Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older.

OBJECTIVE: To investigate whether living alone is significantly associated with expression of suicide ideation among mood-disordered mental health patients and whether degree of family connectedness moderates the association between living alone and expression of suicide ideation. DESIGN: Cross-sectional survey design. SETTING: Inpatient and outpatient mental health services in Rochester, New York. PARTICIPANTS: A total of 130-mood-disordered inpatients and outpatients 50 years and older. MEASUREMENTS: Patients completed a demographics form, an interviewer-rated measure of current suicide ideation (Scale for Suicide Ideation), and a self-report measure of family connectedness derived from the Reasons for Living Scale-Older Adult version. RESULTS: Patients who reported greater family connectedness were significantly less likely to report suicide ideation; this protective effect was strongest for those living with others (Wald χ(2)[df = 1] = 3.987, p = 0.046, OR = 0.905; 95% CI = 0.821-0.998). A significant main effect of family connectedness on suicide ideation suggested that having a stronger connection to family members decreased the likelihood of reporting suicide ideation (Wald χ(2)[df = 1] = 9.730, p = 0.002, OR = 0.852; 95% CI = 0.771-0.942). CONCLUSIONS: These results suggest potential value in assessing the quality of interpersonal relationships when conducting a suicide risk assessment among depressed middle-aged and older adults.

Detection of depression in older adults by family and friends: distinguishing mood disorder signals from the noise of personality and everyday life.

BACKGROUND: The capacity of friends and family member informants to make judgments about the presence of a mood disorder history in an older primary care patient has theoretical, clinical, and public health significance. This study examined the accuracy of informant-reported mood disorder diagnoses in a sample of primary care patients aged 65 years or older. We hypothesized that the accuracy (sensitivity and specificity) of informant reports would vary with the patient's personality. METHODS: Hypotheses were tested in 191 dyads consisting of patients and their friends or relatives (informants) recruited from primary care settings. Gold-standard mood disorder diagnoses were established at consensus conferences based on a review of medical charts and data collected in a structured interview with the patient. Patients completed an assessment battery that included the NEO-Five Factor Inventory. RESULTS: Sensitivity and specificity of informant-derived mood disorder diagnoses were related to patient personality. Sensitivity of informant-derived lifetime mood disorder diagnoses was compromised by higher Extraversion and higher Agreeableness. Specificity of informant-derived lifetime mood disorder diagnoses was compromised by lower Agreeableness and higher Conscientiousness. CONCLUSION: Patient personality has implications for the accuracy of mood disorder histories provided by friends and family members. Given that false negatives can have grave consequences, we recommend that practitioners be particularly vigilant when interpreting collateral information about their extraverted, agreeable patients.

Association of alexithymia and depression symptom severity in adults aged 50 years and older.

OBJECTIVES: Alexithymia is a characteristic style of thinking and feeling involving deficits in the recognition of emotions. It is associated with depression onset and severity in younger adults, but researchers have not yet examined the association between alexithymia and depression severity in clinically depressed older adults. DESIGN: Cross-sectional. PARTICIPANTS: One hundred thirty-four patients aged 50 years or older with a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I mood disorder and currently receiving mental health treatment. MEASURES: Alexithymia was measured using the Toronto Alexithymia Scale-20, a 20-item measure with subscales assessing difficulty identifying feelings, difficulty describing feelings (DDF), and externally oriented thinking. Depression symptom severity was measured using the Beck Depression Inventory, Second Edition (BDI-II). RESULTS: Total alexithymia scores were independently related to depressive symptom severity after controlling for demographics, cognitive functioning, and illness burden. DIF and DDF subscale scores were also independently associated with BDI-II scores. CONCLUSION: The association between alexithymia and depression symptom severity could be attributed to difficulties in recognizing and describing negative emotions and resulting delays in seeking mental health treatment. Future research should focus on modifiable risk factors related to difficulties identifying and describing feelings.

Childhood sexual abuse is associated with physical illness burden and functioning in psychiatric patients 50 years of age and older.

OBJECTIVE: To examine the association of childhood sexual abuse (CSA) with cumulative illness burden, physical function, and bodily pain (BP) in a sample of male and female psychiatric patients >or=50 years of age. Previous research on the health consequences of sexual abuse has focused on nonpsychiatric samples of younger-age adults, especially women. The health implications of abuse for mixed-gender samples of older psychiatric patients have not been explored. METHODS: Participants were 163 patients with primary mood disorders. Sexual abuse histories were collected via patient self-report, as was BP. The measure of medical illness burden was based on chart review. Clinical interviewers rated physical function, using the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales. Linear and logistic regressions examined the association between CSA and health outcomes. RESULTS: As hypothesized, severe childhood sexual abuse was associated with higher cumulative medical illness burden, worse physical function, and greater BP. Comparisons of regression coefficients revealed that severe CSA's influence on illness burden is roughly comparable to the effects of adding 8 years of age. For ADL impairment and BP, the effects are comparable to adding 20 years of age. CONCLUSIONS: Strong relationships exist between CSA and medical illness burden, function, and pain among psychiatric patients >or=50 years of age. These relationships cannot be ascribed to shared method variance. Early detection of patients' abuse histories could inform targeted interventions to prevent or decelerate the progression of morbidity in this high-risk group.

Concordance about childhood sexual abuse among depressed patients 50 and over and their family and friends.

In post-mortem studies of suicide, informant sources are often relied upon to provide information to identify correlates of suicide and suicidal behavior. While previous research has shown that informants can supply reliable information about patients' recent stressful life events, it is unknown whether informants and patients provide concordant data about adverse early life experiences such as childhood sexual abuse. This study examined concordance between patient and informant reports of childhood sexual abuse in a sample of depressed patients 50 years and older. Patients and informants (n=88 pairs) independently responded to items from the Childhood Trauma Questionnaire. Informants' reports of patients' severe sexual abuse histories were in high agreement with patients' reports; concordance was significantly lower, however, for milder forms of sexual abuse. These findings demonstrate the feasibility and limitations of collecting sensitive information about patients' early life experiences in research designs utilizing informant report, including postmortem studies of suicide that use psychological autopsy methodology.

Personality differences in attempted suicide versus suicide in adults 50 years of age or older.

The authors tested hypotheses concerning personality differences in treatment-seeking suicide attempters (AT; n = 60) and a community sample of suicides (SU; n = 43) over age 50. On the basis of prior research, the authors hypothesized that SU would be lower in Neuroticism and Openness and higher in Conscientiousness. A 2-group (AT vs. SU) multivariate analysis of covariance with NEO Personality Inventory--Revised (Informant Version) domain scores as dependent variables revealed that SU were lower in Neuroticism and higher in Conscientiousness. The authors conclude that AT and SU in this age group can be distinguished on the basis of informant ratings of personality traits. These differences can inform risk detection.

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.

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.

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.

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.