Emotion traits in older suicide attempters and non-attempters.

BACKGROUND: Emotion is a flourishing area of cross-disciplinary research that can inform traditional approaches to psychopathology. The present study examines emotion traits associated with attempted suicide in a depressed older sample. METHODS: Seven emotion traits were compared in depressed inpatients, age 50 years or older, who either had made a suicide attempt after age 50 (n=47) or had never made a suicide attempt (n=38) as assessed by self-report and a review of available medical records. RESULTS: In univariate analyses controlled for age and sex, late-life suicide attempters were lower in Warmth and Positive Emotions than non-attempters. However, only lower Anxiety was associated with attempter status when all seven emotion traits were included as predictors. Of the attempters, those who had made a greater number of attempts reported lower Positive Emotions and higher Anger/Hostility and Guilt, though only lower Positive Emotions had a significant effect independent of the other emotions. In a subsample of 41 patients whose index admission was precipitated by an attempt, lower Anger/Hostility was associated with higher intent to die, and lower Anger/Hostility and lower Guilt was associated with higher lethality of method. LIMITATIONS: The assessments of emotion traits may have been colored by transient moods, including, for the recent attempters, moods associated with the aftermath of their attempt. Participants who completed the key measures may not be representative of older attempters. CONCLUSIONS: Emotion traits are associated with suicidal behavior in older depressed patients, and the specific type of emotion and the direction of its association depends on the specific suicide variable examined. Emotion traits may be helpful in assessing suicide risk.

Profile of discrete emotions in affective disorders in older primary care patients.

PURPOSE: This research examined whether the frequencies of specific emotions are associated with major and minor depression in older primary care patients. DESIGN AND METHODS: Older primary care patients (N = 146), prescreened with a depression questionnaire, completed a diagnostic interview and an emotions questionnaire. RESULTS: Controlling for age, sex, and other psychiatric and medical illnesses, major depressives differed from nondepressed controls in nine emotions; minor depressives differed from controls in four emotions. Major depressives differed from the controls more in sadness, joy, and interest--but not anger, fear, or guilt--than in comparison sets of emotions. Minor depressives differed from the controls more in sadness and inner-directed hostility--but not guilt, anger, fear, joy, or interest--than in comparison sets of emotions. IMPLICATIONS: The frequencies of discrete emotions are differentially associated with major and minor depression; future research is needed to determine their specific diagnostic and treatment implications.

Personality factors in mental disorders of later life.

The roles of personality factors in psychopathology are most often examined from the standpoint of personality disorders, but this approach may usefully be complemented by other theoretical and methodological perspectives. In particular, individual personalities can be conceptualized as having measurable degrees of various stable traits or as demonstrating evidence of various dynamic processes, such as specific cognitive, motivational, or emotional patterns. The author discusses these three basic approaches, reviews recent representative studies from each, and indicates directions for further research. A concluding section suggests ways to integrate the various approaches to more fully understand personality factors in late-life mental disorders.

Psychological vulnerability to completed suicide: a review of empirical studies.

Retrospective research shows that close to 90 percent of suicides have a diagnosable psychiatric disorder; however, only a small proportion of individuals with psychopathology take their own lives. This article reviews the empirical literature on psychological vulnerability to completed suicide. A search of the MEDLINE and PsycINFO databases yielded 46 cohort or case-control studies that used standardized or structured assessments of psychological dimensions. Five constructs have been consistently associated with completed suicide: impulsivity/aggression, depression, anxiety, hopelessness, and self-consciousness/social disengagement. Current knowledge of psychological vulnerability to completed suicide could inform social and neurobiological research, and thereby deepen understanding of suicide while potentially bridging these areas of study.

The effect of participation in religious activities on suicide versus natural death in adults 50 and older.

This study tests the hypothesis that older persons dying by suicide, compared with natural death, are less likely to have participated in religious activities. Data from the 1993 National Mortality Followback Survey were used to compare the frequency of participation in religious activities of 584 suicides to those of 4279 natural deaths occurring among women and men ages 50 and older. Adjusting for sex, race, marital status, age, and frequency of social contact, the odds for having never participated in religious activities are greater among suicide victims, compared with natural deaths. Participation in religious activities does appear to reduce the odds of the occurrence of suicide. This effect remains even after controlling for the frequency of social contact. The identification of specific factors contributing to this intrinsic benefit of religious participation requires further investigation.

Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older.

Completed suicide may be the most preventable lethal complication of depressive disorders in older adults. Identification of risk factors for suicidal behavior has therefore become a major public health priority. Using data collected on 81 depressed patients 50 years of age and older, we report analyses designed to determine the associations between the personality traits that constitute the Five Factor Model of personality and measures of suicidal behavior and ideation. We hypothesized that low Extraversion would be associated with a lifetime history of attempted suicide, and high Neuroticism would be associated with suicidal ideation. Results were generally consistent with the hypotheses. We also observed a relationship between Openness to Experience and suicidal ideation. These findings suggest that longstanding patterns of behaving, thinking, and feeling contribute to suicidal behavior and thoughts in older adults and highlight the need to consider personality traits in crafting and targeting prevention strategies.

Completed suicide among older patients in primary care practices: a controlled study.

OBJECTIVE: To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not. DESIGN: A case-control study using data collected by psychological autopsies of suicides and prospective patient interviews for controls. SETTING: Primary care practices in Monroe County, NY. PARTICIPANTS: Forty-two suicides aged 60 years and older who visited a primary care provider within 30 days of death and 196 patients aged 60 years and older from a group practice of general internal medicine (n = 115) or family medicine (n = 81). MEASUREMENTS: Psychiatric diagnosis; depressive symptom severity; physical health and function; psychiatric treatment history. RESULTS: Completed suicides had more depressive illness (P = .001), physical illness burden (P = .0002), and functional limitations (P = .0001) than controls and were more likely to be prescribed antidepressants (P = .004), anxiolytic agents (P = .0001), and narcotic analgesics (P = .022). Among depressed subjects, affective symptom severity (P< .0001) and emotional dysfunction (P<.0001) distinguished suicide completers. However, physical health, overall function, and treatments received did not differ between groups. CONCLUSIONS: The primary care setting is an important venue for late life suicide prevention. Primary care providers should be well prepared to diagnose and treat depression in their older patients. Additional research is needed concerning the interactions of physical health, functional status, and depressive symptoms in determining suicide risk.

Anxiety and functional status in older primary care patients.

OBJECTIVE: The aim of this study was to test the hypothesis that anxiety in older primary care patients is associated with functional impairment after controlling for depression and medical comorbidity. METHOD: Primary care patients (n = 303), aged sixty or older were interviewed with a series of instruments designed to measure psychiatric symptoms including anxiety, depression, medical illness burden, and both examiner-rated and self-reported functional status. Anxiety was measured by the anxiety item of the Hamilton Rating Scale for Depression and the anxiety items of the Medical Outcomes Study Short Form SF-36. Multiple regression techniques were used to examine the association of anxiety with functional status after controlling for age, gender, education, medical burden, and depression. RESULTS: When controlled for depression and medical morbidity, increased anxiety predicted poorer social function. Anxiety was not independently associated with more basic activities of daily living. CONCLUSIONS: Further studies with more comprehensive measures of anxiety are warranted to clarify the relationships between anxiety and functional status.

Age and suicidal ideation in older depressed inpatients.

Age-related patterns of symptom presentation may complicate the recognition of suicide risk. The authors sought to determine whether there is a relationship between age and reported suicidal ideation in depressed suicide attempters (DSAs) and depressed nonattempters (DNs) 50 years of age and over. Regression analyses revealed that increasing age is significantly associated with the absence of suicidal ideation in both DSAs and DNs. Because of their lower rates of depressed mood and suicidal ideation, the depressions of older adults may more readily escape detection. Preventive or treatment measures initiated after the onset of the suicidal state may be insufficient, and other preventive strategies ought to be considered.

Sex differences in the recall of affective experiences.

Three studies tested hypotheses for sex differences in the recall of life events: differences in (a) affect intensity at encoding, (b) affect intensity at retrieval, (c) rehearsal, (d) detail of encoding, and (e) artifacts such as motivation or verbal ability. In Study 1 (N = 419), women recalled more positive (p < .01) and more negative (p < .05) life events than men. Differences in retrieval mood were not found. Study 2 (N = 55) replicated the recall differences and showed that neither rehearsal nor artifacts were responsible. Sex differences in recalling neutral everyday events also were obtained (p < .05), suggesting that affect intensity was not responsible. In Study 3 (N = 132), affective reactions to events were unrelated to recall, but sex differences in the detail of encoding (p < .001) were related to recall (p < .05). Sex differences in autobiographical memory are reliable and may be due to differences in the detail of encoding.

Attitudes of older people toward suicide and assisted suicide: an analysis of Gallup Poll findings.

OBJECTIVES: To describe the older population's attitudes toward suicide and assisted suicide, and to determine whether lenient attitudes are associated with known demographic and psychosocial risk factors for completed suicide. DESIGN: Telephone survey conducted by the Gallup Organization in November 1992. PARTICIPANTS: A sample of 802 adults in the United States (541 women and 261 men) aged 60 years and older. MEASUREMENTS: The dependent variables, attitudes toward suicide, were assessed with five attitude statements. Participants rated their agreement with each statement on 4-point Likert-type scales, subsequently dichotomized for use in univariate analyses and logistic regressions. The independent variables included income and demographic and psychosocial risk factors for suicide: age, gender, race, marital status, religiousness, self-rated health, and satisfaction with family relationships. RESULTS: The majority of respondents did not express lenient attitudes. In comparison with survey findings of physicians and the general population, a relatively smaller percentage (41%) of these older respondents believe that physician-assisted suicide should be legalized. Agreement with one or more of the attitudes presented was associated with age, gender, race, marital status, and religiousness in univariate analyses (P < .05), and race, religiousness (P < .001), gender, self-rated health, and satisfaction with family relations (P < .08) in logistic regressions. CONCLUSIONS: The hypothesized relations between risk factors for suicide and lenient attitudes toward suicide were supported. Although none of the risk factors was associated with all five attitudes, in combination the results suggested that a common set of variables predict both lenient attitudes toward suicide and suicidal behavior. Future research is necessary to determine the role of depression and other factors that may mediate the observed relationships and to determine whether the presence of specific, strongly held attitudes sanctioning suicide in an older person signals the need to assess suicide risk.

Memory for positive versus negative life events: theories for the differences between happy and unhappy persons.

Three studies examined the following hypotheses for the relation of subjective well-being (SWB) with memory for positive versus negative life events: (a) differences in retrieval mood, (b) the incidence of positive and negative events, (c) the interpretation of events, and (d) frequency of rehearsal. In Studies 1 (n = 420) and 2 (n = 94), the partial correlation of retrieval mood with recall, controlling for SWB, was trivial, suggesting that mood had little or no effect on recall. Endorsement frequencies of positive minus negative concrete events and interpretive events on checklists in Studies 2 and 3 each correlated with SWB (ps < .001), suggesting that both incidence and interpretation contributed to the recall differences. In Study 3, the recall of 55 Ss from Study 2 was retested after an 11-month interval. The lack of an interaction between SWB and recall change suggested that rehearsal did not contribute to the recall differences.

The effect of decreased renal artery perfusion pressure on intrarenal hemodynamics in the dog.

The role of decreased renal artery perfusion pressure in redistribution of renal cortical blood flow during acute hemorrhagic hypotension is unclear. Renal artery hypotension was produced in intact dogs by an intra-aortic balloon catheter placed cephalad to the origins of the renal arteries. Renal cortical perfusion was assessed using selective renal magnification arteriography, isotopically labeled microspheres, and xenon-133 washout. After 60 minutes of decreased renal artery perfusion pressure (40 to 50 mm Hg), no changes were noted in renal cortical perfusion arteriographically. Microsphaere distribution to each cortical zone was unchanged, despite a marked decrease in total renal blood flow and in flow to each zone. 133Xe washout curves permitted two interpretations: Either redistribution of blood flow away from the cortex occurred, or parallel decrease in flow to each zone occurred without redistribution. Results indicate decreased renal artery perfusion pressure does not cause redistribution of renal cortical blood flow in our model.

Reversal of oliguria and renal cortical ischemia of hemorrhagic shock in the dog with tris (hydroxymethyl) amino methane (THAM). Hemodynamic studies.

We investigated the functional and hemodynamic effects on the kidney of tris (hydroxymethyl) amino methane (THAM) infusion during sustained hemorrhagic hypotension in dogs. The large osmotic load introduced into the vascular compartment during hemorrhagic hypotension resulted in a marked reduction in systemic vascular resistance and a return of cardiac output, total renal blood flow, and the renal arteriographic pattern to normal range. The observed diuresis is probably due to an osmotic effect, because the glomerular filtration rate remains significantly depressed. Anatomical assignment of the mathematical components of the xenon washout curve led to an assessment of intrarenal blood flow distribution that was at variance with the arteriographic pattern and the intrarenal distribution of tagged microspheres.