The effect of season and weather on suicide rates in the elderly in British Columbia.

OBJECTIVES: The authors examined the relationship of suicide in the elderly (65 years and older) to season and weather and compared it to that in the younger population (10-64 years). METHODS: Information on suicides and on weather was obtained for British Columbia for the period 1981 to 1991. The association of suicide with season and weather was assessed using Poisson regression. RESULTS: Whereas younger suicides were associated with season, showing a spring-summer peak, elderly suicides were associated with actual weather. They increased with higher mean daily temperature for the current month (RR = 1.16, 95% CI 1.05-1.28 for each 2.5 degrees C change in mean temperature), and with lower mean daily temperature for the preceding three months (RR = 1.12, 95% CI 1.01-1.23). CONCLUSIONS: Elderly suicide rates appear to be affected by deviations of monthly mean temperature from values expected for that time of year. Increased support by service agencies at times of predicted high risk is suggested.

Socioeconomic factors associated with suicide in elderly populations in British Columbia: an 11-year review.

OBJECTIVE: The effects of socioeconomic factors on suicide rates in the general population are widely documented. Few of these reports have specifically studied the effects of socioeconomic variables on suicide rates in the elderly population. Elderly persons have the highest suicide rates of any age-group. This group is different from the rest of the population insofar as suicide is concerned. For example, since most elderly persons are no longer in the labour force, it would be expected that they would be affected differently by economic factors such as unemployment. We report the findings of an ecological study of old-age suicide in British Columbia over an 11-year period. METHODS: We obtained information on all suicide counts (International Classification of Diseases [ICD-9] codes E590-959) recorded in the 21 health units of British Columbia over the 11-year period from October 1, 1981, to September 30, 1991, from the Division of Vital Statistics of the Province of British Columbia and Statistics Canada. Social, economic, and demographic information for the health units was obtained from census data and included the number of persons per household, proportion of the population that lived in 1-person households, immigration and migration rates for each region, proportion of the population with less than grade 9 education, proportion with less than grade 12 certification, marital status rates, unemployment rates by gender, average household income, average census family income, and labour-force participation rate by gender. We calculated overall and gender-specific suicide rates for elderly persons (65 years and older) and younger populations. Using Poisson regression analyses, we determined the cross-sectional and longitudinal relative risks associated with the socioeconomic variables for the units, and we also examined trends in suicide rates. RESULTS: There were 4630 suicides in the 11-year period. The mean suicide rate (per 100,000 population) for those over age 9 years was 18.6 (between health unit SD 5.2, 95% confidence interval [CI] = 17.0-20.2). The elderly have a higher suicide rate in every region. The male suicide rates (mean = 26.9, SD 6.4, 95% CI = 24.0-30.0) are higher than female rates (mean = 7.5, SD 1.7, 95% CI = 6.8-8.3) in every region. The factors influencing suicides were different for elderly males and elderly females. In all analyses, suicide rates in elderly females remained essentially stable across age-groups and units and over the years. Elderly male suicide rates varied across units and age-groups and over the years. CONCLUSIONS: Suicide rates are highest in males over age 74 years. There are regional differences in elderly suicide rates and the factors that influence them. Longitudinal and cross-sectional risk factors differ, and there are gender differences in the risk factors. For both elderly males and females, suicide rates appear to be influenced by social factors in the population as a whole, not just in the elderly population. Male and female employment patterns are associated with elderly male suicide rates, even though the latter are not in the labour force. For suicide in elderly women the important factors are population education, income, and migration levels.

Occurrence and effects of personality disorders in depression: are they the same in the old and young?

OBJECTIVES: To determine the frequency and effects of personality disorders on episodes of depression in elderly and young inpatients. Personality disorders are common and may affect the prognosis of Axis I disorders. METHODS: Clinical records of 89 elderly inpatients and a matched comparison group of 119 young inpatients were reviewed to confirm the diagnosis of a major depressive episode according to the DSM-III-R criteria. The frequency of personality disorder diagnoses in the 2 groups was determined. Within each group, severity, functioning, and treatment were compared between those with and without personality disorders. RESULTS: Personality disorders were diagnosed more frequently in the young (40.3%) than in the elderly (27%). Both rates were similar to previous reports. Cluster C disorders were the most common personality disorders found in the elderly, compared to cluster B disorders in the young. Personality disorder in the young was associated with longer episodes of depression (P = 0.035) and poorer family relations (P < 0.001); whereas in the elderly, personality disorder was associated with more severe episodes (P = 0.014). CONCLUSIONS: These findings suggest that the frequency and effects of personality disorders on the depressed patient may differ according to age.

Elderly suicide in British Columbia: an exploration of regional variation and related factors.

In 1986, the Canadian Task Force on Suicide reported coast-to-coast variations in suicide rates across Canada. This review of 1,040 reported suicides in British Columbia between 1985 and 1988 shows variations in suicide rates that are related to population size. Elderly suicides are disproportionate in some, but not all, regions. Urban population centres have lower suicide rates than low population areas. Explorations of the factors which explain these variations may provide understanding of suicide and its prevention.

Pyridoxine, ascorbic acid and thiamine in Alzheimer and comparison subjects.

We compared the intake and functional levels of vitamins B6, C and B1 in 15 pairs of Alzheimer's disease and normal subjects. These were similar in both groups, except that B1 had lower functional values for the subjects with Alzheimer's disease. This suggests that it is unlikely that B6 or C could be used in the treatment of Alzheimer's disease. The role of B1 needs further exploration.

An exploratory use of the Symptoms Checklist-90 in a mixed geriatric study group.

There are currently no self-rating scales of general psychopathology in the older population. Such scales can be used to screen patients who may then be referred on for psychiatric assessment. The validity of the Symptoms Checklist-90 (SCL-90), a self-rating scale of general psychopathology widely used in the nongeriatric adult population, was explored in 44 older subjects. It was compared with the Sandoz Clinical Assessment Geriatric (SCAG) scale and a measure of functional disability, the London Psychogeriatric Rating Scale (LPRS). Caregivers to all subjects also rated the degree of difficulty experienced with their care on a four-point scale. Thirty of the subjects attended a geriatric day hospital, and the remaining 14 were waiting to go into long-term care facilities. Symptoms Checklist-90 was not significantly different between the two groups of subjects (day hospital and preinstitutional) after Bonferroni corrections, though SCAG scale and LPRS were (P less than .01 for both). Although SCL-90 was correlated significantly with the SCAG scale (r = .46), it was not significantly correlated with the LPRS. It showed good internal consistency but poor face validity and an inability to differentiate between levels of difficulty for the caregiver. It is concluded that the use of SCL-90 in older people may be limited because of the lack of sensitivity to functional disability and care difficulty. This nevertheless needs to be further explored, perhaps with some modification of the scale for older people.

Geriatric psychiatry training in Canada: current teaching facilities and resources.

A survey of Canadian psychiatry residency programs requested information on training activities in geriatric psychiatry. Fourteen out of sixteen programs responded. On average ten hours of didactic instruction were provided per year over the four years of the residency program. Only one program had no facility that provided a rotation in geriatric psychiatry. The majority of programs have policies that encourage exposure of trainees to the care of the elderly. There is a concentration of teachers of this sub-specialty in a minority of centres. These findings are discussed in the light of current and future needs in the care of the elderly. Recommendations for meeting these are proposed.

Psychiatric residents' experience and career interest in geriatric psychiatry: implications for training programs.

A survey of residents' experience and career interest in geriatric psychiatry was carried out in Canadian training centres. Residents' exposure to specific training experiences in geriatric psychiatry has been steadily increasing, although a large proportion of residents continue to report insufficient amount of experience and supervision in this area. Residents viewed geriatric psychiatry as involving special skills and knowledge and half were in favour of a compulsory rotation in this area. Geriatric psychiatry was an infrequent career choice along with other areas of psychiatry that have had difficulty in recruiting. Alternative approaches to service provision and recommendations for meeting the manpower needs are discussed.

Earlier psychiatric morbidity in patients with Alzheimer's disease.

The medical charts of 188 Alzheimer patients and a comparison group of 80 nondemented patients matched for age and sex were retrospectively reviewed for history of psychiatric morbidity. The Alzheimer patients were more likely to have had a psychiatric illness earlier in life (chi 2 = 8.5238, df = 1, P less than .001) with unipolar depression and paranoid disorder being the two most frequent psychiatric disorders. Possible explanations for these findings include underreporting, facility bias, functional psychiatric features as prodromal states of Alzheimer's disease, and vulnerability to psychiatric morbidity in those who go on to develop Alzheimer's disease. The likelihood of each of these explanations is discussed.

Effects of a psychiatric rotation on psychiatric knowledge and attitudes towards psychiatry in rotating interns.

The attitudes of trainees toward Psychiatry affect their career choice and ability to properly identify and manage emotional disorders in their patients. These attitudes are determined by several factors which include preclinical and clinical training among others. We report here a study of the attitude of interns toward psychiatry using the 30 item attitude toward psychiatry (ATP-30) scale. The ATP-30 and a multiple choice questionnaire examination (MCQE) in psychiatry were completed by 96 interns at the beginning and end of their compulsory four week psychiatry rotation. The degree of satisfaction of the trainees was rated in four areas--orientation, teaching/learning experience, overall rating of rotation and relevance of rotation to career choice. There was no significant change in the mean ATP-30 scores (N = 55) during the four week rotation, but the MCQE scores (N = 74) improved significantly (P less than 0.0001). A repeated analysis of variance for the four satisfaction variables by change score in MCQE and change score in ATP-30 did not show any significant main effects or significant interactions between these change scores except with relevance of rotation. Reasons for the absence of changes in the ATP-30 scores during this rotation were explored. The implications of the improved knowledge during this rotation are also discussed. We also conclude that attitudinal change and knowledge are two independent factors which should be assessed independently in trainees.

Fathers in the newer family forms: male or female?

Current social trends have produced significant changes in the family system, with the emergence of newer family forms -- single parent and homosexual families. The author used the example of a six year old boy in a female homosexual family to discuss the theories of sex role development. The literature on father-absence and the converging roles of father and mother, men and women, were reviewed with suggestions that women may function as fathers in the newer family forms. Longitudinal studies of children in these newer family forms are needed to define the implications of these social changes for personality development theories and mental health care delivery.

Recognition of organic mental disorders by physicians.

To test the ability of nonpsychiatrist physicians to correctly diagnose organic mental disorders in patients who present with psychiatric symptoms a multiple-choice questionnaire was distributed. Given six brief case histories, little more than half (55%) of the respondents made the right choice even half of the time. The results strongly suggest a need among physicians for increased familiarity with the psychiatric manifestations of medical-surgical conditions.

Consultation liaison training in Canadian psychiatric residency programs.

Canadian Psychiatry Residency programs were surveyed through questionnaires to determine the status of Consultation Liaison Training (CLT) for the year 1979/80. Virtually all the programs offered CLT as lecture/seminars and clinical postings. The majority of residents who received CLT were in their first and second years, with the average trainee spending less than 6% of total clinical training time in Consultation Liaison work. About 9% of the total core teaching time was devoted to Consultation liaison Psychiatry (CLP) and related topics. Canadian medical students are exposed to CLP in various forms during their training. There is little interdisciplinary collaboration or post-residency fellowships in CLP at this time. The authors suggest that CLT be offered in the last two years of training when the trainee can be an effective consultant with a consolidated identity as physician and psychiatrist. They also recommend an increase in inter-departmental collaboration and further development of post-residency fellowships in Consultation Liaison Psychiatry.