Social Connections and Late Life Suicide

社会关系和晚年自杀

• 批准号: 9088500
• 负责人: Kimberly Allison Van Orden
• 金额: $ 16.75万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9088500
• 关键词: Accounting; Address; Adult; Aftercare; Age; Age-associated memory impairment; Award; Behavior; Behavior Therapy; Caring; Cessation of life; Clinical; Cognition; Country; Coupled; Data; Depressed mood; Development; Elderly; Elderly man; Elements; Feeling; Feeling suicidal; Funding; Goals; Growth; Health; Impaired cognition; Individual; Intervention; Intervention Studies; Knowledge; Link; Loneliness; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Mentors; Outcome; Patients; Population; Prevention; Primary Care Physician; Primary Health Care; Protocols documentation; Provider; Psychologist; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Project Grants; Risk Factors; Role; Sampling; Severities; Site; Social Functioning; Suicide; Suicide attempt; Suicide prevention; Training; Woman; Work; aged; base; career development; clinically significant; cognitive function; depressive symptoms; effective therapy; experience; geriatric depression; high risk; ideation; improved; innovation; interpersonal therapy; medical specialties; men; minor depressive disorder; power analysis; programs; reducing suicide; research study; skills; social; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; trial comparing

DESCRIPTION (provided by applicant): Older adults have higher rates of suicide than younger individuals in the U.S. (and most countries in the world) and the size of the older adult population will rise dramatically in the coming decades, making suicide in later life an issue of pressing public health concern. It is not known how to prevent suicide among older adults; empirical data indicating how to prevent suicide among this high-risk population are notably lacking. The Candidate's career development goal is to be a leading expert in the study of suicide and its prevention in older adults. Reaching that goal requires training in three domains of geriatric research (described below), as well as completion of a mentored research project that will produce substantive, foundational results (also described below). Primary care is a key site for late life suicide prevention: two-thirds or more of older adults who die by suicide are seen by primary-care physicians within a month of their deaths, and up to half within a week. Depressed older adults do not tend to seek specialty mental health treatment. For this reason, Training Objective 1 for this K23 proposal is to gain expertise interfacing with primary care as a site for both recruitment and implementation of innovative interventions with older adults at risk for suicide. It is also known that depression is a strong risk factor for late-life suicide, but te vast majority of depressed older adults do not die by suicide. Further, evidence is beginning to accumulate suggesting that targeting depression in older adults does not sufficiently lower suicide risk among older adults. For example, in the PROSPECT trial, a significant number of older adults remained suicidal at the end of the intervention. Thus, intervention studies targeting older adults at risk for suicide are needed; in particular, we need to understand how these interventions work to effectively implement and disseminate them. For this reason, Training Objective 2 is to gain expertise in the implementation of behavioral intervention protocols for older adults. Depressed older adults frequently present with cognitive impairment. Further, social functioning deficits are also associated with cognitive impairment. Thus, to properly characterize research samples and draw valid inferences from data, the candidate will need to know how to accurately assess cognitive decline. For this reason, Training Objective 3 is to gain knowledge of, and skills assessing, aging-related cognitive decline. The candidate's program of research will be informed by her training and experience as a clinical psychologist, in particular by theoretical and empirical evidence that she helped establish showing the central importance of social disconnectedness to suicide. With the long-term research goal of improving interventions for late-life suicide, the principal objective of the research study proposed here is to examine whether increasing social connectedness -- the degree to which older adults feel connected to, and as if they contribute to, valued relationships -- is a mechanism by which behavioral interventions reduce risk for suicide. To achieve this objective, the candidate requires pilot data demonstrating that a manualized (thus replicable) behavioral intervention does, in fact, increase connectedness while adjusting for correlates of connectedness-depression and cognitive functioning. Despite the likelihood of this association, the question has simply not been comprehensively addressed. This study will recruit n = 100 adults aged 60 years from primary care who endorse both disconnectedness (i.e., feeling lonely and/or like a burden on others) and clinically significant depression. Subjects will be randomly assigned to a behavioral intervention targeting disconnectedness (i.e., Interpersonal Psychotherapy; IPT) or care-as-usual (CAU). At baseline, 3-month, and 6-month assessments, subjects will report on social connectedness, cognitive decline, and depression. The project's Research Aims are: Aim 1: To examine whether a manualized intervention (IPT) can increase connectedness among older adults. Aim 2: To examine whether an intervention targeting social functioning (IPT) also reduces late-life suicide risk. Aim 3: To examine increases in connectedness as a mechanism whereby IPT decreases depression. The resulting findings of this K23 project on depression and death ideation (i.e., indicators of suicide risk) will function as the basis for a larger R01-funded study powered to examine suicide ideation and behavior as outcomes. These findings will be coupled with the candidate's substantial pilot data supporting the link between disconnectedness and both suicide ideation/behavior and depression. Subsequent to this award, the candidate will build on the skills acquired in this period of mentored career development to contribute to the development and refinement of approaches to suicide prevention in later life.

描述（由申请人提供）：在美国（以及世界上大多数国家），老年人的自杀率高于年轻人，在未来几十年，老年人人口的规模将急剧上升，使晚年自杀成为一个紧迫的公共卫生问题。人们不知道如何预防老年人自杀；关于如何在这一高危人群中预防自杀的经验数据明显缺乏。候选人的职业发展目标是成为老年人自杀及其预防研究的主要专家。要实现这一目标，需要在老年研究的三个领域进行培训（如下所述），并完成一个将产生实质性基础成果的指导研究项目（如下所述）。初级保健是预防晚年自杀的关键场所：三分之二或更多的自杀身亡的老年人在死亡后一个月内得到初级保健医生的诊治，多达一半的人在死亡后一周内得到诊治。抑郁的老年人不倾向于寻求专门的心理健康治疗。因此，本K23提案的培训目标1是获得与初级保健相结合的专业知识，作为招募和实施针对有自杀风险的老年人的创新干预措施的场所。众所周知，抑郁症是晚年自杀的一个重要风险因素，但绝大多数患有抑郁症的老年人并没有死于自杀。此外，越来越多的证据表明，针对老年人的抑郁症并不能充分降低老年人的自杀风险。例如，在PROSPECT试验中，大量老年人在干预结束时仍有自杀倾向。因此，干预研究有针对性

项目成果

The association between higher social support and lower depressive symptoms among aging services clients is attenuated at higher levels of functional impairment.

老年服务客户中较高的社会支持与较低的抑郁症状之间的关联在功能障碍程度较高时减弱。

• DOI: 10.1002/gps.4266
• 发表时间: 2015
• 期刊: International journal of geriatric psychiatry
• 影响因子: 4
• 作者: VanOrden,KimberlyA;Li,Yan;Podgorski,CarolA;Conwell,Yeates
• 通讯作者: Conwell,Yeates

Domains of Functional Impairment and Their Associations with Thwarted Belonging and Perceived Burden in Older Adults.

功能障碍的领域及其与老年人归属感受挫和感知负担的关联。

• DOI: 10.1080/07317115.2019.1650406
• 发表时间: 2020
• 期刊: Clinical gerontologist
• 影响因子: 2.8
• 作者: Mournet,AnnabelleM;Bower,Emily;VanOrden,KimberlyA
• 通讯作者: VanOrden,KimberlyA

Assessing the role of physical illness in young old and older old suicide attempters.

评估身体疾病在年轻和年长的自杀未遂者中的作用。

• DOI: 10.1002/gps.4390
• 发表时间: 2016
• 期刊: International journal of geriatric psychiatry
• 影响因子: 4
• 作者: Wiktorsson,Stefan;Berg,AnneI;Wilhelmson,Katarina;MellqvistFässberg,Madeleine;VanOrden,Kimberly;Duberstein,Paul;Waern,Margda
• 通讯作者: Waern,Margda

Suicide and aging: special issue of Aging & Mental Health.

自杀与衰老：《老龄化》特刊

• DOI: 10.1080/13607863.2015.1099037
• 发表时间: 2016
• 期刊: Aging & mental health
• 影响因子: 3.4
• 作者: Sachs-Ericsson,Natalie;VanOrden,Kimberly;Zarit,Steven
• 通讯作者: Zarit,Steven

Few Sex Differences in Hospitalized Suicide Attempters Aged 70 and Above.

70 岁及以上住院自杀未遂者的性别差异很小。

• DOI: 10.3390/ijerph15010141
• 发表时间: 2018
• 期刊: International journal of environmental research and public health
• 作者: Wiktorsson,Stefan;RydbergSterner,Therese;MellqvistFässberg,Madeleine;Skoog,Ingmar;IngeborgBerg,Anne;Duberstein,Paul;VanOrden,Kimberly;Waern,Margda
• 通讯作者: Waern,Margda