Ryan J. McCammon

Generations, Cohorts, and Social Change

The transformations that occur via a succession of cohorts cannot, for basic demographic reasons, be equated to the product of a procession of “generations.”... this brute fact is a profound key to the understanding of social continuity and social change. Indeed, a characteristically human type of society might well be impossible were the demography of the species structured differently.

Pain and suicidal thoughts, plans and attempts in the United States ☆

OBJECTIVE This study examined the association between pain and suicidality in the general US population. METHOD Using data from the National Comorbidity Survey-Replication, we assessed relationships between four measures of pain (back and neck, headache, other nonarthritic pain and a summary score of the count of these conditions) and 12-month suicidal thoughts, plans and attempts using chi-square tests and logistic regression models. Multivariate logistic regression models controlled for demographic characteristics, chronic health conditions, mood, anxiety and substance use disorders. RESULTS In multivariate models adjusting for concurrent psychiatric disorders and other chronic medical conditions, suicidal ideation was associated with head pain (OR 1.9, 95% CI: 1.2, 3.0) and the pain summary score (OR 1.2, 95% CI: 1.0, 1.4). Suicide attempt was also associated with head pain (OR 2.3, 95% CI: 1.2, 4.4) and pain summary score (OR 1.7, 95% CI: 1.1, 2.6). Other nonarthritic pain was associated with suicide attempts (OR4.0, 95% CI: 1.8, 9.1). CONCLUSIONS These findings highlight the importance of pain as a potentially independent risk factor for suicide, particularly among those with head pain or multiple forms of co-occurring pain. Individuals suffering from chronic pain may be particularly appropriate for suicide screening and intervention efforts.

Incidence of dementia and cognitive impairment, not dementia in the United States.

Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND.

Sleep problems and suicidality in the National Comorbidity Survey Replication

OBJECTIVE Links between sleep problems and suicidality have been frequently described in clinical samples; however, this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States. METHODS The WHO Composite International Diagnostic Interview was used to assess sleep problems and suicidality in the National Comorbidity Survey Replication (NCS-R). Relationships between three measures of sleep (difficulty initiating sleep, maintaining sleep, early morning awaking), and suicidal thoughts, plans, and attempts were assessed in logistic regression analyses, while controlling for demographic characteristics, 12-month diagnoses of mood, anxiety and substance use disorders, and chronic health conditions. RESULTS In multivariate models, the presence of any of these sleep problems was significantly related to each measure of suicidality, including suicidal ideation (OR=2.1), planning (OR=2.6), and suicide attempt (OR=2.5). Early morning awakening was associated with suicidal ideation (OR=2.0), suicide planning (OR=2.1), and suicide attempt (OR=2.7). Difficulty initiating sleep was a significant predictor of suicidal ideation and planning (ORs: 1.9 for ideation; 2.2 for planning), while difficulty maintaining sleep during the night was a significant predictor of suicidal ideation and suicide attempts (ORs: 2.0 for ideation; 3.0 for attempt). CONCLUSIONS Among community residents, chronic sleep problems are consistently associated with greater risk for suicidality. Efforts to develop comprehensive models of suicidality should consider sleep problems as potentially independent indicators of risk.

Prescription Sleeping Pills, Insomnia, and Suicidality in the National Comorbidity Survey Replication

BACKGROUND Sedative-hypnotics have been associated with suicide attempts and completed suicides in a number of toxicologic, epidemiologic, and clinical studies. Most studies, however, inadequately address confounding by insomnia, which not only is a component of many mental health disorders that increase suicidal risk, but also is independently associated with suicidality. Moreover, the association of nonbenzodiazepine benzodiazepine receptor agonists (NBRAs) with suicidality has not been specifically studied in the US general population. OBJECTIVE The purpose of this study was to assess the independent contribution of prescription sedative-hypnotic use, particularly the NBRAs, to suicidal ideas, plans, and suicide attempts in the general US population, after adjusting for insomnia and other confounding variables. METHOD Secondary analyses of National Comorbidity Survey Replication data for 5,692 household respondents interviewed between 2001 and 2003 assessed the cross-sectional relationships between prescription sedative-hypnotic use and suicidality in the previous 12 months. Multivariate, hierarchical logistic regression analyses controlled for symptoms of insomnia, past-year mental disorders, lifetime chronic physical illnesses, and demographic variables. RESULTS Prescription sedative-hypnotic use in the past year was significantly associated with suicidal thoughts (adjusted odds ratio [AOR] = 2.2; P < .001), suicide plans (AOR = 1.9; P < .01), and suicide attempts (AOR = 3.4; P < .01). It was a stronger predictor than insomnia for both suicidal thoughts and suicide attempts and significantly improved the fit of these regression models (suicidal thoughts, P < .01; suicide attempts, P < .05). CONCLUSIONS Prescription sleeping pills, as exemplified by zolpidem and zaleplon, are associated with suicidal thoughts and suicide attempts during the past 12 months, but no evidence of causality was provided by this study. Clinical practitioners should recognize that patients taking similar types of sedative-hypnotics have a marker of increased risk for suicidality.

Modeling the Effects of Time: Integrating Demographic and Developmental Perspectives

Publisher Summary This chapter focuses on several aspects of time and the way in which processes of within-person change can be modeled using repeated measures in longitudinal designs. When events occurring in historical time affect only distinctive (or unique) subpopulations, concepts other than period effects are used. One such type of effect refers to the potential of historical events to affect only one segment of the age distribution. The dimension of time concerned with the lives of individuals, usually conceptualized in terms of the biological, psychological, and social processes that shape the life cycle and aging of individuals, is referred to as biographical time. A number of different conceptions of time are useful as a way of thinking about individual development and change. The most common are age and life cycle—one continuous and one discrete—both of which measure time from birth. The chapter focuses on five central issues that are uniquely suited to longitudinal analysis using growth curve models: specifying individual trajectories of within-person change, modeling individual differences in trajectories of within-person change, specifying the determinants and/or predictors of individual differences in patterns of change, testing for cohort differences in patterns of within-person change, and modeling the effects of events and transitions on processes of change.

Aging versus cohort interpretations of intercohort differences in GSS vocabulary scores

We investigate the plausibility of aging versus cohort interpretations of cohort-linked differences in vocabulary knowledge using data from 13 GSS surveys over a 22-year period, 1974 to 1996. We argue that one way to assess the effects of aging in these surveys is to examine the diachronic data within cohorts and to assume minimal period effects. Holding cohort constant in this fashion reveals detectable effects of aging that are not likely to be due to period influences between 1974 and 1996. Aging, however, explains only a tiny portion of the variation in the data, and aging effects are of insufficient magnitude to account for the larger intercohort patterns in the GSS vocabulary test data. Even when taking into account the effects of aging, the results of a cohort analysis support the argument that unique cohort experiences make important contributions to variation in GSS vocabulary test scores, especially among cohorts educated in the post- World War II era

Social Status and Risky Health Behaviors: Results From the Health and Retirement Study

Objectives. We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks. Methods. We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age. Results. We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age. Discussion. Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

Development and validation of a brief dementia screening indicator for primary care.

Detection of “any cognitive impairment” is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

Tests and Expenditures in the Initial Evaluation of Peripheral Neuropathy

BACKGROUND Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing. METHODS We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods. RESULTS Of the 12, 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period (