Ehud Bodner

A systematic review of social factors and suicidal behavior in older adulthood

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness—the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

On the origins of ageism among older and younger adults.

BACKGROUND Ageism is apparent in many social structures and contexts and in diverse forms over the life cycle. This review discusses the development and consequences of ageism toward elderly people by others of any age, according to the Terror Management Theory (TMT) and the Social Identity Theory (SIT). METHOD A systematic search of the literature was carried out on the social and psychological origins of ageism in younger and older adults. RESULTS Studies on the reasons for ageism among older adults point to attitudes that older adults have toward their own age group, while studies on ageism in young adults explain it as an unconscious defensive strategy which younger adults use against death anxiety. In other words, TMT can serve as a suitable framework for ageism in younger adults, and SIT appears to explain ageism in older adults. CONCLUSIONS A dissociation of the linkage between death and old age in younger adults can be achieved by changing the concepts of death and old age. For older adults, it is recommended to improve self-worth by encouraging social contacts in which older adults contribute to younger adults, weaken the effects of age stereotypes in TV programs, and prepare middle-aged adults for living healthy lives as older adults. However, these conclusions should be regarded with caution, because several key areas (age related cues, activated cognitive processes, impact of death awareness on ageism) need to be investigated in order to validate this understanding of the origins of ageism among younger and older adults.

Staff attitudes toward patients with borderline personality disorder

OBJECTIVE Our aims were (1) to develop 2 inventories for the measurement of cognitive and emotional attitudes toward borderline personality disorder (BPD) patients and their treatment and (2) to use these tools to understand and compare attitudes of psychiatrists, psychologists, and nurses toward BPD patients. METHOD Two lists of items referring to cognitive (47 items) and emotional attitudes (20 items) toward BPD patients were formulated. Fifty-seven clinicians (25 nurses, 13 psychologists, and 19 psychiatrists), who had been working in public psychiatric institutions for more than 1 year, rated their level of agreement with each item. The list of cognitive attitudes yielded 3 factors (required treatment, suicidal tendencies, and antagonistic judgment). The list of emotional attitudes yielded 3 other factors (negative emotions, experienced difficulties in treatment, and empathy). RESULTS Psychologists scored lower than psychiatrists and nurses on antagonistic judgments, whereas nurses scored lower than psychiatrists and psychologists on empathy. Regression stepwise analyses conducted on the 3 emotional attitudes separately showed that suicidal tendencies of BPD patients mainly explained the negative emotions and the difficulties in treating these patients. All groups were interested in learning more about the treatment of these patients. CONCLUSIONS Suicidal tendencies of BPD patients provoke antagonistic judgments among the 3 professions. Nevertheless, psychiatrists, psychologists, and nurses hold distinctive cognitive and emotional attitudes toward these patients. Mapping these differences can improve the education and training in the management of BPD patients.

Soldiers Who Kill Themselves: The Contribution of Dispositional and Situational Factors

ABSTRACT The present study compared characteristics of combatant and non-combatant Israeli soldiers (ages 18–21), who committed suicide (N = 429) with others who did not commit suicide (N = 499). Measures of pre-military psychological characteristics and data reflecting adjustment to service were culled from army records. Findings indicated that, in comparison to non-suicide soldiers (NS-soldiers), soldiers who committed suicide (S-soldiers) had greater behavioral adjustment and motivation to serve. In addition, as compared to non-combatant S-soldiers, combatant S-soldiers had fewer referrals for psychological evaluation, higher sense of duty and autonomy scores and fewer unit changes. Excessive motivation to excel in the army, and the tendency to be autonomous and independent, may account for suicide among combatant S-soldiers, whereas personality weaknesses may have an impact on suicide among non-combatants. Practical implications for the disclosure of suicide risk and for preventive efforts in both groups are discussed.

Escitalopram in the treatment of negative symptoms in patients with chronic schizophrenia: A randomized double-blind placebo-controlled trial

Antidepressant medication treatment has been associated with improvement in negative symptoms in patients with schizophrenia. In this study, we evaluated the efficacy of escitalopram for the treatment of negative symptoms in patients with schizophrenia. Under double-blind conditions, 40 patients with chronic schizophrenia were randomized to add-on treatment with escitalopram (up to 20mg) or placebo for 10weeks. The primary outcome measures were the scores on the Positive and Negative Syndrome Scale (PANSS)-negative subscale and the Social Functioning Scale (SFS). Secondary outcome measures included the Positive and Negative Syndrome Scale (PANSS)-total and positive scales, the Scale for Assessment of Negative Symptoms (SANS), the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS) and the Abnormal Involuntary Movement Scale (AIMS). Of 40 patients, 36 completed the study and another 2 were excluded after 8weeks due to side effects. Thus, 38 patients (19 on both treatment arms) were considered in the efficacy analysis. The reduction in the PANSS negative subscale score was 5% for escitalopram and 10% for placebo (NS). There were no significant inter-group differences in primary and secondary endpoints. Escitalopram was well tolerated, but was not more effective than placebo in the treatment of negative symptoms in patients with chronic schizophrenia. Further work in this field is needed to determine whether some subgroups of patients with negative symptoms may nevertheless respond to antidepressant medications.

Different dimensions of ageist attitudes among men and women: a multigenerational perspective

BACKGROUND Ageism, a form of prejudice in which one relates negatively to people due to their age, exists throughout life. However, no attempt has been made to compare ageist attitudes across the life cycle, from young adulthood to old age. Consequently, the current study examined age and gender differences in ageism throughout adulthood. METHODS 955 Israeli participants (age range: 18-98 years) were divided into three age-groups: young (18-39), middle-aged (40-67), and old (68-98), and were administered the Fraboni Scale of Ageism. Age and gender differences were examined both for the three groups and for subgroups within the older adult cohort. RESULTS Multivariate analysis of variance revealed that middle-aged participants were significantly more ageist than younger and older groups. Across all age groups, men exhibited more avoidance and stereotypical attitudes toward older adults than women. Among the old age group, participants aged 81-98 held more ageist stereotypes and reported more avoidance of older adults than those aged 68-73. Within the older adult cohort, gender was a significant predictor for ageist attitudes among those aged 68-73 and 81-98, but not for people aged 74-80. CONCLUSIONS Ageism demonstrates a changing pattern across the life span. While gender differences remain stable, ageist attitudes toward growing old as we age ourselves are constantly changing. In order to gain a better understanding of ageism as a general and global phenomenon, we need to consider the role of such attitudes in different stages of life.

Impulsivity, Aggression and Suicide Risk among Male Schizophrenia Patients

Introduction: Impulsivity has been shown to be a major variable in the etiology of suicide and aggression, but has not been researched as much in the schizophrenic population, which is characterized by serious suicide and aggression risks. Methods: 68 male schizophrenia patients responded to a battery of measures including the Positive and Negative Syndrome Scale (PANSS), the impulsivity control scale (IS), the Suicide Risk Scale (SRS) and the Overt Aggression Scale. Results: We divided our subjects into those who received scores above and below the median on the IS. The high- impulsivity group had higher present and past rates of suicidal ideation and showed a trend for more lifetime suicidal attempts than the low-impulsivity group. The impulsivity score correlated positively with the SRS score and with some of the scores of the PANSS (the positive symptoms score, the general psychopathology score and the total score). A multiple regression analysis revealed that an older age, higher levels of aggression, high impulsivity and an elevated score on the general psychopathology subscale of the PANSS contributed positively and significantly to the explained variance of the SRS. Conclusions: Our study supports the contention that high impulsivity in schizophrenia patients is significant in the etiology of suicide in schizophrenia. However, the relationship between impulsivity and aggression in schizophrenia patients, and also the amelioration of impulsivity by pharmacological interventions, require further study.

Relations between attachment styles, ageism and quality of life in late life

BACKGROUND This study is the first to explore the relations between attachment styles, ageism, and quality of life (QoL) among elderly people. The attachment theory describes how human beings relate to each other, according to their attachment style. Previous studies have examined the connection between attachment styles and prejudice toward distinctive social groups and minorities. Ageism as a form of prejudice is a way of relating negatively to people because they are old. QoL among the elderly was found to be associated with negative age-perceptions. It was therefore hypothesized that QoL, attachments styles, and demographic characteristics can explain ageism among the elderly. METHODS Four questionnaires were administered: Fraboni Scale of Ageism (FSA), which comprises four scales (separation, affective, stereotype, and intergeneration); Experiences in Close Relationships Scale, which measures four attachment styles (secure, dismissive, fearful, and preoccupied); SF-36 health status inventory (eight scales); and sociodemographic questions. Ninety-four elderly men and women aged 64-85 years living in the community completed the questionnaires. RESULTS MANCOVAS indicated that securely attached individuals score lower [corrected] than fearfully attached individuals, and that securely and dismissively attached individuals score higher than fearful and preoccupied individuals on seven QoL scales. Multiple regression analyses showed that attachment styles, age, gender, and some QoL scales contribute to the explained variance of ageism. CONCLUSIONS Secure attachment in late life seems to be related to less ageism and a better QoL. The enhancement of a secure attachment base in elderly people may assist in moderating ageism and improving older peoples QoL.

Ageism among Israeli students: structure and demographic influences

BACKGROUND Research concerning negative attitudes toward the elderly among samples of North American respondents has uncovered two distinct yet comparable three-factor structures: (1) avoidance, antilocution and separation; and (2) discrimination, stereotypes and affective attitudes. In addition, previous research has demonstrated that men and younger people have more negative attitudes toward the elderly than do women and older people. The aim of this study is to examine the extent to which these findings can be generalized to individuals from a different culture. METHOD The Fraboni Scale of Ageism (FSA) was administered to 491 Israeli participants aged 20-50 years. RESULTS Exploratory factor analysis with varimax rotation uncovered a three-factor structure, similar to previous investigations. In contrast to the literature, however, no simple group (gender, age) differences were found for ageism. However, discriminant function analysis revealed a more complex relationship between age, gender and ageism. Older males, in contrast to older females, demonstrated a tendency to perceptions of the elderly that associated avoidance of the elderly with negative stereotypes whereas older females, in contrast to younger females, held perceptions that associated avoidance of the elderly with a negative perception of the elderly persons contribution to society. CONCLUSIONS Despite cultural differences between Israel and North America, the similarity of findings provides support for the generalizabilty of the structure of attitudes toward the elderly as measured by the FSA to various cultures. In addition, the combined effect of age and gender on differential forms of ageism is complex and should be examined in future research.

The interactive effect of subjective age and subjective distance-to-death on psychological distress of older adults

Objectives: Subjective age refers to how young or old people experience themselves to be, while subjective distance-to-death reflects how far or close they experience themselves to be from their death. The present study examined whether subjective age and subjective distance-to-death interact in predicting psychological distress. Method: A sample of 1073 community-dwelling older adults at the age range of 50–86 (M = 58.1, SD = 5.3) evaluated their subjective age, subjective distance-to-death, psychological distress, and rated several measures of physical health. Results: After controlling for background characteristics and physical health indices, perceiving death as far and reporting younger subjective age predicted lower psychological distress. The combination of feeling close to death and older subjective age was related to the highest ratings of psychological distress. Moreover, the effect of subjective distance-to-death on psychological distress was mitigated by younger subjective age. Conclusion: The findings underscore the importance of an integrative view of two time perspectives – one that focuses on time since birth and another that concerns time left till death – to psychological distress of older adults.