Social Disconnection as a Global Behavioral Epidemic-A Call to Action About a Major Health Risk Factor.

This Viewpoint describes ways to address social isolation and loneliness as an urgent public health problem, through education, health policy, research, and clinical practice.

Durkheim's Theory of Social Integration and Suicide Revisited: Is It Diversity of Social Networks or Perceived Strength of Social Support That Matters?

Objective: Poor social support is a robust predictor of suicidal thoughts and behaviors (STB). However, little is known about which components of social support (ie, diversity of social networks and perceived strength of social support) may play a protective role for STB.Methods: We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions Wave III to examine whether diversity of social networks or perceived strength of social support was inversely associated with lifetime STB (ie, suicidal ideation and suicide attempts). Multivariable-adjusted analyses examined the independent association between components of social support and STB, while accounting for sociodemographic, clinical, and behavioral covariates.Results: Among adults with a history of suicide attempt, the majority reported low diversity/high perceived support (48.5%), followed by high diversity/high perceived support (36.0%). Similar patterns were found among adults with lifetime suicidal ideation. In multivariable-adjusted analyses, greater social network diversity was associated with a lower relative risk (RR) of suicidal ideation (RR = 0.83; 95% confidence interval [CI], 0.75-0.83) and attempt (RR = 0.79; 95% CI, 0.67-0.94). While greater perceived strength of social support was linked to a lower risk of suicide attempt (RR = 0.81; 95% CI, 0.68-0.97), such an association was not observed for ideation.Conclusions: Greater diversity of social networks was more strongly associated with lower risks of suicidal ideation and attempt than perceived strength of social support. Psychosocial interventions to enhance the diversity of social networks may be a source to mitigate risks for STB, but further research is warranted.

Increased Admissions of Older Adults to Substance Use Treatment Facilities and Associated Changes in Admission Characteristics, 2000-2017.

Objective: Although substance use disorder (SUD) among older adults is increasing, little has been documented about recent increases in admissions to treatment facilities and associated patient and population characteristics.Methods: We used nationwide data from the Treatment Episode Data Set: Admissions to examine annual admissions to SUD treatment facilities between 2000-2001 and 2016-2017 among adults 55 years and older compared to those aged 21 to 54. Analyses addressed the impact on admission rates of increases in the general older adult population and in sociodemographic and clinical characteristics of those admitted using bivariate and multivariate logistic regressions.Results: From 2000 to 2017, the number of older adults admitted to SUD treatment facilities increased by 203.7% as compared to 13.0% among younger adults. Admissions per 1,000 adults in the general population moderated these differences to 98.4% vs 7.2%. Older adults showed greater increases relative to younger adults in proportions admitted for cocaine/crack (odds ratio [OR], 5.35; 95% confidence interval [CI], 5.20-5.51) and cannabis (OR, 1.81; 95% CI, 1.72-1.91) use and a relative decrease in admission for opiates (OR, 0.76; 95% CI, 0.73-0.80) and alcohol (OR, 0.79; 95% CI, 0.78-0.80) along with changes in some demographics. Multivariate analysis showed that the OR for admission among older adults, as compared to younger adults, was 1.73 (95% CI, 1.65-1.80) in 2016-2017 compared to 2000-2001, adjusting for other factors.Conclusions: The number and proportion of older adults admitted to SUD treatment facilities increased substantially from 2000 to 2017 and were associated with changes in both population numbers and patient characteristics, especially a relative increase among older adults in cocaine/crack and cannabis use and a relative decrease for use of alcohol and opioids.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Utility of pretransplant psychological measures to predict posttransplant outcomes in liver transplant patients: a systematic review.

OBJECTIVE: Evaluation of liver transplant (LT) candidacy involves psychosocial evaluation to ensure appropriate organ allocation. However, the utility of pre-LT psychiatric and neuropsychological factors in predicting posttransplant outcomes remains uncertain. We reviewed current evidence on the prognostic value of pre-LT psychological factors for outcomes after LT. METHOD: We conducted a systematic review of studies with adult LT recipients that investigate the relationship between pre-LT psychiatric and neuropsychological variables and posttransplant outcomes. We searched Ovid, MEDLINE, PsycINFO, EMBASE/Scopus, Cochrane Controlled trials register and Web of Science (January 1975 to May 2015) for longitudinal, peer-reviewed studies of at least 20 subjects and written in English. RESULTS: The 19 studies included in this review are heterogeneous in population, prognosis and duration of follow-up (from 20days to more than 3 years). Findings on the prognostic value of pre-LT depression or anxiety on post-LT outcomes are mixed, though depression appears to predict lower quality of life (QOL). Pre-LT suicidal thoughts in particular are associated with post-LT depression. High submissiveness may predict rejection within 20days of LT, and low conscientiousness is associated with greater nonadherence. Whereas pre-LT cognitive performance has not been shown to predict survival, poorer performance may predict poorer QOL after LT. CONCLUSION: Further studies are needed to examine this important element of LT candidacy evaluation. Studies should evaluate psychiatric factors in large samples, include systematic evaluations by mental health clinicians and explore broader neuropsychological domains in predicting posttransplant outcomes.