlling for age, gender, severity of depression, and psychiatric comorbidity showed that patients with a lifetime history of attempted suicide were less inclined to experience positive emotions and be more self-effacing. Patients with more severe suicidal ideation were less warm and more self-effacing. Results indicated that specific personality traits confer risk for suicidal behaviors in middle age and older adults. Interventions tailored to specific personality profiles in this high-risk group should be developed, and their efficacy examined.

Affect↗

PubMedDate not supplied

Personality traits and symptom reduction in a group treatment for women with histories of childhood sexual abuse.

The influence of personality on symptom reduction has not been examined in research on treatments for women with childhood sexual abuse histories, although personality has demonstrated predictive value in other treatment contexts. This study examined personality variables associated with symptom reduction in group therapy for hospitalized women with histories of sexual abuse. Personality was measured with the NEO-Five-Factor Inventory (NEO-FFI), which yields scores on neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Among 86 women who participated in either the Women's Safety in Recovery (WSIR) group therapy or treatment as usual, 43 completed assessments of symptom reduction at discharge and 6-month follow-up. We hypothesized that extraversion, agreeableness, and openness to experience would be associated with treatment outcome. Our results showed that agreeableness and extraversion moderated the effect of treatment on symptom reduction. WSIR participants who were less agreeable improved more at discharge and 6-month follow-up than more agreeable WSIR participants. Moreover, women in the WSIR group who were more introverted showed greater symptom improvement at discharge than more extraverted women. Our findings suggest that more introverted, less agreeable patients with sexual abuse histories may indeed benefit from structured group treatments.

Adult↗

PubMedDate not supplied

Psychosocial factors and the response to influenza vaccination in older adults.

OBJECTIVE: We examined the influence of psychological state (depression, negative affect, perceived stress) and social support on pre- and post-vaccination response to influenza vaccine. METHODS: Venous blood was drawn from 37 nursing home residents before and following injection of the trivalent influenza vaccine (comprised of the New Caledonia (NC), Hong Kong (HK), and Panama (Pan) strains of flu). The Geriatric Depression Scale, Perceived Stress Scale, Positive and Negative Affect Schedule, and Multidimensional Scale of Perceived Social Support were completed following the initial blood draw. RESULTS: Social support and perceived stress were correlated with pre-vaccine antibody responses to two of the three vaccine components (HK and NC). Social support was negatively correlated with both pre- and post-vaccine titers to Pan. Depression, positive affect, and negative affect were not related to vaccine response. CONCLUSIONS: Perceived stress and social support influence the rate of decline of antibody titers to previous exposures to some strains of influenza occurring either naturally or via deliberate vaccination.

Affect↗

PubMedDate not supplied

Physicians' responses to patients' medically unexplained symptoms.

OBJECTIVE: To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS). METHODS: After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux disease (GERD) with nausea and insomnia (the GERD role) and poorly characterized chest pain with fatigue and dizziness (the MUS role). The visits were surreptitiously audiorecorded and analyzed using the Measure of Patient-Centered Communication (MPCC), which scores physicians on their exploration of the patients' experience of illness (component 1) and psychosocial context (component 2), and their attempts to find common ground on diagnosis and treatment (component 3). RESULTS: In multivariate analyses, MUS visits yielded significantly lower scores on MPCC component 1 (p = .01). Subanalysis of component 1 scores showed that patients' symptoms were not explored as fully and that validation was less likely to be used in response to patient concerns in the MUS than in the GERD visits. Component 2 and component 3 were unchanged. CONCLUSION: Physicians' inquiry into and validation of symptoms in patients with MUS was less common compared with more medically straightforward patient presentations. Further research should study the relationship between communication variables and poor clinical outcomes, misunderstandings, mutual distrust, and inappropriate healthcare utilization in this population, and test interventions to address this problem.

Adult↗

PubMedDate not supplied

Preliminary report on childhood sexual abuse, suicidal ideation, and suicide attempts among middle-aged and older depressed women.

OBJECTIVE: Authors examined the relationship between childhood sexual abuse histories and suicidal ideation and behavior among depressed women age 50 years and older. METHODS: After admission to a psychiatric unit, participants were administered the Structured Clinical Interview for DSM-III-R and measures of suicidal ideation and behavior. RESULTS: Women who reported abuse histories were more likely to report suicidal ideation at the time of hospitalization and a history of multiple suicide attempts. CONCLUSIONS: These preliminary findings underscore the need for more study of how childhood abuse amplifies risk for suicidal ideation and behavior among women across the life course.

Child↗

PubMedDate not supplied

Religious coping and depression among spouses of people with lung cancer.

A cancer diagnosis frequently activates a range of coping responses in patients and their spouses and may affect their emotional well-being. The authors hypothesized a curvilinear relationship between religious coping and depression in 156 spouses of lung cancer patients. Hierarchical regression analyses were conducted with blocks of variables entered as follows: demographic characteristics; cancer stage; perceived control, self-efficacy, and social support; religious coping (linear); and religious coping squared (quadratic). There was a significant association between religious coping squared and depression. Spouses who used moderate levels of religious coping were rated as less depressed than those who used lower or higher levels.

Adaptation, Psychological↗

PubMedDate not supplied

Levels of depressive symptoms in spouses of people with lung cancer: effects of personality, social support, and caregiving burden.

The authors sought to identify the personality correlates of depressive symptoms in 120 spouses of people with lung cancer. Spouses completed questionnaires, including measures of personality (neuroticism, extraversion, and interpersonal self-efficacy), social support, and caregiving burden. Their level of depressive symptoms was measured with self-report (Center for Epidemiologic Studies Depression Scale) and interviewer (Hamilton Depression Rating Scale) ratings. Structural equation modeling showed that neuroticism was directly associated with greater depressive symptoms and indirectly associated with less social support and greater caregiving burden. Interpersonal self-efficacy was indirectly associated with the severity of depressive symptoms through both social support and caregiving burden. These findings have implications for identifying spouses of individuals with lung cancer who are vulnerable to depression and could inform the design of programs to reduce depressive symptoms in the context of cancer caregiving.

Adult↗

PubMedDate not supplied

Depressive disorders and symptoms in older primary care patients: one-year outcomes.

Syndromically diagnosable and subsyndromal depressions have substantial prevalence and functional morbidity among older persons seen in primary care, but their naturalistic outcome is largely unknown. The authors describe depressive symptoms and syndromes and functional outcomes at 1-year follow-up and examine specific outcome predictors in a cohort study using psychopathological, medical, and functional assessments at intake and 1-year follow-up. Subjects were 247 patients over age 60, recruited from private internal medicine offices and a university-affiliated family medicine clinic. Multiple-regression techniques examined the independent association of intake variables to outcome measures. Of the 63 subjects with an active depression diagnosis at study intake, 36 (57%) still had an active depression diagnosis at 1 year. The outcome for major depression was worse than for minor or subsyndromal depression. Medical illness burden and neuroticism were independent predictors of outcome. Major depression and depressive symptom severity were independently associated with poorer social functioning at follow-up. Depressive conditions had considerable rates of persistence, yet the outcome was not uniformly poor. Longer-term naturalistic study is needed, as are treatment studies targeting those at highest risk of recurrence or chronicity.

Aged↗

PubMedDate not supplied

Access to firearms and risk for suicide in middle-aged and older adults.

Elderly white men are at the highest risk for suicide. Firearms are the most common method of suicide used by both men and women in later life, and a greater proportion of older than younger suicide victims use a gun. This psychological autopsy study aimed to test hypotheses concerning the risk for suicide associated with access to and storage of firearms. Subjects included 86 suicide victims age 50 years of age and over and 86 community control subjects individually matched on age, sex, race, and county of residence. Presence of a firearm in the home was associated with increased risk for suicide, even after controlling for psychiatric illness. Elevated risk was accounted for by access to handguns rather than long guns and was more pronounced in men than women. Among subjects who kept a gun in the home, storing the weapon loaded and unlocked were independent predictors of suicide. Findings support the potential benefit for suicide prevention of restricting access to handguns. Education programs for older persons, their families, and healthcare providers concerning the risks of having a gun in the home and reinforcement of rules for safe storage may contribute to reducing the rate of suicide in older people.

Age Factors↗

PubMedDate not supplied

Aggression in suicide among adults age 50 and over.

OBJECTIVE: Aggression confers risk for suicide in younger adults, but there is a paucity of research in middle and older adults. The authors examined the link between aggression and suicide in individuals age 50 and over. METHODS: Scores on general aggression and aggression in the past month were compared in 85 cases and 85 community-comparison subjects matched on age, gender, race, and county of residence. Bivariate and multivariate tests controlling for mood disorders were conducted, along with analyses to examine age- or gender-related patterns. RESULTS: General aggression distinguished Suicide from Control subjects in men and women and in younger (50-64 years) and older (65-plus) subjects. General aggression was more strongly related to suicide in individuals under age 65. Aggression in the past month was also higher in Suicide than in Control subjects from the total sample but was not consistently higher across age and gender strata. General aggression and past-month aggression were not associated with suicide after controlling for mood disorders. CONCLUSIONS: The association of general aggression and suicide extends to middle and older adulthood, and aggression may serve as a marker for suicide risk before the onset of depression.

Aged↗

PubMedDate not supplied

Self-rated health, depression, and one-year health outcomes in older primary care patients.

OBJECTIVE: The authors tested the hypothesis that poorer self-rated health is associated with poorer health outcomes. METHOD: They prospectively examined the association of self-rated health to 1-year outcomes in 247 older subjects from primary care settings. RESULTS: Poorer self-rated health was independently associated with 1-year functional disability, after covarying initial clinical and functional measures, but was not independently associated with 1-year depression diagnosis. Results were mixed regarding associations with 1-year medical burden or mortality. CONCLUSIONS: Clinicians should be vigilant for functional decline in patients who perceive their health negatively. Future research should test potential mechanisms that might underlie this association.

Aged↗