David Baxter PhD
Late Founder
Social disconnectedness ups depression severity, suicide ideation
By SHARON WORCESTER, Clinical Psychiatry News
April 2, 2013
Older adults who screen positive for social disconnectedness in the primary care setting have high levels of depressive symptom severity and a high likelihood of suicide ideation and behavior during their lifetime, according to findings from a survey of 153 patients.
A smaller proportion of the subjects screened positive for current death and suicide ideation, Kimberly A. Van Orden, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.
The findings suggest that social disconnectedness is a form of distress that might indicate an elevated suicide risk, according to Dr. Van Orden of the University of Rochester (N.Y.).
The study subjects, mean age 71 years, screened positive for social disconnectedness based on responses to the 9-item Patient Health Questionnaire, or PHQ-9 (a measure of depression symptom severity), the Interpersonal Needs Questionnaire, (a measure of belongingness and perceived burdensomeness), the Geriatric Suicide Ideation Scale, or GSIS (a measure of meaning in life, suicide ideation, and death ideation), and the Paykel Scale (a measure of "worst point" lifetime suicide ideation and behaviors). Substantial proportions of patients indicated having experienced suicide ideation and behaviors, based on the Paykel Scale.
For example, 52% had felt that life was not worth living, 41% had wished they were dead, 41% had thought of taking their own life, 26% had seriously considered suicide or made plans to commit suicide, and 19% had attempted suicide. Furthermore, PHQ-9 responses indicated that 7% of respondents had current death/suicide ideation.
Similarly, GSIS responses indicated that 6% of subjects had wanted to end their life, 6% reported that they would end their life "if things get much worse," 4% said they had recently been thinking a great deal about specific ways to end their life, and 2% said they might end their life if they "could only muster the energy to do so."
The findings are important, because although social disconnectedness is a known risk factor for mental illness and increased risk for suicide in later life, it is not well characterized among older adult primary care patients.
This is a key gap in the literature, particularly given that older adults with depression and other mental health problems are likely to seek treatment through primary care, Dr. Van Orden noted.
Patients in the current study underwent screening in the primary care setting and an in-home baseline psychosocial interview as part of a baseline evaluation for a randomized trial of peer companionship.
The findings underscore the importance of social disconnectedness in older adults, and suggest a possible role for screening and intervention in those affected by it, she said.
"Social disconnectedness is malleable via psychosocial intervention," she concluded. "Thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behavior, and indicate a target for intervention."
This study was funded by grants from the Centers for Disease Control and Prevention, the National Institute of Mental Health, and the National Institutes of Health.
By SHARON WORCESTER, Clinical Psychiatry News
April 2, 2013
Older adults who screen positive for social disconnectedness in the primary care setting have high levels of depressive symptom severity and a high likelihood of suicide ideation and behavior during their lifetime, according to findings from a survey of 153 patients.
A smaller proportion of the subjects screened positive for current death and suicide ideation, Kimberly A. Van Orden, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.
The findings suggest that social disconnectedness is a form of distress that might indicate an elevated suicide risk, according to Dr. Van Orden of the University of Rochester (N.Y.).
The study subjects, mean age 71 years, screened positive for social disconnectedness based on responses to the 9-item Patient Health Questionnaire, or PHQ-9 (a measure of depression symptom severity), the Interpersonal Needs Questionnaire, (a measure of belongingness and perceived burdensomeness), the Geriatric Suicide Ideation Scale, or GSIS (a measure of meaning in life, suicide ideation, and death ideation), and the Paykel Scale (a measure of "worst point" lifetime suicide ideation and behaviors). Substantial proportions of patients indicated having experienced suicide ideation and behaviors, based on the Paykel Scale.
For example, 52% had felt that life was not worth living, 41% had wished they were dead, 41% had thought of taking their own life, 26% had seriously considered suicide or made plans to commit suicide, and 19% had attempted suicide. Furthermore, PHQ-9 responses indicated that 7% of respondents had current death/suicide ideation.
Similarly, GSIS responses indicated that 6% of subjects had wanted to end their life, 6% reported that they would end their life "if things get much worse," 4% said they had recently been thinking a great deal about specific ways to end their life, and 2% said they might end their life if they "could only muster the energy to do so."
The findings are important, because although social disconnectedness is a known risk factor for mental illness and increased risk for suicide in later life, it is not well characterized among older adult primary care patients.
This is a key gap in the literature, particularly given that older adults with depression and other mental health problems are likely to seek treatment through primary care, Dr. Van Orden noted.
Patients in the current study underwent screening in the primary care setting and an in-home baseline psychosocial interview as part of a baseline evaluation for a randomized trial of peer companionship.
The findings underscore the importance of social disconnectedness in older adults, and suggest a possible role for screening and intervention in those affected by it, she said.
"Social disconnectedness is malleable via psychosocial intervention," she concluded. "Thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behavior, and indicate a target for intervention."
This study was funded by grants from the Centers for Disease Control and Prevention, the National Institute of Mental Health, and the National Institutes of Health.
