Confidence of primary care physicians in assessing the suicidality of geriatric patients.

This study examined the confidence levels of physicians in assessing the risk of suicide among older adults in clinical settings. Of the 300 physicians who were selected from a population of 4980 family practice, internal medicine, and geriatric physicians in Illinois, 63% responded to the mail survey. Several categorical items inquired about specific assessment and treatment approaches, referral resources used, barriers to meeting the mental health needs of older patients, and sources of training in suicide risk assessment. All the training items (suicide assessment in medical school, residency, and CME courses; rating of medical school training; and insufficient training in geriatric mental health) were significantly (p < 0.01) associated with confidence in assessing suicidality. The overall model consisting of six variables explained 57% of the variation in confidence scores [F (6, 130) = 28.48, p < 0.001]. Three variables accounted for 50% of the explained variance: confidence in diagnosing depression, residency training in the assessment of suicide risk, and assessment of the intentional misuse of medication. Confidence in diagnosing depression (beta = 0.38, p < 0.001) was the strongest predictor. More effective mental health care will require specific preparation in treating geriatric patients through the full spectrum of medical training, including medical school, residency, and CME courses. Improved prevention of elderly suicide hinges on the enhancement of clinical skills in diagnosing and treating geriatric depression.

Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners.

OBJECTIVE: This study sought to describe patterns of mental health care for depressed and suicidal geriatric patients by primary care physicians (MDs) and nurse practitioners (NPs). METHODS: A probability sample of 300 Illinois MDs from the AMA Physician Masterfile and a national sample of 595 NPs from the American Academy of Nurse Practitioners were surveyed. Sixty-three percent of MDs and 61 percent of NPs responded regarding their approaches to assessing, treating, and referring older adult patients who were depressed or suicidal. Respondents rated their confidence in assessing and treating depression and suicidality and identified barriers to mental health treatment in a primary care setting. RESULTS: Both similarities and differences were found among MDs and NPs in their patterns of managing depressed and suicidal older adults. NPs used more varied approaches in assessing, treating, and referring their geriatric patients with mental health problems. MDs relied more heavily on psychotropic medications for the treatment of depression and on psychiatrists when referring suicidal older patients. NPs were more likely than MDs to note lack of training and referral resources as barriers to treating depression of older patients. NPs rated their training in geriatric mental health more favorably than MDs. CONCLUSIONS: In terms of assessment of depression, preferred treatment approaches, the use of referral resources, and perceived barriers to mental health care, there appears to be a greater orientation towards a psychosocial approach among NPs. Primary care MDs and NPs often have different perspectives that in combination could enhance the mental health care of geriatric patients.

Managing depressed and suicidal geriatric patients: differences among primary care physicians.

This study examined differences by specialty of primary care physicians in managing suicidal and depressed geriatric patients. A probability sample of 300 Illinois physicians drawn from the American Medical Association Physician Masterfile was surveyed. Significant differences were found between specialties in estimates of the prevalence of psychiatric disorders; use of assessment procedures, treatment approaches, and referrals; perceptions of obstacles to providing mental health care; and confidence in diagnosing and treating depression and suicidality. Meeting the mental health needs of the rapidly growing older population will require a greater emphasis on geriatric mental health and consistency across primary care specialties.

Prevention of elderly suicide. Physicians' assessment of firearm availability.

INTRODUCTION: Physicians have a unique role to play in the prevention of elder suicide, yet they may not be sufficiently attentive to the prominence of firearms in the rising trend in suicide by elder persons. This study sought to examine the extent to which physicians inquired about firearms with their depressed and suicidal elderly patients and further identified factors associated with physicians' likelihood of asking about firearms. METHODS: A probability sample of 300 primary care physicians in Illinois was drawn from the American Medical Association Physician Masterfile. Physicians were chosen from the specialties most likely to be involved with elderly persons: internal medicine and family practice. A mailed questionnaire yielded a 63% response rate. RESULTS: Although they were treating depressed and suicidal older patients, a sizable proportion of the respondents (42%) reported that they did not ask such patients or their family members whether they had access to a firearm. Several factors distinguished physicians who assessed for firearms from those who did not. The most salient predictors were: continuing medical education training in suicide risk assessment, expertise in geriatric mental health, confidence in diagnosing depression, having a patient mention suicide in the past year, and indicating patient reluctance as a barrier to mental health treatment. DISCUSSION: Physicians working with depressed and suicidal elderly persons need to be informed about the prevalence of elder suicide and about the likelihood of elderly persons using firearms as a method of suicide. Effective suicide prevention will require physician training that directly addresses geriatric mental health and firearm suicide, in particular, at the student, residency, and continuing education levels.

Firearm suicide among older women in the U.S.

Contrary to the common view that older women (65+) in the United States use suicide methods that have relatively low potential for death, firearms have become the most common suicide method in this group. The present study examines the association between demographic and geographic factors and the use of firearms vs other suicide methods. Data were derived from the National Center for Health Statistics (NCHS) Mortality Detail Files (1989-1991). Results from a logistic regression analysis indicate that among white women 65 and over who died by suicide in 1989-1991, the risk of using firearms varied significantly across demographic and geographic subcategories of the population. The following characteristics among women were significantly more likely to be associated with the use of firearms as a suicide method: ages 65-74, married, of lower educational attainment, in nonmetropolitan areas, and in the South. Research is needed to assess the effects of limiting firearms on the growing proportion of firearm-related suicides among older women.

Sociodemographic predictors of firearm suicide among older white males.

Compared to women, younger males, and other racial/ethnic groups in the United States, white males 65 and over have the highest suicide rates. Using the Mortality Detail Files (1989-1991), this study examined the sociodemographic factors associated with late life firearm (vs other methods) suicide among white males. White males aged 65-84 residing in nonmetropolitan areas who were married, divorced, or widowed and with less than a high school education were significantly more likely to have killed themselves with a firearm than with other methods. Policy initiatives and community interventions should incorporate knowledge of those demographic subgroups most at risk for firearm suicide.

The growing use of firearms by suicidal older women, 1979-1992: a research note.

Suicide among older women (65+) has received very little attention despite increasing numbers of suicides in this population. An examination of national mortality data from the National Center for Health Statistics for the years 1979 through 1992 shows an increasing trend in rates of suicide among older women and a declining trend among women under 65. Over the 14-year period, firearms replaced poisoning as the most prevalent method of suicide by women 65 and over. The results seem consistent with the assertion that the availability, familiarity, and cultural acceptability of firearms may play a role in the choice of suicide method among older women. Although violent death and the use of firearms are generally associated with males in our society, the trends reported here indicate that greater attention to firearm suicides among older women is warranted.

Firearm suicide among older men.

Data from the Compressed Mortality File for the years 1979 to 1991 were analyzed to determine epidemiologic trends in the rates of suicide by firearms among three age groups of white and black men age 65 and older (65 to 74 years, 75 to 84 years, and 85 years and older). In 1991, among men age 65 and older, firearms accounted for 80 percent of all suicides. Firearm suicide rates increased significantly over time among white men in all three age groups, especially those age 75 and older, and among black men between the ages of 75 and 84. Clinicians should regularly conduct a firearm-availability history with elderly men who are depressed or suicidal.

Managing elder suicide: a profile of American and Canadian Crisis Prevention Centers.

Suicides among older adults in the United States and Canada in the last decade have accounted for an increasing share of all suicides. In both countries the use of firearms among older adults has steadily increased. Despite these trends, little is known about the extent to which crisis centers are prepared to prevent elder suicide. A survey of AAS-listed crisis prevention centers examined the training, knowledge, and current practices relevant to elder suicide among personnel in 321 crisis prevention centers in both countries. Results revealed insufficient training, a lack of familiarity with recent suicide trends, and limited outreach to older adults.

Trends in firearm suicide among older American males: 1979-1988.

Elderly men are more likely to commit suicide than any other age group in the United States. Moreover, their rate of suicide steadily increased between 1979 and 1988. National Center for Health Statistics (NCHS) Compressed Mortality data were used to perform an age-specific analysis of linear trends. Males 65 and over were the most likely to use firearms followed by those 55-64. In 1988, nearly 8 out of 10 suicides by males 65 and over were committed with a firearm. Firearm-related suicide rates were much lower for blacks than whites 65 and over; however, suicides among blacks were more likely to involve firearms than among whites in this age group. The authors call for a broad public policy effort directed at reducing the availability of firearms.

Should the government pay? Caregiver views of government responsibility and feelings of stigma about financial support.

Financial support strategies to assist informal caregivers of the elderly have been implemented and/or experimented with in several states. Little is known about how receptive caregiving families are to receiving financial support from the government to assist with in-home care, particularly whether they feel stigmatized. Few existing programs have assessed caregivers' views. In examining caregivers' reactions to receiving means-tested financial assistance, it is important to assess whether they consider support of the disabled a government responsibility as well as a possible stigma. Caregivers (N = 155) of disabled veterans aged 65 and older who receive Veterans' Administration disability allowances (Aid and Attendance) were surveyed. Results indicate that caregivers feel the government is primarily responsible for supporting the long-term disabled who are cared for at home. For the most part, these caregivers did not feel stigmatized or uncomfortable receiving means-tested government assistance to support in-home care. An important implication of this study is that financial support can be a workable component of an integrated service delivery system to support informal caregiving.