Suicidal Symptoms Research Articles

Personality disorder traits in young adults with subclinical obsessive-compulsive symptoms: Not just traits related to obsessive- compulsive personality.

Research is scarce regarding personality disorder traits of individuals with subclinical obsessive-compulsive symptoms. Cluster analysis based on obsessional, schizotypal, and borderline personality and autism-spectrum features was conducted on the results for 118 students scoring above cutoff on the Obsessive Compulsive Inventory-Revised. This identified four groups: O, L, S, and A. One third of the sample was represented by individuals with obsessional traits (O), while another third was composed of individuals with low traits (L); the last two profiles corresponded to a cluster with autistic traits (A) and a group with schizotypal and borderline features (S), both clusters together comprising the remaining third. Significant differences were observed between groups, both on personality traits and on psychopathological symptoms. The S cluster displayed the highest scores of suicidality, depression, and obsessive-compulsive symptoms. This study identified meaningful profiles of personality disorder traits, distinct from obsessive-compulsive personality, in individuals with subclinical obsessive-compulsive symptoms.

Troubling blind spots in understanding cancer risks among transgender patients: Bias, discrimination, and a lack of good data may be impeding cancer screening and risk assessments for the transgender population. In this article, the second of a 2-part series, we explore the remaining gaps in understanding and communicating the risks.

Troubling blind spots in understanding cancer risks among transgender patients: Bias, discrimination, and a lack of good data may be impeding cancer screening and risk assessments for the transgender population. In this article, the second of a 2-part series, we explore the remaining gaps in understanding and communicating the risks.

For Whom Does Cognitively Based Compassion Training (CBCT) Work? An Analysis of Predictors and Moderators among African American Suicide Attempters.

Both Cognitively-Based Compassion Training (CBCT) and support-based group intervention have been found to be effective for African American suicide attempters in reducing suicidal ideation and depression, as well as enhancing self-compassion. This study aims to further our understanding of effective interventions by exploring participants' responses to both interventions. Exploratory analyses were conducted in a sample of low-income African Americans who had attempted suicide (n=82) to determine how baseline demographic and psychological characteristics would (1) predict outcomes (i.e., suicidal ideation, depression, and self-compassion) regardless of intervention conditions, and (2) moderate outcomes in interaction with intervention condition. Non-reactivity, a mindfulness facet, was identified as an intervention moderator for suicidal ideation and depressive symptoms, suggesting that CBCT outperformed the support group for African American suicide attempters who had low baseline non-reactivity (or high reactivity). Individuals who had high non-reactivity at baseline appeared to benefit more from both conditions in self-compassion as an outcome. There was a pattern that homeless individuals benefited less in terms of their levels of depressive symptoms and self-compassion as outcomes regardless of the assigned condition. When applying Bonferroni corrections, only non-reactivity as an intervention moderator for depressive symptoms was significant. Findings reveal the relevance of mindfulness and to a lesser extent socioeconomic status in informing compassion-based intervention outcomes with this underserved population and the importance of intervention matching and tailoring to maximize treatment effects. Future large trials are needed to replicate findings and directions indicated from the current pilot study.

Antidepressant use and its relationship with current symptoms in a population-based sample of older Australians

BackgroundAustralia has the second highest per capita users of antidepressants globally, and their use is pronounced in older Australians. A better understanding of antidepressant use in older adults is important because the elderly are often prescribed multiple drugs, without review, for long periods. MethodsThis study analysed questionnaire data obtained from the Personality and Total Health through life project. Individual respondent data was linked to Pharmaceutical Benefits Scheme (PBS) records. Associations between self-reported medicine use and current symptoms with antidepressant dispensing were examined. Results1275 participants aged over 65 were included in the final analysis. One hundred and forty-six (11.5%) participants were dispensed an antidepressant within the specified timeframe. Of those, 38.4% self-reported that they use medicine for depression, 12.3% for anxiety, 17.8% for both depression and anxiety, 6.2% for sleep problems and 3.4% for pain. One fifth of those dispensed an antidepressant did not self-report use of the medicine. Being female or reporting symptoms of depression, anxiety or suicidality were significant predictors of being on an antidepressant. Increasing pain severity was also associated with increased likelihood of being on an antidepressant. LimitationsWe have presented a cross-sectional analysis, which can only provide associations between current symptoms and medicine use. We have only assessed respondents who received their scripts with PBS concession, which limits generalizability. ConclusionOur analysis highlights the high use of antidepressants in the elderly for various reasons. Our findings also uncovered a high amount of under-reporting of antidepressant use by respondents.

Suicidal Ideation in Pregnant and Postpartum Women Veterans: An Initial Clinical Needs Assessment.

Pregnancy and postpartum, or the perinatal period, are times when women are particularly vulnerable to mental health concerns, including suicidal ideation. Risk factors for suicidal ideation during this period of a woman's life are depression and exposure to trauma, the latter of which may occur during military operations. The number of women veterans in the United States continues to rise, as does their use of maternity benefits. In this pilot study, we examined the feasibility of recruiting pregnant veterans for longitudinal research. We hypothesized that hopelessness and depressive symptoms would be related to suicidal ideation during the perinatal period, and we investigated a possible relationship between post-traumatic stress symptoms (PTSS) and suicidal ideation. Using the designated Veterans Affairs (VA) maternity care coordinator's census, we contacted pregnant women veterans for assessment during the 3rd trimester of pregnancy and 6 weeks postpartum at the San Diego VA. Between September 2017 and October 2018, 28 women volunteers completed the following measures: the Columbia-Suicide Severity Rating Scale (C-SSRS); the Beck Hopelessness Scale (BHS); the Edinburgh Postnatal Depression Scale (EPDS); and the PTSD Checklist for DSM-5 (PCL-5). We used correlational analyses and descriptive statistics to determine associations among the measures. As gathered from the C-SSRS, over 30% of the veteran women had past lifetime suicide attempts, and over 10% of the veterans had suicidal ideation in the perinatal period. Both depression and PTSS rates neared 30% during pregnancy and postpartum. Hopelessness and depressive symptoms were positively correlated at both time points. While the intensity of lifetime suicidal ideation was correlated with postpartum depressive symptoms, there was no correlation with current suicidal ideation and depressive symptoms. PTSS correlated with both depressive symptoms and hopelessness, but not suicidal ideation, at both time points. There was no correlation between hopelessness and suicidal ideation during the perinatal period in this cohort. It is important to understand the mental health needs of perinatal veterans given their vulnerability to develop mental health concerns, including suicidal ideation. The unpredicted pattern of correlations determined in this study implies the need for multifaceted measures for safety-related mental health assessment of perinatal veterans, including assessment for PTSS. Strengths of this study include its longitudinal assessment and a sampling from a general population of veterans. Limitations include small sample size, a single gestational time point, and loss of participants who did not return for their postpartum assessment. We demonstrated the feasibility of longitudinal research with pregnant and postpartum veterans, but additional assessment points during the perinatal period could help identify critical times for mental health intervention in this population.

To Treat or Not to Treat: The Effect of Hypothetical Patients’ Suicidal Severity on Therapists’ Willingness to Treat

Therapists’ intense negative emotional responses regarding suicidal patients raise questions about therapists' willingness to treat them; however, this issue has yet to be investigated. The aim of the current study is to examine to what extent the severity of suicidality of a hypothetical patient will influence therapists' willingness to treat and the likelihood of their referring out. Mental health professionals (N = 249) completed a questionnaire that presented a vignette of a hypothetical patient referred for psychological treatment. The vignette contained a manipulation of the severity of suicidality levels of the referred patient, with two randomly assigned conditions: suicidal or depressive symptoms. Participants were then asked about their willingness to treat the hypothetical patient. Our results showed that willingness to treat was significantly lower and the likelihood of referring out was significantly higher among therapists in the suicidal patient condition, relative to the depressive patient condition. Longer professional seniority and previous training in suicide prevention moderated these effects. Our findings highlighted therapists' reluctance, especially among young practitioners, to treat suicidal patients, an inclination that may have a critical impact on patient suicidal outcomes. Findings reinforced the need for specific training on suicide prevention in the mental health curriculum.

Predicting Effective Treatment Selections for Depressive Patients to Achieve Early Improvement According to Their Subtype Affiliations

Background: The treatment outcomes of the depression remain unsatisfactory. The timely selection of the optimal treatment at early-stage is a critical issue. Despite of significant findings in neuroimaging biomarkers, few studies included neuroimaging assessments in early-phases of treatment and a single biomarker is hard to guide personal treatment selection. Thus, a data-driven approach combined with functional circuits and clinical symptom was applied to predict effective treatment selection by identifying treatment-related subgroups. Methods: Our study was a naturalistic study and 489 participants were enrolled from three sites. We identified symptom-guided brain connectome subgroups and built an early-stage treatment prediction model in the discovery dataset (n=228). Subgroups were compared in the aspects of effective intervention, symptomatic improvement, demographics, brain connectomes and clinical symptoms. Notably, we employed two independent datasets (n=89) to externally validate model. New patients' effective intervention was then expected to be consistent with the pre-defined subgroup. Results: Three subgroups with distinct treatment recommendations emerged: (1) an SSRIs-oriented subgroup with more symptomatic improvements of apathy. (2) a physiotherapy-oriented subgroup with high improvement of suicide symptom. (3) an SNRI-oriented subgroup, unique decreased interactions within salience network (SN), between SN and cognition control network, together with the high baseline depressive severity. Specially, our model had a high sensitivity of 83.6% in improvement prediction, with an overall accuracy of 69.7%. Furthermore, our model was more effective for SSRIs prediction with 87.5% accuracy. Conclusion: Our study offers guidance of multiple treatment strategies in early-stage treatment and extrapolates neuroimaging findings to 'real-world' practice. Funding Statement: The work was supported by the National Natural Science Foundation of China [grant numbers: 81871066，81571639]; Jiangsu Provincial Medical Innovation Team of the Project of Invigorating Health Care through Science, Technology and Education [grant number: CXTDC2016004]; Jiangsu Provincial key research and development program [grant number: BE2018609]. Declaration of Interests: The authors state that they have no conflict of interest with the content of this article. Ethics Approval Statement: A complete description of the study was informed to all subjects and written informed consents were obtained from all participants as approved by the Research Ethics Review Board of the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Drum Tower Hospital and Peking University Sixth Hospital.

Prediction of suicidal ideations based on socioeconomic status and mental health among University of Tabriz students

Introduction: The purpose of this study was to investigate the association of socioeconomic status and dimensions of mental health with suicidal tendency among students of the University of Tabriz, Iran. Methods: The present descriptive and correlational study was conducted on 900 students of the University of Tabriz in the academic year of 2016-2017. The study tools included the Beck Scale for Suicidal Ideation (BSSI), Symptom Checklist-90-Revised (SCL-90-R), and Socio-Economic Status Questionnaire (SESQ) of Ghodratnama et al. Results: Correlation results showed that depression (r = 0.514, P < 0.01), psychoticism (r = 0.478, P < 0.01), and obsessive-compulsive disorder (OCD) (r = 0.463, P < 0.01), respectively, had the highest correlation with suicidal ideations. Somatization was also correlated with suicidal ideations (r = 0.231, P < 0.05). Of the components of socioeconomic status, income (r = -0.401, P < 0.01), and the economic class component (r = -0.321, P < 0.05) had the highest correlation coefficients, respectively. Results of regression analysis indicated that the mental health variable predicted suicide in merely 58.6% of people. Moreover, with the addition of the socioeconomic status variable to the equation, both variables predicted an average of 71.6% of the overall suicidal ideations among individuals. Conclusion: Results indicated that mental health difficulties and socioeconomic problems might have a negative impact on the development of suicidal thoughts. Therefore, it is highly recommended that students’ mental health and social/financial problems be taken into consideration by educational managers responsible in universities, a mission that would be included in curriculum plans.

Comparison of Quality of Life, Depression, Anxiety, Suicide, Social Anxiety and Obsessive-Compulsive Symptoms Between Adolescents with Acne Receiving Isotretinoin and Antibiotics: A Prospective, Non-randomised, Open-Label Study.

The effects of isotretinoin on suicide, social anxiety and obsessive-compulsive symptoms in adolescents with acne have not been sufficiently investigated. This study aimed to evaluate the quality of life, depression, anxiety, suicide, social anxiety, and obsessive-compulsive symptoms of adolescents receiving systemic isotretinoin and antibiotic treatments at baseline and at 3months. The study included a total of 102 adolescents using isotretinoin (n = 60) and antibiotics (n = 42). The Acne Quality of Life Scale (AQLS), Hospital Anxiety and Depression Scale (HADS), Suicide Probability Scale (SPS), Liebowitz Social Anxiety Scale (LSAS), and Maudsley Obsessive-Compulsive Question List (MOCQL) were administered to both groups at baseline and at 3months. In order to exclude patients with comorbid psychiatric disorders, the patients were evaluated at the beginning of the study with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). There were no significant differences in the mean age, gender distribution, educational level, and family history of mental illness between the two groups. There were significant decreases in the Global Acne Grading System scores, visual analogue scale scores, AQLS scores, total and subscale scores of LSAS, and total and subscale scores of MOCQL at 3months compared with baseline in both groups. However, there were no significant changes in the total and subscale scores of HADS and total and subscale scores of SPS at 3months compared with baseline in both groups. We found that neither isotretinoin nor antibiotic treatment affected the levels of depression, anxiety, and suicide in acne patients. Moreover, both isotretinoin and antibiotic treatment were shown to improve the quality of life, social anxiety, and obsessive-compulsive symptoms in acne patients. However, clinicians should be careful about psychiatric side effects in patients using isotretinoin. Further studies with a larger number of cases and with a longer follow-up period are needed to investigate the complex effects of isotretinoin on the central nervous system.

Parental Suicidal Ideation and Child Depressive Symptoms: The Roles of Optimism and Gratitude

This study aimed to compare the influence of paternal and maternal suicidal ideation on child depressive symptoms and examine the moderating effects of children’s positive psychological traits: optimism and gratitude. A cross-sectional survey with 302 children and parents from five primary schools in Hong Kong were recruited. Results indicated that maternal suicidal ideation was significantly related to child depressive symptoms while paternal suicidal ideation was not. Moreover, the moderating effects of child optimism and gratitude were shown in the link between paternal suicidal ideation and children depressive symptoms. In contrast, the influencing power of maternal suicidal ideation of maternal suicidal ideation seems too strong to be attenuated by child optimism and gratitude. Findings of this study implicate the importance of prevention and intervention to suicidal parents and their offspring. Besides, positive psychology programs to enhance child optimism and gratitude might promote child resilience in the face of parental suicidal ideation. Future research is suggested to include other risk factors and protective factors that might be involved in the complex pathway from parental suicidal ideation to their children’s depression, and to collect data from multiple informants of a longitudinal representative sample.

Symptom network connectivity in adolescents with comorbid major depressive disorder and social phobia

PurposeMajor depressive disorder (MDD) and social phobia (SP) are both common and highly co-occurring psychiatric disorders. This study used symptom network analysis approach to examine comorbidity structure and the complex symptom dynamics which may play a role in the co-occurrence of MDD and SP. MethodData comes from the National Comorbidity Survey – Adolescent Supplement, a nationally representative survey of adolescents ages 13 to 18 years. This study examined data of adolescents with a lifetime diagnosis of MDD (n = 597), SP (n = 708), and adolescents with comorbid MDD and SP (n = 189). Networks were estimated by means of 26 symptoms from both disorders. ResultsAll MDD and SP symptoms were involved in the network of both pure disorders (MDD; SP) and comorbid condition (MDD + SP). Network structure was different between the pure disorders (p = 0.014), but not when comparing each of these disorders that have comorbid condition. Depressive symptoms of poor self-esteem and suicidal symptoms were central (i.e., showed a higher influence) in the symptom network for the pure disorders and for the comorbid condition. Other key symptoms in the comorbid condition network were two depressive symptoms: feelings of worthlessness and anhedonia. SP and MDD networks showed two common key SP symptoms: feeling uncomfortable when meeting new people and feeling uncomfortable talking to people do not know well. ConclusionThe study of symptom dynamics will provide useful targets for preventing the development of comorbid disorders as well as new lines of intervention to deal with key symptoms of psychiatric disorders.

Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in Epileptic Patients: A Multidimensional Comparison of the Psychiatric Profile of Patients Suffering From Epilepsy and Patients Suffering From Psychogenic Nonepileptic Seizures.

Introduction: Patients with psychogenic nonepileptic seizures (PNESs) have often been exposed to traumatic events, which is a risk factor for suicidal behavior. This would suggest that the severity of suicidal ideation is greater in PNES than in patients suffering only from epileptic seizures (ESs). However, these psychiatric symptoms may be underestimated in the ES population. The specific features or similarities between the psychiatric clinical profiles of these two groups should be elaborated to improve therapeutic management. Our study is the first to compare suicidal ideation, suicide risk, posttraumatic stress disorder (PTSD), and depression disorder simultaneously in both groups, in a tertiary care epilepsy center. Material and methods: We prospectively enrolled patients hospitalized for video-electroencephalography (EEG) monitoring to assess repeated seizures before an ES or a PNES diagnosis was made. During the psychiatric consultation that accompanied the video EEG, we rated the severity of suicidal ideation and depressive symptoms, suicidal risk, traumatic exposure history, and PTSD symptoms. Results: Eighteen subjects were enrolled and diagnosed with PNES, and 42, with ES. The PNES group reported more exposures to traumatic events and more intense PTSD symptoms (median: 17 vs. 27; p = 0.001). The severity of suicidal ideation did not differ significantly between the two groups. Conclusion: It is the severity of PTSD symptoms in PNES patients that differentiates them from ES patients, although exposure to traumatic events is also frequent in ES patients. We demonstrated that suicidal ideation and suicide risk are equally high in the ES and PNES groups. Therefore, both groups require extreme vigilance in terms of suicidal risk.

Intranasal Ketamine for Alleviation of Acute Suicidal Ideation. An Emergency Department, Trans-Diagnostic Approach: Randomized, Double-Blind, Placebo-Controlled, Proof-of-Concept Trial

Background: suicidal patients are often presented to the Emergency Department, where specific treatment is lacking. Ketamine, a rapidly acting antidepressant with anti-suicidal properties might offer relief. Methods: thirty eligible participants who suffered acute suicidal ideation and required hospitalization were randomized to intranasal ketamine 40mg or placebo, between August 2016 to April 2018. Safety and efficacy evaluations were scheduled for two and four hours, on days 1, 3, 7, and 21 post administration. Primary outcome was suicidal ideation four hours post administration. Randomization was carried out by the pharmacist while the rest of the study group was blinded. Outcomes: Fifteen subjects were randomised for ketamine and fifteen for control, all were analyzed for primary and secondary outcomes. Four hours post administration the mean difference in suicidal symptoms between the groups, measured by the Montgomery-Asberg Depression Rating Scale (MADRS) item of suicidal thoughts, was 1.267 (95% confident interval 0.1-2.43, P<0.05) favoring the ketamine group, with suicidal ideation remission rates of 80% of the ketamine group compares with 33% of the controls (p<0.05). The mean difference in depressive symptoms, measured by MADRS, at the same time was 9.75 (95% confident interval 0.72-18.79, P<0.05) favoring the ketamine group. The treatment was safe and well-tolerated. Interpretation: Intranasal ketamine alleviated suicidal ideation and improved depressive symptoms four hours post ketamine administration. We present an innovative paradigm for the management of suicidal individuals in emergency setting. Future larger-scale studies are warranted to establish treatment recommendation. Trial Registration Number: ClinicalTrials.gov Identifier: NCT02183272. Funding Statement: This study was supported by the American Foundation of Suicide Prevention. Declaration of Interests: All authors declare no conflict of interests. Ethics Approval Statement: This study was reviewed and approved by the University of Cincinnati Institutional Review Board.

Esketamine Approved for Refractory Depression

Esketamine Approved for Refractory Depression

Knowledge of Suicide Risk Factors, But Not Suicide Ideation Severity, Is Greater Among College Students Who Viewed 13 Reasons Why

Objective: To test associations between viewing 13 Reasons Why, Season 1 and past week suicide ideation severity, behavior risk, stigma, and knowledge in college students. To explore whether personal exposure to suicide and depressive symptom severity moderated these associations. Participants: Eight-hundred and eighteen college students, 64% (n = 522) of whom watched 13 Reasons Why. Methods: Students completed surveys online. Multivariate negative binomial regressions were used to test associations between watching 13 Reasons Why and suicide-related variables, and interaction terms. Results: Suicide ideation severity and suicide behavior risk were not significantly associated with viewing 13 Reasons Why; however, there was limited statistical power to detect associations. The association between watching 13 Reasons Why and greater suicide knowledge was stronger among those who did not have personal exposure to suicide. Conclusions: 13 Reasons Why may be a platform for psychoeducation on suicide, particularly among those who do not have personal exposure.

Benefits of spirituality and/or religiosity in patients with Chronic Kidney Disease: an integrative review.

Identify and analyze existing evidence regarding the benefits of spirituality and / or religiosity in patients with Chronic Kidney Disease. Integrative review carried out through consultation of databases: Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, US National Library of Medicine and Scopus. The following descriptors were used: chronic kidney disease, spirituality and religion. Primary articles published by December 2017 were included. Twenty-six articles were selected, from which four thematic categories emerged: benefits as a modality of coping, perception of quality of life, mental health and improvement of renal function after transplantation. Benefits included those related to situational coping modalities, such as the strengthening of hope, social support and coping with pain; those related to mental health, such as the lower risk of suicide and fewer depressive symptoms; improvement in the perception of quality of life and in renal function after transplantation.

Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: the differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia

ObjectiveInsomnia and depression are closely related. However, few studies have investigated whether certain insomnia symptoms differentially relate to certain depressive symptoms. The present study aimed to examine relationship between specific types of insomnia symptoms (sleep symptoms, daytime symptoms, and perception symptoms) and specific symptoms of depression. DesignCross-sectional, observational study data from the Sleep, Health, Activity, Diet and Environment and Social Factors (SHADES) Survey. SettingCommunity-level population. ParticipantsA total of 1003 community-based adults aged 22–60 from the Philadelphia area. MeasurementsInsomnia symptoms were represented by scores of sleep symptoms, daytime symptoms and perception symptoms, derived from the Insomnia Severity Index (ISI). Depression symptoms were assessed with the items of the Patient Health Questionnaire 9 (PHQ-9). ResultsA Confirmatory Factor Analysis (CFA) supported the three-factor model based on ISI data. Binary logistic regressions examined independent associations between the three insomnia symptom types and individual depression symptoms. Sleep symptoms were more strongly associated with physiological aspects of depressive symptoms (appetite symptoms, psychomotor symptoms, and suicidal ideation). The daytime symptoms, on the other hand, were significantly associated with almost all depressive symptoms, except for appetite. Moreover, daytime symptoms were exclusively related to cognitive symptoms of depression (eg, trouble concentrating). The perception symptoms were independently associated with mood symptoms, tiredness, appetite, and judgment of oneself as a failure, but not with psychomotor, cognitive and suicidal ideation symptoms. ConclusionDaytime symptoms and perception symptoms of insomnia were more strongly associated with a full range of depressive symptoms than sleep symptoms. The sleep symptoms were mainly associated with more physiological symptoms of depression, implicating more biological mechanisms. Further research is needed regarding how these types of insomnia symptoms differentially related to multiple health consequences.

Antisuicidal effect, BDNF Val66Met polymorphism, and low-dose ketamine infusion: Reanalysis of adjunctive ketamine study of Taiwanese patients with treatment-resistant depression (AKSTP-TRD)

Background: Growing evidence suggests a rapid antisuicidal effect of low-dose ketamine infusion in Caucasian patients with treatment-resistant depression (TRD). However, the antisuicidal effects of ketamine on Taiwanese patients with TRD remains unknown. Methods: Seventy-one patients with TRD were randomly classified into three treatment groups: 0.5 mg/kg ketamine, 0.2 mg/kg ketamine, or normal saline (placebo) infusion. The Hamilton Depression Rating Scale (HAMD) and Montgomery-Åsberg Depression Rating Scale (MADRS) were applied prior to initiation of test infusions, at 40, 80, 120, and 240 min postinfusion, and sequentially on Days 2, 3, 4, 5, 6, 7, and 14 after ketamine or placebo infusion. Item 3 (suicide) of the HAMD and item 10 (suicidal thoughts) of the MADRS were extracted for generalized estimating equation (GEE) model analyses to investigate the antisuicidal effects of ketamine infusion. Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism was genotyped. Results: The GEE model revealed significant group (p = 0.007) and time (p = 0.004) effects on suicidal symptoms over times (prior to infusion to day 14 postinfusion). The group that received 0.5 mg/kg ketamine infusion exhibited a significantly lower score in item 3 of the HAMD and item 10 of the MADRS compared with the groups that received 0.2 mg/kg ketamine or placebo infusion. Among those carrying any Val allele of BDNF, both 0.5 and 0.2 mg/kg ketamine infusions were effective in reducing suicidal thoughts; however, among those with Met/Met of BDNF, only 0.5 mg/kg ketamine infusion was effective in reducing suicidal thoughts. Discussion: A single low-dose ketamine infusion was effective in reducing suicidal ideation among Taiwanese patients with TRD. BDNF Val66Met polymorphism may play a crucial role in the antisuicidal effects of ketamine infusion.

Differences in Speed of Response of Depressive Symptom Dimensions in Older Persons During Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight into putative differences in speed of response of depressive symptom dimensions may enable clinicians to optimally inform patients and their relatives. Therefore, we aim to examine course trajectories of depressive symptom dimensions in depressed older persons during ECT. Data were derived from the Mood Disorders in Elderly treated with Electro Convulsive Therapy study, including 110 persons, aged 55 years or more, with a current diagnosis of major depressive disorder and referred for ECT. Exploratory factor analysis was used to identify symptom dimensions, using the 10 depression items of the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences in course trajectories of symptom dimension during 2 weeks were examined by multilevel analyses. Three symptom dimensions were identified: a "mood," "melancholic," and "suicidal" dimension. Mood showed a significantly greater severity decline as compared with melancholic and suicidal at the 1-week follow-up. At the 2-week follow-up, both mood and melancholic demonstrated a significantly greater decline as compared with suicidal. However, because scores on the suicidality item of the Montgomery-Asberg Depression Rating Scale were already lower at baseline compared with the other items, a floor effect cannot be ruled out. All symptom dimensions of depression showed a rapid response to ECT. Our findings did not support the general assumption that suicidal symptoms may be the first to improve. However, a floor effect on the suicidality item cannot be ruled out.

SUPPORTING OLDER VETERANS WITH SUICIDAL SYMPTOMOLOGY AND THEIR CAREGIVERS WITH A NOVEL TREATMENT

Introduction Older Veterans are the largest and fastest growing segment of the Veteran population. In a report published by the Veterans Affairs (VA), the rate of depression is doubled in Veterans aged ≥65 years as compared to the general population within the same age group (VHA Report, 2015). Additionally, the rates of suicide completion are highest in older Veterans; 68% of all deaths by suicide are in Veterans that are 50 and older (VA National Suicide Data Report, 2005-2015, 2018). Despite their elevated risk, there is limited research and fewer interventions targeting suicide and suicidal behavior in older Veterans. Methods Creating a Suicide Safety Plan (SSP) is an effective treatment for Veterans with suicidal ideation and can decrease suicidal behaviors (Miller et al., 2017; Stanley et al., 2016). Due to the deaths of spouses and friends, many older adults do not have a strong social network and very few whom they would turn to in a suicidal crisis. Therefore, increasing communication between the existing social supports and increasing the usage of the Safety Plan would be possibly life-saving to older Veterans. Additionally, it could also reduce caregiver burden that may exist in the existing social supports. A current randomized clinical trial titled Safe Actions for Families to Encourage Recovery (SAFER), a novel, 4-session manualized family-based intervention being conducted at the James J. Peters VA Medical Center, focuses on implementing the SSP in Veterans at moderate-risk for suicide. Using psychoeducation and disclosure, SAFER provides the structure to support caregiver involvement in suicide safety planning with the development and revision of both the Veteran and a complementary family member safety plan. Please see Table 1. Results The current SAFER sample only includes five individuals 65 and older (total sample average: 56.53 years). Reviewing preliminary data from the Beck Scale for Suicidal Ideation suggests that those over the age of 65 experienced almost twice as much ideation (M=25.33, SD=9.45) as compared to those under 65 (M=13.61, SD=9.54). An independent samples T-test was performed to further explore this relation suggesting that even in this small sample the difference in scores was approaching significance t(24)= -2.003, p=.057. These initial findings conceptualize a need for research and treatment targeting the geriatric population. To target the moderate-risk and high-risk geriatric population, our research team is developing ways to adapt SAFER. In adapting SAFER for older adults, accommodations will be made for potential hearing and vision impairments as well as limitations in attention spans among older adults who may have mild deficits in working memory and short-term memory. Additionally, modifications will also need to be made for the caregivers of older adults, such as co-morbidities or possible memory loss of the older adult. Please see Table 2 for existing SAFER session outline. Full data set to be included in final presentation. Conclusions Many elderly adults experience challenges, such as retirement, loss of spouse or close friends, depreciated physical capabilities, survivor guilt, unresolved grief, and limited social support (Rose, 2017). These challenges can be a trigger for suicidal symptoms; therefore, more research and interventions should target suicide and suicidal behavior in older Veterans. One significant limitation to the ongoing study is the lack of representation of geriatric patients; therefore, a future direction of SAFER is to have modules focusing the geriatric population This research was funded by This research was supported by VA Merit Award (1I01RX002432-01) and the VISN 2 South MIRECC. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000446/AAGP2019-000446_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000446/AAGP2019-000446_Fig2.pdf