Competence to terminate life-sustaining care: ethical and legal considerations.
Explore the source record for details and available documents.
Advance Directives↗
Biomedical subjects
Yeates Conwell
Publications and source records attributed to Yeates Conwell.
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↗
Comparison of characteristics between geriatric and younger subjects with schizophrenia in community.
Relatively little is known about the different characteristics of non-institutionalized geriatric and younger subjects with schizophrenia. This study compared demographic and clinical characteristics of all the geriatric, middle-age and young subjects with schizophrenia living in a Chinese rural community. Geriatric (age >/= 65 years) (N = 51), middle-age (age 41-64 years) (N = 263) and young subjects with schizophrenia (age 15-40 years) (N = 196) in a rural community were assessed with the Present State Examination and Social Disability Screening Schedule. Age at first onset was significantly older in geriatric male and female groups. While there were no significant differences of negative symptoms among the three groups, the rates of lifetime nuclear syndrome were significantly lower in geriatric subjects compared to the other two groups. Geriatric subjects were less likely to have been hospitalized (9.8%) than middle-age (19.0%) and younger subjects (24.8%). Although the duration of illness was significantly longer in geriatric subjects than in the other two groups, the clinical outcome was significantly better in the geriatric group and social functioning scores were similar among the three groups. Geriatric subjects were more likely to be female, with longer duration of illness, fewer "core" symptoms, relatively stable social functioning and clinical outcome. The pathogenesis and psychopathology of geriatric subjects may be different compared to younger subjects with schizophrenia.
Adolescent↗
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↗
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↗
Theme issue: suicidal behaviors in older adults.
Explore the source record for details and available documents.
Aged↗
Risk factors for late-life suicide: a prospective, community-based study.
Despite the fact that people age 65 and older have the highest rates of suicide of any age-group, late-life suicide has a low prevalence, making it difficult to conduct prospective studies. The authors examined risk factors for late-life suicide on the basis of general information collected directly from older subjects participating in a community-based prospective study of aging, the Established Populations for Epidemiologic Studies of the Elderly. Demographic variables, presence of a relative or friend to confide in, alcohol use, and sleep quality were assessed at baseline interview. Baseline and follow-up data were used to determine physical, cognitive, and affective functioning, as well as medical status. Of 14,456 people, 21 committed suicide over the 10-year observation period. Depressive symptoms, perceived health status, sleep quality, and absence of a relative or friend to confide in predicted late-life suicide. Suicide victims did not have greater alcohol use and did not report more medical illness or physical impairment. This study provided additional information about the context of late-life depression that also contributes to suicidal behavior: poor perceived health, poor sleep quality, and limited presence of a relative or friend to confide in.
Age Factors↗
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↗
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↗
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↗