Showing papers in "International Journal of Psychiatry in Medicine in 2013"

Association of Anxiety and Depression with Pulmonary-Specific Symptoms in Chronic Obstructive Pulmonary Disease

Abstract: Objectives:To examine the association of anxiety and depression with pulmonary-specific symptoms of Chronic Obstructive Pulmonary Disease (COPD), and to determine the extent to which disease severity and functional capacity modify this association.Method:Patients (N = 162) enrolled in the INSPIRE-II study, an ongoing randomized, clinical trial of COPD patients and their caregivers who received either telephone-based coping skills training or education and symptom monitoring. Patients completed a psychosocial test battery including: Brief Fatigue Inventory, St. George's Respiratory Questionnaire, UCSD Shortness of Breath Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory. Measures of disease severity and functional capacity (i.e., FEV1 and six-minute walk test) were also obtained.Results:After covariate adjustment, higher anxiety and depression levels were associated with greater fatigue levels (ps < .001, ΔR2 = 0.16 and 0.29, respectively), shortness of breath (ps < .001, ΔR2 = 0....

Improving the doctor-patient relationship in china: the role of balint groups

Abstract: Objective:Doctor-patient relationships in China have been deteriorating for the past 10 years. Many Chinese doctors are involved in tense and conflictual doctor-patient relationships. Most patients do not trust doctors or other medical staff and physical attacks on these professionals have become a common event. The Balint group offers a better understanding of the doctor-patient relationship in a safe environment and relieves the doctors from the daily stress.Method:This article (1) describes the specifics of Balint work in China, (2) reports experiences from the first International Balint Conference in China, and (3) compares these experiences with the doctor-patient relationship described by Michael and Enid Balint in the 1950s.Results:Chinese doctors have a great need to communicate, to share their own feelings of powerlessness, helplessness, frustration, and anger. The Balint method is highly appreciated in China. All participants experienced the 2½-day meeting as very helpful. Also, in China, Balint...

The psychological well-being of people living with HIV/AIDS and the role of religious coping and social support.

Abstract: Objective:This study examined correlates of depressive symptoms, particularly the role of religious coping (RCOPE), among people living with HIV/AIDS (PLWHA). The study also examined social support as a possible mediator of the proposed association between religious coping and depressive symptoms and the impact of depressive symptomatology on health outcomes such as HIV medication adherence, immune function, and health-related quality of life (HRQOL) among PLWHA.Method:A convenience sample of 292 PLWHA were recruited from an out-patient infectious disease clinic and AIDS-service organizations in the Southeastern United States.Results:56.7% reported depressive symptoms. PLWHA with depressive symptomatology reported significantly poorer health outcomes, including poorer HIV medication adherence, lower CD4 cell count, and poorer HRQOL. The odds of being depressed was significantly associated with birth sex (female: OR = 0.43, 95% CI = .23-.80), sexual orientation (gay/bisexual: OR = 1.95, 95% CI = 1.04–3.65)...

Factors associated with influenza vaccination decisions among patients with mental illness.

Abstract: Objective:To determine influenza (flu) vaccination status among the mentally ill population and identify factors associated with vaccination status.Method:A non-interventional, cross-sectional study was conducted. A self-administered survey to investigate the vaccination status and perceptions related to flu vaccine was administered between October 2011-January 2012 in an outpatient psychiatry clinic that served the indigent, severely mentally ill population of Alabama. All statistical analyses were based upon a significance level of 0.05.Results:Of the 736 patients invited, 302 participated (41%). Only 28.4% were vaccinated in 2010–2011 and 24.2% had been vaccinated at the time of the survey for 2011–2012. Respondents who had private health insurance, received a recommendation from healthcare providers, and who perceived a greater degree of vaccine effectiveness were more likely to obtain flu vaccination while respondents who had education beyond high school and were more in agreement that they can get t...

Balint Groups: The Nuts and Bolts of Making Better Doctors

Abstract: Balint Group seminars were developed by Michael and Enid Balint based on the application of psychological principles in a group setting for the purpose of developing an improved understanding of the doctor-patient relationship. This article focuses on the development and application of the Balint method to the training of resident physicians (particularly Family Physicians) within the United States. An effort is made to describe the practicalities of resident physician Balint training (e.g., size, frequency, duration of such groups), conceptual underpinnings (e.g., biphasic nature of patient identification, disease versus illness concept, transference/counter-transference, over-identification, under-identification, biphasic nature of physician empathy), and pedagogic goals (mastering empathic skills inherent in being a good doctor) of residency-based Balint groups. In aggregate, this article provides a useful framework for behavioral science educators interested in applying the Balint seminar method to resident physician training. The authors encourage both the continued study and educational application of the Balint seminar method in the training of physicians both within and outside of the United States.

Gender differences in serum testosterone and cortisol in patients with major depressive disorder compared with controls.

Abstract: Objective:Testosterone may have a role distinct from cortisol in the pathophysiology of depression. The hypothalamus-pituitary-adrenal (HPA) axis affects the functions of sex steroid hormones throu...

Suicide risk in dialysis: review of current literature

Abstract: Background:Studies have shown that patients with end-stage kidney disease (ESKD) are at risk of experiencing suicidal ideation and suicide attempt.Study Design:The aim of the present review was to investigate whether there was a relationship between dialysis and suicide. A careful systematic review of the literature was conducted to determine the potential association between dialysis and suicide.Selection Criteria for Studies:Abstracts that did not explicitly mention suicide and dialysis were excluded. We identified as specific fields of interest in the analysis of dialysis or ESRD and suicidal behavior.Results:A total of 26 articles from peer-reviewed journals were considered and the most relevant articles (N = 13) were selected for this review.Outcomes:It has been posited that suicidal ideation, occurring in dialysis, may arise from co-morbid depression and psychiatric symptoms are frequent in patients who underwent dialysis.Limitations:The present review should be considered in the light of some limit...

Diagnostic validity of the composite international diagnostic interview (CIDI) depression module in an East African population.

Abstract: Objective:To evaluate the validity and reliability of the structured Composite International Diagnostic Interview (CIDI) in diagnosing current major depressive disorder (MDD) among East African adults.Methods:A sample of 926 patients attending a major referral hospital in Ethiopia participated in this diagnostic assessment study. We used a two-stage study design where participants were first interviewed using an Amharic version of the CIDI and a stratified random sample underwent a follow-up semi-structured clinical interview conducted by a psychiatrist, blinded to the screening results, using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) instrument. We tested construct validity by examining the association of the CIDI and World Health Organization Quality of Life (WHO-QOL) questionnaire. We calculated the psychometric properties of the CIDI using the SCAN diagnostic interview as a gold standard.Results:We found that the Amharic version of the CIDI diagnostic interview has good internal ...

The incidence of and risk factors for postpartum depression at an urban maternity clinic in Turkey.

Abstract: OBJECTIVE: Postpartum depression (PPD) is an important health issue that affects not only mothers, but also entire families. Postpartum follow-up should address emotional and psychological issues, as well as physical issues, especially in those at risk. This study aimed to determine the incidence of PPD and the associated risk factors in a group of new mothers undergoing routine follow-up at an urban maternity clinic. METHODS: This is a cross-sectional study investigating the relationship between PPD and various factors. A total of 187 women that presented to a university hospital for routine postpartum follow-up 4-6 weeks post delivery were recruited consecutively. The mothers were administered a sociodemographic form that included questions about the known risk factors (sociodemographic and sociocultural factors, and mother-related, pregnancy-related, and child-related factors) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The incidence of PPD based on EPDS scores was 28.9% (scores > 12 were defined as PPD). Unplanned/unintended pregnancy, bottle-feeding only, mother's lack of satisfaction with the baby's sleep pattern, lack of family support for baby care, lack of satisfaction with the marital relationship, and family violence were significantly correlated with PPD (P Language: en

Current State of Psychiatry in Saudi Arabia

Abstract: Background:In 1983, an article and accompanying editorial was published on the state of psychiatry in the Kingdom of Saudi Arabia (KSA), which was described as “a mental health system in statu nascendi.”Methods:We provide a 30-year update on advances in mental health care in KSA. Data are reported from a wide range of sources, including the 2007 Saudi Arabian Mental and Social Health Atlas, which compares services in KSA with the rest of the world.Results:We examine how the current mental health system operates in KSA, including recent changes in mental healthcare policy and development of a national mental healthcare plan. Discussed are current needs based on the prevalence and recognition of mental disorders; availability of services and providers (psychiatrists, psychiatric nurses, psychologists, and social workers); education and training in psychiatry; developments in consultation-liaison, addictions, child-adolescent, and geriatric psychiatry; and progress in mental health research.Conclusions:Menta...

Effectiveness of Prolonged Exposure for PTSD in Older Veterans

Abstract: Exposure-based therapy is an effective treatment for PTSD, including combat-related PTSD. However, questions remain within PTSD treatment literature and among front-line clinicians about the appropriateness of exposure-based therapies for older adults. The current study examined the effectiveness of Prolonged Exposure (PE) in reducing PTSD and depression symptoms in a sample of 65 Veterans age 60 and older who were diagnosed with PTSD via structured clinical interview. In addition to within-subject repeated measure analyses, the entire intent to treat sample was compared to treatment completers. Within group d-type effect sizes across both groups were large (1.13-1.90) and the retention rate was high (85%). Importantly, no adverse medical or psychiatric events were reported over the course of the study. Results are discussed and limitations, along with future directions, are presented.

Educational attainment, MRI changes and cognitive function in older postmenopausal women from the Women’s Health Initiative Memory Study

Abstract: The relationship between neuropathology and clinically manifested functional and cognitive deficits is complex. Clinical observations of individuals with greater neuropathology who function better than some individuals with less neuropathology are common and puzzling. Educational attainment, a proxy for "cognitive reserve," may help to explain this apparent contradiction. The objective of this study is to determine if educational attainment is correlated with cognitive decline, brain lesion volume, and total brain atrophy. One thousand three hundred ninety of the 7,479 community-dwelling women 65 years of age and older enrolled in the Women's Health Initiative Memory Study, two parallel randomized, placebo-controlled clinical trials comparing unopposed and opposed postmenopausal hormone therapy with placebo, were studied. Study participants received annual assessments of global cognitive function with the Modified Mini Mental State exam. One thousand sixty-three participants also received supplemental neurocognitive battery and neuroimaging studies. Magnetic resonance imaging was used to calculate total ischemic lesion and brain volumes. Incident cases of probable dementia and mild cognitive impairment were centrally adjudicated. After adjustment for total lesion and total brain volumes (atrophy), higher educational attainment predicted better cognitive performance (p < 0.001). Following conversion to dementia/MCI, higher education predicted steeper declines in cognitive function (p < 0.001). Thus, higher educational attainment was associated with a delay in diagnosis of dementia/MCI in the face of a growing neuropathological load.

Depression, irritability, and anxiety in women with premenstrual dysphoric disorder.

Abstract: Objective:Depression, anxiety, and irritability are the three most studied symptoms of premenstrual dysphoric disorder (PMDD). This study aimed to assess the premenstrual exacerbation of these symp...

Creating a Culture of Wellness: Conversations, Curriculum, Concrete Resources, and Control

Abstract: Burnout and depression across the career life cycle of healthcare providers are increasing at alarming rates We need to devote our resources and efforts to bolster the next generation of healthcare providers who have the capacity for resiliency and well-being—the antidote to burnout and depression A handful of organizations have implemented general wellness programs to combat burnout but there are surprisingly few documented, well-researched interventions to build resiliency Wellness provides an alternative framework to approach the epidemic rates of burnout and depersonalization within the healthcare profession In this article we describe our rationale for developing a culture of wellness among primary care physicians along with the specific activities and initiatives for creating a culture of wellness throughout medical educational training Examples of the four core components of a residency wellness program—concrete resources, positive conversations, curriculum, and control—are described with rega

Training family medicine residents to practice collaboratively with psychology trainees.

Abstract: Objective: This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. Methods: The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: 1) clinic huddle, 2) shadowing, 3) pull-ins and warm handoffs, 4) co-counseling, 5) shared precepting, 6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, 7) lectures, 8) video-observation and

Parenting stress and dimensions of parenting behavior: cross-sectional and longitudinal links with adolescents' somatization.

Abstract: Objective: This study explored direct and indirect associations between adolescents' somatization, parenting stress, and three parenting dimensions (warmth, psychological control, and harsh punishment). First, the associations were explored cross-sectionally. Second, significant cross-sectional links were further examined longitudinally in order to decide upon temporality. Method: A total of 1499 adolescents and one of their parents (mostly the mother) agreed to participate. Questionnaires were administered when the child was respectively 12-13 (T1), 13-14 (T2), and 14-15 (T3) years old. Adolescents reported on their somatization, parents on their parenting behavior and parenting stress. Results: Cross-sectionally, indirect links were found between all parenting dimensions and adolescents' somatization, through parenting stress. Longitudinal examination revealed two key aspects. First, parenting stress significantly predicted somatization. Higher T1 parenting stress was predictive for higher T2 and T3 somatization. When controlled for T1 parenting stress, higher T2 parenting stress (or in other words increased parenting stress at T2) was predictive for lower T3 somatization. Second, parenting stress was found to significantly predict parenting behaviors. Higher T1 parenting stress was predictive for higher T2 and T3 harsh punishment but increased parenting stress at T2 was predictive for lower harsh punishment one year later. Higher T1 parenting stress significantly predicted higher T2 psychological control. Conclusions: Clinicians should be aware that parenting stress may be a risk factor for the development of somatization in early adolescence. However, in later adolescence, increased parenting stress might be protective.

Suicide prevention as a prerequisite for recovery from severe mental illness.

Abstract: For a significant number of people suffering from severe mental illness (SMI) prevention of suicide is a prerequisite for their recovery. This review summarises and interprets risk/protective factors for suicide in the context of schizophrenia and bipolar disorder, thereby enabling evidence-based suicide risk assessment and management. A history of self-harm greatly increases suicide risk among people with schizophrenia or bipolar disorder. Suicide prevention for patients with SMI necessitates constant vigilance by (mental) health and social care professionals in contact with them, particularly those with a history of self-harm, males, young people, those near illness onset, people with a family history of suicidal behaviour (especially suicide), victims of childhood abuse, those challenged by recent adverse life events (notably interpersonal conflict), people with aggressive/impulsive personality features, and those who have expressed hopelessness. Research suggests that suicide risk associated with SMI should be reduced by early intervention, restricting access to lethal means, improvement of treatment adherence, treating more patients with clozapine and lithium, assertive outreach, treating psychiatric comorbidity (depression, alcohol/drug misuse, etc.), 24-hour crisis care, timely (compulsory) hospitalization (sufficient bed provision imperative), improving psychiatric inpatient ward safety, lowering the risk of absconding from wards, appropriate use of electroconvulsive therapy, intensive follow-up postdischarge, and improving access to psychological/psychosocial interventions, notably cognitive behavioural therapy. The clinical interview is the optimum method of suicide risk assessment and locally developed risk assessment tools should not be used. Evidence-based suicide risk assessment/management within primary care and secondary mental health services warrants recurrent, mandatory training.

Association of CD8 T cells with depression and anxiety in patients with liver cirrhosis.

Abstract: Objective:Depression and anxiety frequently co-occur in patients with cirrhosis, but their underlying biological substrates are unclear. There is now evidence to suggest that depression is accompan...

An update on the efficacy of cognitive-behavioral therapy, cognitive therapy, and exposure therapy for posttraumatic stress disorder.

Abstract: Objective:Even though cognitive-behavioral therapy (CBT) is the current treatment of choice for posttraumatic stress disorder (PTSD), it is still unclear which components of its protocol are more i...

Perioperative psycho-educational intervention can reduce postoperative delirium in patients after cardiac surgery: a pilot study.

Abstract: Objective:Postoperative delirium after cardiac surgery is associated with many consequences such as poorer functional recovery, more frequent postoperative complications, higher mortality, increased length of hospital stay, and higher hospital costs. The aim of this study was to evaluate the efficacy of perioperative psycho-educational intervention in preventing postoperative delirium in post cardiac surgery patients.Method:We conducted a comparative retrospective study between 49 patients who had received perioperative psycho-educational intervention and 46 patients who had received standard care. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included length of ICU stay, and severity and duration of postoperative delirium among the patients who had developed delirium.Results:The incidence of postoperative delirium was significantly lower in the intervention group than that in the control group (12.24% vs. 34.78%, P = 0.009). Among the patients who had developed posto...

The relationships between postpartum adaptation and postpartum depression symptoms of first pregnancy mothers in Taiwan.

Abstract: Background:Motherhood is a critical situation characterized by role conflicts. These conflicts between the roles of mother, worker, and wife are the norm in the postpartum period and may jeopardize...

Metabolic syndrome: differences between psychiatric and internal medicine patients.

Abstract: Objectives:The existence of specific features of Metabolic Syndrome (MetS) in psychiatric population in comparison to not psychiatric patients has not been systematically investigated. The purpose of this study is to evaluate the differences of MetS among a group of psychiatric patients and a group of internal medicine patients in terms of anthropometric measurements, biochemical variables, and cardiovascular risk.Methods:We enrolled 83 psychiatric inpatients under pharmacological treatment (schizophrenia n = 24, bipolar disorder n = 27, major depression n = 14, other n = 18) and 77 internal medicine patients visited for supposed MetS as affected by overweight or arterial hypertension.Results:Psychiatric patients differed from control subjects by age (yrs) (47 ± 9 vs. 52 ± 8.6, p = 0.001), waist circumference (cm) (111.9 ± 10.9 vs. 106 ± 12.6,p= 0.02), HDL cholesterol (mg/dl) (36.8 ± 7 vs. 48 ± 11.3, p = 0.001), serum insulin (µU/ml) (26 ± 12.5 vs. 16.4 ± 8.8, p = 0.001), triglyceride/HDL cholesterol rati...

Greater frequency of depression associated with chronic primary headaches than chronic post-traumatic headaches

Abstract: Objective:To compare the prevalence of co-morbid depression between patients with chronic primary headache syndromes and chronic posttraumatic headaches.Method:A prospective cross-sectional analysi...

Forty days after the Great East Japan Earthquake: field research investigating community engagement and traumatic stress screening in a post-disaster community mental health training.

Abstract: The current article describes the results of posttraumatic stress educational outreach and screening offered to 141 citizens of Japan who attended a public-service mental health training regarding post-disaster coping 40 days after a 6.8 Richter Scale earthquake, local and regional deaths, and an ongoing nuclear radiation threat. Attendees were given access to anonymous questionnaires that were integrated into the training as a tool to help enhance mental health literacy and bridge communication gaps. Questionnaires were turned in by a third of those in attendance. Among respondents, multiple exposures to potentially-traumatic events were common. More than a quarter of respondents met criteria for probable PTSD. Physical health and loss of sense of community were related to PTSD symptoms. Associations and diagnosis rates represented in these data are not generalizable to the population as a whole or intended for epidemiological purposes; rather, they are evidence of a potentially useful approach to post-disaster clinical screening, education, and engagement. Results are presented in the context of previous findings in Japan and ecologically-supportive post-disaster field research is discussed.

Evaluation of the relationship between the ZNF804A single nucleotide polymorphism rs1344706 A/C variant and schizophrenia subtype in Han Chinese patients.

Abstract: Objective:Recent genome wide association studies (GWASs) assessing the relationship between schizophrenia (SZ) and the ZNF804A gene, particularly the single nucleotide polymorphism (SNP) rs1344706, have yielded conflicting results. Schizophrenia is a heterogeneous disorder, so it is possible that an association may be restricted to specific SZ subtypes and that population heterogeneity may obscure a contribution of ZNF804A allelic variation to SZ risk. We thus evaluated the association between rs1344706 and different clinical SZ subtypes in a large Han Chinese patient population.Method:The rs1344706 genotype was determined in 1,025 SZ patients and 977 healthy controls using polymerase chain reaction restriction fragment length polymorphisms (PCR-RFLPs). The clinical SZ subtypes included paranoid, catatonic, disintegrated, and undifferentiated, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition IV (DSM-IV).Results:No significant differences in genotype and allel...

Control Strategies and Suicidal Ideation in Older Primary Care Patients with Functional Limitations

Abstract: Suicide is an important public health problem that disproportionately affects older adults. In 2010, adults age 65 or older comprised 13.0% of the U.S. population but represented 15.6% of the suicides [1]. Risk of suicide is especially elevated in men aged 75 and older, whose rate is nearly triple the overall suicide rate in the United States [2]. Depression, the predominant risk factor for suicide among older adults, is implicated in the majority of suicides in this age group [3]. Nevertheless, it is a non-specific risk factor, as the vast majority of older adults with a depressive disorder do not die by suicide. Thus, there is a pressing need to identify factors independently associated with suicide risk in older adults. Physical illness and disability are associated with increased risk of suicide in late life, and effects appear to be partially independent of depression [4]. Although there may be multiple explanations for the link between physical health problems and suicide, evidence suggests that difficulties adapting to physical limitations may play a role. Among health problems associated with suicide in late life, many are chronic and potentially disabling conditions, including some types of cancer, neurological disorders, congestive heart failure, chronic pulmonary disorder, renal failure and impairments in vision and hearing [4]. Functional impairment has been linked to suicide risk in older adults [5, 6; cf. 7], although the possibility that functional impairment explains the relation between physical illness and suicide remains to be evaluated. Additional evidence comes from studies showing that among individuals with cancer, the risk of suicide is especially elevated early in the course of the disease [8], consistent with the possibility that suicide risk is related to problems adapting to the disease. Furthermore, qualitative reports suggest that older adults who died by suicide had pronounced problems adapting to loss of control, including limitations in physical functioning [9]. Taken together, these findings are consistent with the proposition that suicidal ideation in late life may be related, in part, to problems of adaptation. The Motivational Theory of Life Span Development [10] provides a framework for understanding mental health outcomes in the context of age-associated limitations in physical functioning. According to this theory, individuals of all ages prefer to attain their goals by exerting control directly on their environment, but opportunities to exert control tend to decline with age. Individuals who exhibit flexibility in coping with their changed circumstances should have the most positive outcomes. Successful adaptation theoretically requires changing strategies for attaining goals as well as managing motivation through cycles of disengaging from unobtainable goals and reengaging with more feasible ones. Heckhausen and colleagues [10] define control strategies along two dimensions: selective versus compensatory and primary versus secondary. Selective strategies reflect investment of one’s own effort to attain a goal. In contrast, compensatory strategies involve recruitment of external resources, such as asking for help from others. Primary control strategies are those aimed at changing the environment, whereas secondary control strategies are focused on changing the self. The theory specifies that selective primary control strategies are preferred across the lifespan, but as individuals age and encounter limitations in the ability to exert primary control, use of other strategies becomes adaptive. Research supports the theory, showing that control strategies change in predicted ways with normal aging [e.g., 11], as well as following onset of health problems among older adults [12]. Furthermore, control strategies reflecting an active engagement in personal goals are associated with lower levels of depressive symptoms [13], and buffer the effects of health problems on both depressed mood and the stress response [14]. In addition, a growing literature has shown that disengagement from unobtainable goals (compensatory secondary control) is associated with better mental health outcomes relative to continued striving [e.g., 15, 16, 17]. Research also supports theoretical predictions that specific type of control strategy employed should be related to outcomes, as successful aging involves a match between opportunity for control and strategy used to exert control [10]. Similarly, Clark’s model of late life suicidal behavior suggests that individuals who have limited flexibility will have the greatest difficulty adapting to the losses associated with aging and will consequently be at risk of suicide [18]. Consistent with these theoretical frameworks, evidence shows that individuals who continue striving (selective primary control) without employing a more diverse repertoire of control strategies are at risk of poor outcomes when they encounter age-related limitations in their ability to exercise control [e.g., 15, 16, 19]. Compensatory primary control strategies, which involve the recruitment of external resources, may be particularly relevant for older adults facing health-related limitations. Among both older [20] and middle-aged adults [21] with vision impairment, compensatory primary control strategies were the most frequently endorsed strategies. Strategies related to seeking or accepting help from others were more often used by participants with more severe impairments, whereas use of technical aids was more frequently used by participants with the least severe impairments. These strategies may also be particularly adaptive. In a prospective study, older men with “health-induced task-related restrictions” who endorsed primary control striving (“persistence”) but did not endorse help seeking or task modification were at increased risk of subsequent hospitalization for medical or other reasons [19]. The Motivational Theory of LifeSpan Development also provides a basis for predicting suicidal outcomes in late life. For individuals who are not able to attain goals through direct effort (selective primary control), are not willing or able to seek help (compensatory primary control) and do not disengage from the goal (compensatory secondary control), hopelessness and suicidal thinking may ensue. Given this conceptual rationale, as well as previous research demonstrating that older adults who die by suicide are characterized by an inability to adapt to age-related losses in functioning [9], endorsement of a diverse set of control strategies in the face of independence-limiting conditions should be associated with less suicidal ideation than continued striving alone. In summary, specific profiles of control strategies have been shown to predict mental and physical health outcomes in older adults with health problems, but the relation between control strategies and suicidal ideation has not yet been tested. The purpose of the present study was to examine this relation in older primary care patients with functional limitations. Our first hypothesis, based on existing research, was that greater endorsement of compensatory primary control strategies would be associated with lower levels of both depressive symptoms and suicidal ideation, controlling for other types of control strategies. Given our conceptualization that failure to adapt to limitations may lead specifically to a hopeless state, we also anticipated that the relation between compensatory primary control strategy endorsement and suicidal ideation would be partially independent of the effects of depressive symptoms. Our second hypothesis, also based in prior empirical literature, was that greater endorsement of secondary control strategies (both selective and compensatory) would be associated with lower levels of depressive symptoms and suicidal ideation.

Physician Wellness in Rural America: A Review:

Abstract: Objective:The primary purpose of this article is to review the unique wellness factors that affect physicians practicing in rural communities. Research has indicated that rural communities often st...

The Impact of Physical and Psychological Comorbid Conditions on the Quality of Life of Patients with Acute Myocardial Infarction: A Multi-Center, Cross-Sectional Observational Study from Turkey

Abstract: Objective:Acute myocardial infarction (MI) has significant and detrimental effects on the lifestyles of the patients. It has been shown that quality of life (QoL) in patients with MI is impaired in...

Does a copycat effect exist in the emergency department

Abstract: Objective:This study aimed to examine the copycat effect of a famous actress's suicide on suicide attempts visiting the emergency department (ED) in Korea.Method:We retrospectively reviewed the medical records of suicide attempt cases which had visited the EDs of two general hospitals during the 6 months before and after a celebrity suicide. We obtained data pertaining to demographics, history of psychiatric illnesses and suicide attempts, method of the suicide attempts, discharge status, and follow-up compliance.Results:We identified 319 cases during the study period, of which 158 cases occurred before the celebrity suicide, and 161 occurred after the event. Following the celebrity suicide, suicide attempts with the similar age and the same method as the celebrity's suicide (hanging), presence of psychiatric history, and use of intensive and multiple methods increased. We observed that suicide attempts with the similar age and the same method of hanging were consistent with a copycat effect. Despite a de...

Hopelessness the "active ingredient"? Associations of hopelessness and depressive symptoms with interleukin-6.

Abstract: Objective: Previous research has revealed a relationship of depressive symptoms and hopelessness with cardiovascular diseases (CVDs) which are associated with elevated levels of interleukin-6 (IL-6). The objective of this study was to explore whether depressive symptoms and hopelessness are independent predictors of IL-6 levels. Method: Hopelessness, depressive symptoms, and IL-6 were measured in 45 Swedish adults (26 women and 19 men; age range: 31-65 years). Two separated linear regressions were conducted with hopelessness and depressive symptoms serving as individual predictors of IL-6. Another regression analysis examined whether the two predictors predict IL-6 when controlling for each other. The regression coefficients of the models with one predictor and with both predictors were compared. Results: As predicted, after adjusting for age, BMI, illness, smoking, and gender, more depressive symptoms and more hopelessness predicted higher IL-6 levels in independent regressions. When controlling for each other, hopelessness, but not depressive symptoms, predicted IL-6 levels. Finally, when controlling for hopelessness, the regression between depressive symptoms and IL-6 level was significantly reduced; however, there was no significant change in the regression between hopelessness and IL-6 level when controlling for depressive symptoms. Conclusions: Thus, these results suggest that depressive symptoms and hopelessness are not independent predictors of IL-6 levels. Future research should explore the interplay of hopelessness and depressive symptoms on other risk factors of CVDs.