ABSTRACT
OBJECTIVES: To evaluate the role of cognitive functioning and other clinical and demographic characteristics as potential predictors of suicidal ideation in older primary care patients. DESIGN: Cross-sectional. SETTING: Primary care clinics at three Department of Veterans Affairs Medical Centers, three community health centers, and two hospital networks. PARTICIPANTS: Fifteen thousand five hundred ninety older adults without dementia who were receiving primary care (mean age+/-standard deviation 74.0+/-6.4; 62.8% men). MEASUREMENTS: Hierarchical logistic regressions were conducted with passive (e.g., thoughts of being better off dead) and active (e.g., thoughts of hurting one self) suicidal ideation as outcome variables. All demographic variables (age, sex, marital status, and ethnicity) were entered in the first block. All clinical variables (distress, cognitive functioning, alcohol consumption, and perceived health) were entered in the second block. RESULTS: In addition to the typical demographic predictors of late-life suicide (age, martial status, and ethnicity), having poorer cognitive functioning, poorer health, and greater mental distress were associated with passive suicidal ideation (chi-square (chi2) (14, n=14,618)=1,192.12, P<.001). Younger age, female sex, poorer cognitive functioning, and greater mental distress were associated with active suicidal ideation (chi2(14, n=14,605)=205.35, P<.001). CONCLUSION: Distress and cognitive impairment are the only two variables that consistently predicted passive and active suicidal ideation. Primary care providers who work with older adults need to take both into consideration when evaluating suicidal ideation.
Subject(s)
Cognition Disorders/psychology , Cognition/physiology , Geriatric Assessment , Stress, Psychological/psychology , Suicide, Attempted/psychology , Aged , Cognition Disorders/epidemiology , Cognition Disorders/etiology , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Prevalence , Prognosis , Risk Factors , Stress, Psychological/complications , Stress, Psychological/epidemiology , Suicide, Attempted/prevention & control , Suicide, Attempted/statistics & numerical data , United States/epidemiologyABSTRACT
OBJECTIVES: This study focuses on examining the relations of religious participation and affiliation to mental health status among older primary care patients, and to the use and clinical outcomes of mental health services. METHODS: A sample of older adults participating in a clinical study (PRISM-E) to treat their depression with or without co-morbid anxiety (n = 1610) were queried about their religious affiliation and the frequency of their participation in religious activities. The diagnoses of depressive and anxiety disorders were made based on the MINI-International Neuropsychiatric Interview. Severity of depressive disorders was assessed by emotional distress using the CES-D. RESULTS: Those attending religious activities on a weekly, monthly, or occasional basis were significantly less likely to have suicidal ideation (p < 0.02) and emotional distress (p < 0.0001) than those who never participated or participated on a less frequent basis. Frequency of religious participation was not associated with mental health service utilization (p = 0.16), but it was predictive of a lower CES-D score at the end of the study intervention (p < 0.001). CONCLUSIONS: Religious participation is positively associated with older adults' mental health status and treatment effects, but results regarding mental health service utilization were inconclusive.
