Hopelessness as a measure of suicidal intent in the depressed elderly.

Suicidal ideation in the elderly has been related to depression, changes in health, and anticipation of a limited future. The present study examined the Hopelessness Scale (HS) and its relation to these factors in a depressed geriatric population. A total of 120 elderly outpatients, who had applied to receive psychotherapy for depression, completed the HS, Beck Depression Inventory (BDI), health ratings, and the Schedule for Affective Disorder and Schizophrenia (SADS) at intake. The HS was found to be internally consistent, and a principal components analysis revealed three distinct factors that were related to hope, feelings of giving up, and future planning. The HS, BDI, and health ratings were predictive of suicidal ideation as measured by specific items in the SADS. The relation among suicidal ideation hopelessness, depression, and health perceptions for the depressed aged are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classification of suicidal behaviors. II. Dimensions of suicidal intent

A factor analysis of a scale to assess suicidal intent showed four major dimensions: expectancies and attitudes, premeditation, precautions against intervention, and oral communication. Certain types of actions associated with attempted suicide such as seeking help or social isolation appear to be revealing of particular behavioral patterns or motives. Dealing with intent only as a global concept is an oversimplification. Suicidal ideation and suicidal acts are seen as complex patterns of behavior requiring increasingly thorough analyses for better understanding, prediction, and prevention.     

Therapy of depressed and suicidal children

The author postulates that depression exists in adolescents, with the level of ego development producing varying clinical pictures. Therapy is based upon the psychoanalytic theory of personality development. Individual treatment is based on age and intelligence of patient, level of ego development, defenses utilized, attitude of parents, and community facilities available.     

Reduction in suicidal ideation with SSRIs: a review of 459 depressed patients

This paper is a review of 459 outpatients treated in double-blind clinical drug trials using similar protocols which compared the clinical responses to specific serotonin reuptake inhibitors, norepinephrine reuptake inhibitors, mixed norepinephrine serotonin reuptake inhibitors, serotonin-2 antagonists and placebo. Although improvements in the total score on the Hamilton Rating Scale for Depression did not differ significantly among the groups, there were differences in the profile of response based on analysis of the items of the scale. The most striking difference was the significantly more rapid and effective improvement in depressed mood and the lessening of suicidal ideation among the patients treated with specific serotonin reuptake inhibitors.     

Possible association of a polymorphism of the tryptophan hydroxylase gene with suicidal behavior in depressed patients

OBJECTIVE: This study was designed to test the hypothesis that serotonin-system-related genes may be correlated with suicide risk. METHOD: Fifty-one unrelated Caucasian inpatients with major depression, with or without a history of suicidal acts, were genotyped for a biallelic polymorphism at the tryptophan hydroxylase locus. RESULTS: The less common tryptophan hydroxylase U allele occurred with greater frequency in the patients who had attempted suicide. A logistic regression analysis confirmed an association between tryptophan hydroxylase genotype and lifetime history of suicide attempts. CONCLUSIONS: Serotonergic-system-related genes may influence the risk of suicide in persons with major depression.     

Cynicism, hostility, and suicidal ideation in depressed outpatients

Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in relationship to measures of anger, aggression, hostility, cynicism, life events, and depression. There were no differences on measures of anger, aggression, hostility, and on most measures of severity of depression, but the suicidal group demonstrated more evidence of cynicism. Suicidal ideation is associated with cynicism but is unrelated to measures of hostility, anger, or aggression or to severity of depression in outpatients.     

A date with death: management of time-based and contingent suicidal intent

OBJECTIVE: The patient who voices suicidal intent in terms of the future or in terms of certain life contingencies presents special difficulties for the therapist. The authors outline the challenges posed by this problem for assessment, clinical management, and risk management. METHOD: The authors examined and analyzed case examples from both clinical and risk-management aspects. RESULTS: Problematic cases can be grouped into categories that offer insight as to management. The authors discuss this area and offer suggestions for appropriate clinical responses to this challenge. CONCLUSIONS: The authors recommend that therapists 1) treat the expressed "date with death" as a communication to be explored, 2) explore the problem of helplessness while monitoring their own countertransference responses, 3) assess the patient's competence to inform clinicians about suicidal state, and 4) readily use involuntary commitment.     

Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children.

The Hoplessness Scale for Children was developed and administered to 66 8–13 yr old children along with the Children's Depression Inventory, Bellevue Index of Depression, Depression Symptom Checklist, and the Self-Esteem Inventory. As predicted, Ss who scored high on the Hopelessness Scale showed significantly more severe depression and lower self-esteem than those who scored low on the scale. Ss who evinced suicidal attempt or ideation, independently assessed at intake diagnosis, showed greater hopelessness than Ss with no such intent. Suicidal intent was more consistently correlated with hopelessness than with depression, a finding parallel to results obtained with adults. Overall, findings suggest that negative expectations toward oneself and the future can be assessed in children and are related both to depression and suicidal intent. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stockholm and Los Angeles: A cross-cultural study of the communication of suicidal intent.

Studied the communication of suicidal intent in 50 consecutive cases of confirmed suicide selected from coroner's records in both Stockholm, Sweden, and Los Angeles, California. Using the "psychological autopsy" method, intensive interviews were conducted with a close friend or relative of the decedent approximately 2 mo. after the suicide. Results indicate that at least 60% of the victims in both cities had made direct verbal threats prior to taking their lives,while more than 80% had voiced direct or indirect threats. Responses to the suicidal communications were generally maladaptive. Cross-cultural differences in the data, and the need for better understanding of suicide dynamics among laymen are discussed. (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerability to specific life events and prediction of course of disorder in unipolar depressed patients.

Tested a cognitive-life stress integrative model that predicted depressive symptoms following stressful life events when the negative events were personally meaningful to the individual, and likely to be interpreted as depletions or failure in the domain of central relevance to self-worth. 27 unipolar depressed outpatients completed a sociotropy-autonomy scale and were followed prospectively for periods of up to 2 yrs, with periodic assessments of life events and symptoms. As predicted, Ss' periods of worst symptoms followed a 3-mo period in which life event stress that matched their personally relevant domain significantly exceeded that of the nonrelevant domain. For Ss who experienced an onset following a symptom-free period, the severity of symptoms was significantly predicted by the interaction of their autonomy score and achievement events; however, the same pattern did not occur for sociotropy score and interpersonal events. (French abstract) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The diagnosis and treatment of subclinical hypothyroid states in depressed patients

The diagnosis and treatment of subclinical hypothyroidism in mood-disordered patients is complex and somewhat controversial. The psychiatrist must recognize that such subclinical states may contribute to depression, mood cycling, or delayed response to treatment if undetected. Autoimmune thyroiditis, which may ultimately lead to various grades of hypothyroidism, may also be seen in depressed populations, particularly in postpartum females. The author discusses these issues by means of a clinical vignette, then proposes an algorithm for the diagnosis and treatment of hypothyroid states in mood disordered populations.     

Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients

The aims of this study were to determine whether detection of major depression in primary care was associated with improved outcome, and to compare the 4.5 month outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients. Primary care patients with major depression were recruited from the practices of 50 family physicians in Southeastern Michigan using a two-stage selection procedure employing the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Structured Clinical Interview for DSM-III-R (SCID); clinician detection of depression was ascertained by response to a direct query on a rating form. Depressed patients seeking treatment in an outpatient psychiatric setting also received the CES-D and the SCID. Data on patient demographics and clinical characteristics were obtained for both primary care and psychiatric patients. Initial and 4.5 month scores on the Hamilton Depression Rating Scale (HAM-D) were obtained for 34 undetected and 25 detected depressed primary care and 55 depressed psychiatric patients. Improvement in depression over time was assessed by the change in HAM-D scores over the 4.5 months. The three groups did not differ in initial severity. Both psychiatric and undetected primary care patients showed significant improvement at 4.5 months, whereas detected primary care patients did not improve. At 4.5 months there were no differences in mean HAM-D scores between undetected, depressed primary care patients and depressed psychiatric outpatients. This result did not change after controlling for age and severity of depression at initial presentation, nor did it change after exclusion of cases of mild depression to control for a possible "floor effect." However, differences among groups in the stage of depressive episodes may have affected this comparison. These findings suggest that an exclusive focus on increasing detection of depression in primary care patients is unlikely to improve outcomes, and that undetected depression among primary care patients does not necessarily represent poor quality of care. Although depressed psychiatric patients in this study had better outcomes than detected depressed primary care patients, the presence of unmeasured differences among groups in the stage of the depressive episode makes it impossible to determine whether treatment of depression by psychiatrists is superior to that provided by primary care physicians. These findings should stimulate efforts to examine a more comprehensive model for detection and treatment of depression in primary care.     

Problem-solving skills in suicidal psychiatric patients.

We examined a diathesis-stress-hopelessness model of suicidal behavior, the diathesis in question being a cognitive deficit in problem solving. We further expanded an analysis of the problem-solving skills and deficits of suicidal persons. This we accomplished by comparing a sample of 50 hospitalized patients on suicidal precautions with a control sample of 50 nonsuicidal hospitalized patients. The suicidal group differed from the control group on a number of dependent measures in accordance with the hypothesis that suicidal individuals are deficient in impersonal and interpersonal problem solving, experience more stress, and are more hopeless. Interpersonal problem-solving deficits were confined to tasks requiring subjects to generate alternative solutions to problems, as well as to anticipate negative consequences for proposed solutions. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies, self-perceptions, hopelessness, and perceived family environments in depressed and suicidal children.

This study evaluated factors associated with depression and suicidal behavior in 8–13-year-old child psychiatric inpatients. Major differences were found in the correlates of depression and suicidal behavior. Suicidal behavior was associated with a tendency for children to perceive their families as low in control and cohesiveness and high in conflict. Suicidal children also spontaneously generated significantly fewer cognitive mediational strategies for coping with stressful life events than nonsuicidal children. Depression was associated primarily with variables reflecting negative cognitive biases. However, this negative bias was not generalized across all situational contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malpractice risks with suicidal patients.

Discusses the suicide of a patient as one of the most difficult events that a psychotherapist will ever experience. In addition to the emotional turmoil, a psychotherapist may encounter legal complications because patient suicides are potentially the basis of a malpractice suit. The malpractice risks when treating suicidal patients in inpatient and outpatient settings are explored. The legal principles of abandonment and duty to warn are reviewed and related to suicide. Psychotherapists should be certain they can provide adequate service to suicidal patients and should have back-up arrangements with a local hospital where patients may be hospitalized if necessary. Reasonable available coverage during evening hours and weekends is essential. Psychotherapists should also seek a consultation when treatment has reached an impasse or the suicidal potential is dangerously high. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protein kinase C in platelets of depressed patients

Though described in 1769, the etiology of Zenker's diverticulum remains unclear. Various primary esophageal motor disorders have been proposed, but no consistent manometric pattern or anatomic etiology has been uniformly recognized. An association with clinical neurologic disease at our institution prompted a review of 12 cases of Zenker's diverticulum in patients over 60 years of age, treated in the last 8 years. Nine patients (75%) underwent cricopharyngeus myotomy and diverticulectomy, with uniformly good results. Ten patients (83%) had an associated neurologic disorder, substantiated by cranial CT or MRI, in most cases. A wide range of neurologic problems were identified, but a strong trend toward brainstem or basilar lesions was present. As expected, the etiology of the neurologic abnormality in most patients in this group was cerebrovascular disease, but two patients had peripheral neuropathies. We suggest that the etiology of Zenker's diverticulum in the elderly may be neurologic in origin. Esophageal motor disorders, including incomplete upper esophageal sphincter opening and increased hypopharyngeal pressures, which may result in Zenker's diverticulum, may be a manifestation of central or peripheral neurologic disease in the elderly.     

The prediction of outcome in elderly psychiatric patients

Clinical and psychometric characteristics of a sample of elderly psychiatric patients were established soon after admission and they were then followed for 1 year. An attempt to predict outcome was most successful for an unfavourable type which was predictable by measures related to intellectual impairment.     

Speed in test performance in depressed patients.

Compared the performance of 2 groups of nonschizophrenic, nonorganic, psychiatric patients—25 depressed (mean age 41.4 yrs) and 25 nondepressed (mean age 37.8 yrs) Ss—on several tests, including the Quick Test, the WAIS, and 10 speed tests and measures of ambiguous figure reversal rates. The 2 groups of Ss were matched for general psychopathology, sex, age, and education. No difference in the performance on power-cognitive (i.e., intelligence) tests was found. Depressed patients performed more slowly on psychomotor speed tests, confirming an earlier study comparing depressed patients and normal controls. Findings generally confirm those of the 1st author et al (1972) and those of several earlier studies summarized by W. R. Miller (see record 1975-20082-001). (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)