ABSTRACT
BACKGROUND: People who have attempted suicide display suboptimal decision-making in the lab. Yet, it remains unclear whether these difficulties tie in with other detrimental outcomes in their lives besides suicidal behavior. We hypothesize that this is more likely the case for individuals who first attempted suicide earlier than later in life. METHODS: A cross-sectional case-control study of 310 adults aged ≥ 50 years (mean: 63.9), compared early- and late-onset attempters (first attempt < 55 vs. ≥ 55 years of age) to suicide ideators, non-suicidal depressed controls and non-psychiatric healthy controls. Participants reported potentially avoidable negative decision outcomes across their lifetime, using the Decision Outcome Inventory (DOI). We employed multi-level modeling to examine group differences overall, and in three factor-analytically derived domains labeled Acting Out, Lack of Future Planning, and Hassles. RESULTS: Psychopathology predicted worse decision outcomes overall, and in the more serious Acting Out and Lack of Future Planning domains, but not in Hassles. Early-onset attempters experienced more negative outcomes than other groups overall, in Lack of Future Planning, and particularly in Acting Out. Late-onset attempters were similar to depressed controls and experienced fewer Acting out outcomes than ideators. LIMITATIONS: The cross-sectional design precluded prospective prediction of attempts. The assessment of negative outcomes may have lacked precision due to recall bias. CONCLUSIONS: Whereas early-onset suicidal behavior is likely the manifestation of long-lasting decision-making deficits in several serious aspects of life, late-onset cases appear to function similarly to non-suicidal depressed adults, suggesting that their attempt originates from a more isolated crisis.
ABSTRACT
Structured surveys were conducted with 19 medical experts, and 17 non-medical experts in related fields, attending a meeting about pandemic influenza. Respondents gave quantitative judgments for key variables potentially affecting the extent of a possible H5N1 pandemic. The medical experts saw about a 15% (median) chance of efficient human-to-human transmission, in the next 3 years. Should it occur, they saw almost no chance of there being adequate vaccines or antiviral responses. They saw varying chances of six other mitigation strategies reducing the threat, expressing the greatest faith in improved surveillance. Compared to the medical experts, the non-medical experts saw much higher chances of both human-to-human transmission and of effective vaccine and antiviral responses being available. The medical experts and the non-medical experts had similar, dire predictions for the extent of casualties, should transmission occur in the next 3 years. Their responses to open-ended questions revealed some of the theories underlying these beliefs.
