[Suicidality in older adults]. / Suizidalität im Alter.

Older people have the highest suicide risk compared to all other age groups. Expressions of no longer wanting to live are also found in a large number of older people. The reasons are usually multifactorial and sometimes go back a long way in the personal biography. Limitations resulting from physical illness, mental disorders and social problems make an important contribution. Doctors are often the contact person, even though many older people avoid direct communication in this respect. It is important to perceive and actively address indirect notes, because suicidality is also changeable in very old age. Suicide prevention includes the multimodal treatment of the physical and mental illness, including the (re)activation of resources; however, it also begins in advance, when differentiated images of old age are communicated at the societal level, social participation of older people is practised and the quality of life is maintained until the end.

Depressive coping is a predictor for emotional distress and poor quality of life in a German-Austrian sample of cardioverter-defibrillator implant recipients at 3 months and 1 year after implantation.

OBJECTIVE: The implantable cardioverter defibrillator (ICD) has been proven to prolong the lives of patients with life-threatening ventricular arrhythmia. However, implant recipients must cope with numerous challenges. We studied the effects of specific coping strategies and the adaptability of coping in ICD implant recipients. METHOD: This prospective study investigated the subjective well-being and objective disease course in 180 patients with life-threatening cardiac arrhythmias, who were recruited while awaiting implantation of a cardioverter defibrillator. Patients completed well-validated self-assessment questionnaires before implantation (T0), as well as 3 months (T1) and 1 year (T2) after implantation. In addition, cardiological findings were documented. RESULTS: Depressive coping (range Beta, -0.36 to -0.58) was found to be a stable highly-significant predictor for low emotional well-being and quality of life. Active problem-oriented coping showed small positive influence (range Beta, 0.10 to 0.19). Employing a broad range of coping strategies was predictive of less emotional distress and better quality of life. CONCLUSIONS: Depressive coping is a risk factor for emotional distress and poor quality of life after ICD implantation. Patients with this tendency should be identified early and offered supportive psychotherapy.

[Cardiological and psychosocial status of patients with malignant ventricular arrhythmias before implantation of a cardioverter defibrillator. First results from the German Austrian ICD Multicenter Study (GAIMS)]. / Kardiologische und psychosoziale Befunde bei Patienten mit malignen ventrikulären Herzrhythmusstörungen vor Implantation eines internen Defibrillators--Erste Ergebnisse aus der deutsch-österreichischen Multizenterstudie zu Krankheitserleben und -verlauf bei Patienten mit implantiertem Defibrillator.

In a prospective multicenter study of coping, subjective well-being and objective course of the disease we recruited patients with life-threatening cardiac arrhythmias awaiting the implantation of a cardioverter defibrillator. All patients received a semistructured interview and a number of well validated self-assessment questionnaires. In addition, detailed cardiological findings were documented. The present paper describes the study rationale and design as well as the main study hypotheses. In addition, we present representativity data for the inclusion sample and cross-sectional psychometric findings obtained before implantation of the device. The study sample consists of 286 patients with severe ventricular arrhythmias and is almost representative for all ICD recipients in the participating centers and ICD recipients in general. Despite their severe physical impairment, patients only showed moderate levels of psychological abnormalities. Only patients with severe heart failure or a history of repeated resuscitations showed elevated rates of anxiety or depression. However, there were relevant associations among the self-rating scales: Patients with abnormal anxiety or depression scores reported significantly elevated levels of physical complaints and depressive coping. They also showed low social support and an impaired quality of life. These cross-sectional findings add to the international literature on coping and well-being of patients with malignant cardiac arrhythmias. On the background of earlier research findings and clinical experience our results show high plausibility. Prospective changes over time in the different dimensions of psychosocial adjustment and their prognostic power for future quality of life and arrhythmic events will be reported separately.