Arjan W. Braam

Is Self-Rated Health Still Sensitive for Changes in Disease and Functioning Among Nonagenarians?

OBJECTIVES With age, there is an increasing gap between relatively stable levels of self-rated health (SRH) and actual health status. This study investigates longitudinal changes in SRH and examines its sensitivity to changes in chronic conditions and functioning among people aged 90 and older. METHODS In the Vitality 90+ Study, questionnaires were sent to all people aged 90 years and older living in Tampere, Finland. Included were respondents who provided data on the 2001 measurement and at least one follow-up measurement in 2003, 2007, or 2010 (N = 334). Generalized Estimating Equations analyses examined longitudinal change in SRH and the predictive value of number of chronic conditions and a functioning score based on 5 activities. RESULTS Within 2 years, most people (56.3%) had unchanged SRH, but declined SRH (22.3%) was associated with worse baseline functioning and declined functioning. Clear declines in SRH after 6 and 9 years were associated with increased chronic conditions (odds ratio [OR] = 1.23) and decreased functioning (OR = 1.28). The impact of chronic conditions and functioning was smaller among institutionalized people (chronic conditions OR = 0.90; functioning OR = 1.18) than among people living independently (chronic conditions OR = 1.30; functioning OR = 1.44). DISCUSSION SRH among nonagenarians was sensitive to changes in the number of chronic conditions and functioning although more pronounced on the longer than on the shorter term.

Do negative life events promote gerotranscendence in the second half of life

Objectives: Gerotranscendence has been defined as a developmental shift in meta-perspective from a materialistic and pragmatic view to a more cosmic and transcendent view. Although gerotranscendence has been argued to increase with age and life experiences, the results have been mixed and based on cross-sectional studies. We use a longitudinal setting to investigate the role of negative life events, age, and gender on change in one dimension of gerotranscendence, cosmic transcendence. Method: 1569 individuals (ages 58–89) answered a questionnaire on cosmic transcendence in two cycles of the Longitudinal Aging Study Amsterdam in 1995–1996 (time 1) and 1998–1999 (time 2). Controlling for education, marital status, religious affiliation, chronic diseases, functional limitations, depressive symptoms, and social support, change models based on structural equation modeling were fitted to the data to test whether negative life events, age, and gender were associated with change in cosmic transcendence. Results: A higher number of negative life events, especially negative life events other than deaths of others, were associated with increased cosmic transcendence, whereas experiencing no negative life events was associated with decreased cosmic transcendence. The level of cosmic dimension was higher at older than younger ages. Cosmic transcendence decreased over time among the older participants and women, whereas it increased among the younger participants and men. Conclusion: Experiencing negative life events has the potential to promote the development of cosmic transcendence, even when controlling for age and gender. In the absence of negative life events, however, cosmic transcendence was observed to decline with aging.

Structured assessment of suicide risk in a psychiatric emergency service: Psychometric evaluation of the Nurses’ Global Assessment of Suicide Risk scale (NGASR):

Background: Risk of suicide is notoriously difficult to assess, and no gold standard is available, in terms of an instrument of first choice. Many different instruments are in use, among which are some that are not properly psychometrically investigated. Aim: The aim of this study is to establish the psychometric properties of the Dutch version of the Nurses’ Global Assessment of Suicide Risk scale (NGASR), and the feasibility of its use in assessing suicide risk. Therefore, our research questions are as follows: what is the reliability, validity, interpretability and feasibility of the NGASR? Methods: A psychometric study of acceptability, reliability and predictive validity among 252 patients making use of a concurrent instrument, the Suicide Intention Scale (SIS), concurrent assessment by a physician and 6-month follow-up. Results: Factor analysis identified five factors. Cronbach’s alpha was .45. Intraclass correlation was .92 (95% confidence interval (CI) = .85–.95). Association between total NGASR and SIS was substantial and significant (B = 0.66, standard error of mean (SE) = 0.19, ß = .66, p = .003). NGASR total score had a significant and moderately strong association with judgement by a physician on ‘suicidal thoughts’ (odds ratio (OR) = 1.24, p = < .001) or ‘suicidal thoughts or plans’ (OR = 1.35, p = .001). No significant association of NGASR scores and 6-month follow-up of suicidality was found. Conclusions: Internal consistency of the NGASR and most of the subscales identified was low. Other indicators of reliability of the NGASR were sufficient, although predictive validity was poor. The NGASR did not outperform other instruments but is easy to use, and may contribute to identification of risk factors, as well as to a more integral assessment of suicide risk.

Revelation, delusion or disillusion: subjective interpretation of religious and spiritual experiences in bipolar disorder

The objective of this study is to explore the interpretation of religious and spiritual experiences during mania, depression and recovery, from the perspective of bipolar clients and to inquire into their expectations of treatment in relation to these experiences. For this purpose, a qualitative pilot study is designed, which includes interviews with 10 outpatients of Altrecht, a Dutch mental health institution. The meaning of religious and spiritual experiences and the question of their authenticity proved to be an important theme for the participants. The support of spirituality for illness management was brought to the fore, as well as the temporary lack of this support during depression by some participants. Participants considered it desirable that more attention be paid to the topic during treatment, and to establish better cooperation between spiritual counsellors of the institution and other professionals. Thus, a more existential or hermeneutical approach towards religious experiences in relation to bipolar disorder would be a desirable contribution to standard treatment. The exact outlines of such an approach demand more empirical research.

An Item Response Theory Analysis of The Questionnaire of God Representations

ABSTRACT The Dutch Questionnaire of God Representations (QGR) was investigated by means of item response theory (IRT) modeling in a clinical (n = 329) and a nonclinical sample (n = 792). Through a graded response model and IRT-based differential functioning techniques, detailed item-level analyses and information about measurement invariance between the clinical and nonclinical sample were obtained. On the basis of the results of the IRT analyses, a shortened version of the QGR (S-QGR) was constructed, consisting of 22 items, which functions in the same way in both the clinical and the nonclinical sample. Results indicated that the QGR consists of strong and reliable scales which are able to differentiate among persons. Psychometric characteristics of the S-QGR were adequate.

Towards a Multidisciplinary Guideline Religiousness, Spirituality and Psychiatry: What do we need?

ABSTRACT A multidisciplinary guideline on religion, spirituality (R/S), and psychiatry aims to address: (1) organising R/S consultation in mental health care, (2) categorising research findings, and (3) professionalism and education with respect to R/S. Contents are derived from brainstorm sessions with key participants in the field of R/S and psychiatry in the Netherlands, and from the position statements on R/S and psychiatry in the UK and by the World Psychiatric Association. The following chapters are proposed: (1) ethical and existential themes and R/S, (2) R/S in stages of mental health care practice, (3) R/S counselling, (4) collaboration, and (5) relationship to other guidelines. The core themes need verification by specialists in the field, nurses, therapists, counsellors, patient-practitioners, and psychiatrists. The author recommends to approach R/S in an easy way, to listen to matters of personal meaning, and to leave the task to others in case of a lack of affinity.

Late-life depressive symptoms, religiousness, and mood in the last week of life

Aim of the current study is to examine whether previous depressive symptoms modify possible effects of religiousness on mood in the last week of life. After-death interviews with proxy respondents of deceased sample members of the Longitudinal Aging Study Amsterdam provided information on depressed mood in the last week of life, as well as on the presence of a sense of peace with the approaching end of life. Other characteristics were derived from interviews with the sample members when still alive. Significant interactions were identified between measures of religiousness and previous depressive symptoms (CES-D scores) in their associations with mood in the last week of life. Among those with previous depressive symptoms, church-membership, church-attendance and salience of religion were associated with a greater likelihood of depressed mood in the last week of life. Among those without previous depressive symptoms, church-attendance and salience of religion were associated with a higher likelihood of a sense of peace. For older adults in the last phase of life, supportive effects of religiousness were more or less expected. Fore those with recent depressive symptoms, however, religiousness might involve a component of existential doubt.

Moral Objections and Fear of Hell: An Important Barrier to Suicidality

This review explores the literature to test the hypothesis that ‘moral objections to suicide (MOS), especially the conviction of going to hell after committing suicide, exert a restraining effect on suicide and suicidality.’ Medline and PsycInfo were searched using all relevant search terms; all relevant articles were selected, rated and reviewed. Fifteen cross-sectional studies were available on this topic, and raise sufficient evidence to confirm a restraining effect of MOS, and sparse data on fear of hell. MOS seem to counteract especially the development of suicidal intent and attempts, and possibly the lethality of suicidal attempts. A differential pattern of influence of MOS on the suicidal continuum is suggested.

Patients’ Needs of Religion/Spirituality Integration in Two Mental Health Clinics in the Netherlands

Abstract Introduction: In the last decades, the attention for religion/spirituality (R/S) in mental health care (MHC) has considerably increased. However, patients’ preferences concerning R/S in treatment have not often been investigated. The aim of this study was to find out how patients in clinical multidisciplinary MHC want R/S to be addressed in their care. Methods: Thirty-five semi-structured interviews were carried out between September 2015 and July 2016 among patients in a secular and a Christian MHC in the Netherlands. Qualitative inductive content analysis was performed, using Atlas Ti. Results: Patients appreciated (1) individual R/S conversations between patients and care team members (mainly nurses), (2) a familiar R/S environment, (3) a special R/S program and (4) contact with their R/S network. Patients varied in their presentation of R/S care needs from (a) explicit, mostly in the Christian MHC, to (b) implicit, predominantly in the secular MHC, or showed (c) hidden R/S care needs. A non-acute stage of the illness and R/S affinity of the mental health professionals, were classified as possible conditions for addressing R/S. Discussion and implications for practice: Nurses are recommended to be aware of the diversity of patients’ R/S care needs. Actively addressing R/S may help in recognizing implicit or even hidden R/S care needs. Further considerations on whether and how to respond to patients’ R/S care needs would be justified.

Sweet delight and endless night: a qualitative exploration of ordinary and extraordinary religious and spiritual experiences in bipolar disorder.

ABSTRACT The authenticity of religious and spiritual experiences during mania is an important subject for bipolar patients. The exploration of such experience in bipolar disorder is the central point of this qualitative study. A psychiatrist and a hospital chaplain conducted 35 semi-structured interviews with recovered participants, recruited from mental health care institutions in the Netherlands, the patients’ association and via the internet, about their religious and spiritual experiences during illness episodes and in stable times. A variety in types (such as divine presence, unity, mission, meaningful synchronicity) during mania was reported, which were on a sliding scale with experiences/views in stable times in more than half of the interviews. During depression, absence of religious or spiritual experience was predominant. The reported experiences were viewed by most participants as both authentically religious or spiritual but also related to the disorder, requiring therefore language that transcended medical terminology. Also indicated is the relevance of the results for fundamental discussions about the nature or religious experience.