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Factors Associated With High Frequency of Suicidal Ideation in Medically Ill Veterans

WENDELL, JOEL, PhD; RATCLIFF, CHELSEA G., MA, PhD; PRICE, ELIZABETH, MA, PhD; PETERSEN, NANCY J., PhD; DINAPOLI, ELIZABETH A., PhD; CULLY, JEFFREY A., PhD

Journal of Psychiatric Practice®: September 2016 - Volume 22 - Issue 5 - p 389–397
doi: 10.1097/PRA.0000000000000174
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Suicide is a leading cause of death, and rates are especially high among medically ill, older individuals. Health-related psychosocial correlates of suicidal ideation (SI) may be particularly important for medically ill older adults as they may clarify who may benefit from interventions to reduce SI. This study examined whether demographic, physical health, and/or health-related psychosocial factors were associated with high frequency of SI in older, medically ill Veterans experiencing elevated anxiety or depression. This cross-sectional study included 302 Veterans with (1) a cardiopulmonary condition and functional impairment and (2) elevated symptoms of depression and/or anxiety. Participants were classified as having either no, low, or high SI, based on self-reported ideation, from the Patient Health Questionnaire-9. SI was reported in 26.8% of the full sample and high SI was reported by 12.6% of participants. Logistic regression analyses predicting high versus no SI found the odds of high SI increased 4.7 times (95% confidence interval, 2.6–8.3) for each 1-unit increase in maladaptive coping and 4.1 times (95% confidence interval, 1.2–14.3) for each 1-unit increase in physical health severity/functional limitations. Older, medically ill Veterans with comorbid depression and/or anxiety frequently reported SI and were at greater risk of experiencing a high frequency of SI if they engaged in maladaptive coping strategies and/or had high levels of functional impairment. Effective interventions to reduce SI for this population should focus on reducing maladaptive coping and minimizing negative behavioral, cognitive, and emotional reactions to functional limitations.

WENDELL: Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK

RATCLIFF and CULLY: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX; Baylor College of Medicine, Houston, TX; and South Central Mental Illness Research, Education and Clinical Center, Houston, TX

PRICE: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX; and Baylor College of Medicine, Houston, TX

PETERSEN: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX; and Baylor College of Medicine, Houston, TX

DINAPOLI: Pittsburgh Veterans Affairs Healthcare System, Pittsburgh, PA

Supported by the Department of Veterans Affairs (HSR&D Grant IIR 09-088). The study was also partly supported by the Veterans Health Administration, Office of Research and Development and the Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (CIN13-413) and the South Central Mental Illness, Research, Education, and Clinical Center.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the US government, or Baylor College of Medicine.

The authors declare no conflicts of interest.

Please send correspondence to: Jeffrey A. Cully, PhD, Houston VA HSR&D COIN (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX 77030 (e-mail: jcully@bcm.edu)

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