0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Clinical Determinants of Suicidal Ideation and Behavior in Geriatric Depression FREE

[+] Author Affiliations

From the Weill Medical College, Cornell University, White Plains, NY.


Arch Gen Psychiatry. 1999;56(11):1048-1053. doi:10.1001/archpsyc.56.11.1048.
Text Size: A A A
Published online

ABSTRACT

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.

Probability of suicidal ideation as a function of depression (N = 354). Fitted values are shown for low (10th percentile), moderate (50th percentile), and high (90th percentile) levels of social support and seriousness of suicidal intent during previous suicide attempts. Suicidal ideation was rated with the Hamilton Depression Rating Scale suicide item (present vs absent); severity of depression was assessed by the Hamilton Depression Rating Scale total score minus the suicide item. Social support was assessed with a multiphasic assessment instrument. Suicidal intent was assessed with the Schedule for Affective Disorders and Schizophrenia.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Mean level of suicidal ideation, observed vs predicted (N = 308). Suicidal ideation was rated with the Hamilton Depression Rating Scale suicide item; severity of depression was assessed by the Hamilton Depression Rating Scale total score minus the suicide item. Disability, medical burden, and social support were assessed with the Philadelphia Multiphasic Assessment Instrument. The concordance correlation (C) measure evaluated the goodness of fit estimated by predicative models to fluctuations of observed suicidal ideation.

Graphic Jump Location

Tables

Table Graphic Jump LocationBaseline Demographic and Clinical Characteristics of 354 Elderly Patients With Unipolar Major Depression*

References

Suicide Research Consortium, Suicide Fact Sheet.  Rockville, Md National Institute of Mental Health, Centers for Disease Control and Prevention, National Center for Health Statistics1998;
Conwell  Y Suicide in the elderly. Schneider  LSReynolds  CFLebowitz  BDFriedhoff  AJeds.Diagnosis and Treatment of Depression in Late Life: Results of the NIH Consensus Development Conference. Washington, DC American Psychiatric Press1994;397- 418
Carney  SSRich  CLBurke  PAFowler  RC Suicide over 60: the San Diego Study. J Am Geriatr Soc. 1994;42174- 180
Conwell  YDuberstein  PRHerrmann  JForbes  NCaine  ED Age differences in behaviors leading to completed suicide. Am J Geriatr Psychiatry. 1998;6122- 126
Link to Article
Wallace  JPfohl  B Age-related differences in the symptomatic expression of major depression. J Nerv Ment Dis. 1995;18399- 102
Link to Article
Moscicki  EK Epidemiologic surveys as tools for studying behavior: a review. Suicide Life Threat Behav. 1989;19131- 146
Beck  ATBrown  GSteer  RADahlsgaard  KKGrisham  J Suicide ideation at its worst point: a predictor of eventual suicide in psychiatric outpatients. Suicide Life Threat Behav. 1999;291- 9
Pearson  JLConwell  YLyness  JM Late-life suicide and depression in the primary care setting. Schneider  LSed.Developments in Geriatric Psychiatry: New Directions for Mental Health Services. Vol 76 San Francisco, Calif Jossey-Bass Publishers1997;13- 38
Link to Article
Simon  GEVonKorff  M Suicide mortality among patients treated for depression in an insured population. Am J Epidemiol. 1998;147155- 160
Link to Article
Conwell  YOlsen  KCaine  EDFlannery  C Suicide in later life: psychological autopsy findings. Int Psychogeriatr. 1991;359- 66
Link to Article
Conwell  YBrent  D Suicide and aging, I: patterns of psychiatric diagnoses. Int Psychogeriatr. 1995;7149- 164
Link to Article
Henriksson  MMMarttunen  MJIsometsä  ETHeikkinen  MEAro  HMKuoppasalmi  KILönnqvist  JK Mental disorders in elderly suicide. Int Psychogeriatr. 1995;7275- 286
Link to Article
Dennis  MSLindesay  J Suicide in the elderly: the United Kingdom perspective. Int Psychogeriatr. 1995;7263- 274
Link to Article
Conwell  YDuberstein  PRCox  CHerrmann  JHForbes  NTCaine  ED Relationship of age and Axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry. 1996;1531001- 1008
Diekstra  RFvan Egmond  M Suicide and attempted suicide in general practice, 1979-1985. Acta Psychiatr Scand. 1989;79268- 275
Link to Article
Frierson  RL Suicide attempts by the old and the very old. Arch Intern Med. 1991;151141- 144
Link to Article
Spitzer  RLEndicott  JRobins  E Research Diagnostic Criteria for a Selected Group of Functional Disorders. 3rd ed. New York, NY Biometrics Research Division, New York State Psychiatric Institute1977;
Hamilton  M A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;2356- 62
Link to Article
Folstein  MFFolstein  SEMcHugh  PR Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12189- 198
Link to Article
Lawton  MPMoss  MFulcomer  MKleban  MH A research and service oriented multilevel assessment instrument. J Gerontol. 1982;3791- 99
Link to Article
Spitzer  RLEndicott  J Schedule for Affective Disorders and Schizophrenia: Life-Time Version. 3rd ed. New York, NY Biometrics Research Division, New York State Psychiatric Institute1979;
Mattis  S Dementia Rating Scale.  Odessa, Fla Psychological Assessment Resources1989;
Shay  KADuke  LWConboy  THarrell  LECallaway  RFolks  DG The clinical validity of the Mattis Dementia Rating Scale in staging Alzheimer's dementia. J Geriatr Psychiatry Neurol. 1991;418- 25
Link to Article
Vonesh  EHChinchilli  VMPu  K Goodness of fit in generalized nonlinear mixed-effects models. Biometrics. 1996;52572- 587
Link to Article
Gurland  BJCross  PSKatz  S Epidemiological perspectives on opportunities for treatment of depression. Am J Geriatr Psychiatry. 1996;4(suppl 1)S7- S13
Alexopoulos  GS Geriatric depression in primary care. Int J Geriatr Psychiatry. 1996;11397- 400
Link to Article
Wassertheil-Smoller  SApplegate  WBBerge  KChang  CJGrimm  R  JrKostis  JPressel  SSchron  Efor the SHEP Cooperative Research Group, Change in depression as a precursor of cardiovascular events. Arch Intern Med. 1996;156553- 561
Link to Article
Frasure-Smith  NLesperance  FTalajic  M Depression and 18-month prognosis after myocardial infarction. Circulation. 1995;91999- 1005
Link to Article
Bruce  MLLeaf  PJ Psychiatric disorders and 15-month mortality in a community sample of older adults. Am J Public Health. 1989;79727- 730
Link to Article
Louhivuori  KAHakama  M Risk of suicide among cancer patients. Am J Epidemiol. 1979;10959- 65
Fox  BHStanek  EJBoyd  SCFlannery  JT Suicide rates among cancer patients in Connecticut. J Chronic Dis. 1982;3585- 100
Link to Article
Chochinov  HMWilson  KGEnns  MMowchun  NLander  SLevitt  MClinch  JJ Desire for death in the terminally ill. Am J Psychiatry. 1995;1521185- 1191
Alexopoulos  GSVrontou  CKakuma  TMeyers  BSYoung  RCKlausner  EClarkin  J Disability in geriatric depression. Am J Psychiatry. 1996;153877- 885
Bruce  MLSeeman  TEMerrill  SSBlazer  DG The impact of depressive symptomatology on physical disability: MacArthur studies of successful aging. Am J Public Health. 1994;841796- 1799
Link to Article
Wells  KBBurman  MA Caring for depression in America: lessons learned from early findings of the Medical Outcomes Study. Psychiatr Med. 1991;9503- 519
Heiligenstein  JHWare  JE  JrBeusterien  KMRoback  PJAndrejasich  CTollefson  GD Acute effects of fluoxetine versus placebo on functional health and well-being in late-life depression. Int Psychogeriatr. 1997;(suppl 7)125- 137
Borson  SMcDonald  GJGayle  TDeffenbach  MLakshminarayan  SVan Tuinen  C Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics. 1992;33190- 201
Link to Article
Fawcett  JScheftner  WClark  DHedeker  DGibbons  RCoryell  W Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study. Am J Psychiatry. 1987;14435- 40
Alexopoulos  GSMeyers  BSYoung  RCKakuma  TFeder  MEinhorn  ARosendahl  E Recovery in geriatric depression. Arch Gen Psychiatry. 1996;53305- 312
Link to Article
Norris  FHMurrell  SA Transitory impact of life event stress on psychological symptoms in older adults. J Health Soc Behav. 1987;28197- 211
Link to Article
Blazer  DG Impact of late-life depression on the social network. Am J Psychiatry. 1983;140162- 166
Brim  JAWitkoff  CWetzel  RD Social network characteristics of hospitalized depressed patients. Psychol Rep. 1982;50423- 433
Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 103

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Depression

The Rational Clinical Examination
Original Article: Is This Patient Clinically Depressed?