The relationships between quality of life, psychiatric illness, and suicidal ideation in geriatric veterans living in a veterans' home: a structural equation modeling approach.

OBJECTIVE: This study tested a structural model and examined the relationships between age, suicidal ideation, and scores on the 5-item Brief Symptom Rating Scale (BSRS-5), the 15-item Geriatric Depression Scale (GDS-15), and the Medical Outcome Study Short Form-12 (MOS SF-12) in a sample of veterans' home residents. METHODS: Of the 266 individuals recruited, 226 completed the questionnaires, resulting in a response rate of 84.9%. Participants completed the BSRS-5, GDS-15, MOS SF-12, and a demographic survey. Analysis of Moment Structures, Version 7.0, was used to test the structural relationships of the model with a structural equation modeling analysis and a maximum likelihood ratio estimation. Patient subitem scores, which ranked their feelings of depression, hostility, and inferiority, were summed to determine their 3-BSRS-subitem sum scores. RESULTS: The measures of model fitness were as follows: goodness-of-fit (χ = 12.03, df = 7, p = 0.1), goodness-of-fit index (0.98), adjusted goodness-of-fit index (0.95), comparative fit index (0.99), parsimony ratio (0.47), and root mean square error of approximation (0.06). All indices suggested that the final model fit the data well. Age was inversely related to physical component summary, which was inversely related to the 3-BSRS-subitem sum score. Mental component summary was inversely related to the 3-BSRS-subitem sum score and the GDS-15. Physical component summary was inversely related to the GDS-15. The 3-BSRS-subitem sum score correlated with suicidal ideation. CONCLUSIONS: The data reveal a significant relationship between quality of life and suicidal ideation, which may be affected more by the 3-BSRS-subitem sum score than by the GDS-15. The proposed model has the potential to help healthcare professionals effectively design and implement their suicide prevention programs.

Factors predicting transferal after psychiatric emergency management in the elderly.

AIMS: The purpose of this study was to examine the demographic and clinical characteristics that differentiate between elderly and non-elderly visitors in the psychiatric emergency room (ER), and to identify factors predicting transferal after psychiatric emergency management in the elderly. METHODS: Data were collected over four years for patients who visited the psychiatric ER. The elderly were defined as patients older than 65 years old. Demographic and clinical characteristics were analyzed using the chi(2)-test for categorical data and t-tests for continuous data. Multivariate logistic regressions were carried out to find predictive factors associated with being transferred to a general hospital for elderly visitors in the psychiatric ER. RESULTS: Elderly patients made up 3.4% of all included visitors (n = 243) during the four-year period. The mean number of visits for elderly visitors was 1.63 +/- 1.18, ranging from 1 to 7. The chi(2)-test and the t-test indicated that the elderly visitors were different from controls in many demographic and clinical variables. Multivariate logistic regression analysis showed that being transferred to a general hospital for elderly visitors in the psychiatric ER was associated with age (odds ratio = 1.32) and a greater number of previous psychiatric hospitalizations (odds ratio = 1.42). Patients without a thought-form problem also required transferal to a general hospital more often in our study. CONCLUSIONS: The study suggested that elderly visitors in the psychiatric ER were a unique group, and specific considerations should be included in the intervention for these patients.