RESUMEN
OBJECTIVE: Adverse life events may contribute to the emergence of suicidality. We aimed to test the relationship between the impact of the Greek recession and suicidal risk in people with long-term conditions (LTCs) and to determine whether this relationship is moderated by the presence of a mental disorder. METHODS: Suicidal risk (RASS) and crisis parameters were assessed in a cross-sectional survey including 376 patients with LTCs (type-II diabetes mellitus, rheumatological disorders and chronic obstructive pulmonary disease) attending the Emergency Department or specialty clinics. A diagnosis of mental disorder was confirmed by the Mini International Neuropsychiatric Interview (MINI) interview. Hierarchical regression models were used to quantify moderator effects. RESULTS: Suicidal risk was significantly associated with the perceived impact of the recession (p=0.028). However, moderation analysis showed that this relationship was significant only in those diagnosed with either major depressive disorder or generalized anxiety disorder. CONCLUSIONS: These findings suggest that the perceived impact of the current Greek recession is not correlated with suicidal risk per se, but the recession may act as precipitator in combination with other risk factors, such as the presence of a mental illness, thus supporting the importance of early diagnosis and treatment of mental disorders in vulnerable groups.
Asunto(s)
Recesión Económica , Trastornos Mentales/psicología , Percepción , Suicidio/psicología , Anciano , Enfermedad Crónica/psicología , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Grecia , Humanos , Masculino , Trastornos Mentales/complicaciones , Persona de Mediana Edad , Factores de Riesgo , Suicidio/estadística & datos numéricosRESUMEN
BACKGROUND: The B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated. METHODS: The B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated. RESULTS: The Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach's alphas were 0.91-0.96 and 0.77-0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility. CONCLUSIONS: These findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies.
RESUMEN
BACKGROUND: Suicidal risk is often unrecognized in emergency department (ED). We aimed to assess its prevalence in patients with long-term conditions (LTCs) attending an ED and to test whether gender differences influence suicidal risk assessment, using the diagnostic accuracy properties of the Risk Assessment Suicidality Scale (RASS). METHODS: The RASS was administered to 349 patients with diabetes, COPD and rheumatic diseases visiting an ED. The MINI interview was used as the criterion standard. ROC curve analysis was performed to determine the optimal RASS cutpoint for suicidal risk separately for males and females. Somatic (PHQ-15) and depressive (PHQ-9) symptoms were also assessed and factors associated with suicidal risk across gender were determined in hierarchical regression models. RESULTS: The prevalence of suicidal risk according to the MINI was 22.9%; 16.6% of patients were at low, 5.1% at moderate, and 0.9% at high risk. At an optimal cutpoint of 270, RASS had 81.3% sensitivity and 81.8% specificity. The optimal RASS cutpoint for females (340) was double the cutpoint for males (175). Somatic symptom burden was associated with suicidal risk in both sexes but it became non-significant after depressive symptoms were taken into account; suicidal risk was also associated with history of depression in females and lower income in males. CONCLUSION: There is a high prevalence of suicidal risk in patients with LTCs attending the ED. As the optimal RASS cutpoint for females was double the cutpoint for males, clinicians should bear in mind gender differences when assessing for suicidal risk in the ED.
Asunto(s)
Enfermedad Crónica/epidemiología , Enfermedad Crónica/psicología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Ideación Suicida , Prevención del Suicidio , Suicidio/psicología , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Estudios de Cohortes , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Femenino , Grecia , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Factores Socioeconómicos , Estadística como Asunto , Suicidio/estadística & datos numéricosRESUMEN
OBJECTIVE: To determine whether illness perceptions of patients with long-term conditions (LTCs) are associated with urgent healthcare use and whether this association is independent from mental illness and somatic symptom burden. METHODS: Illness perceptions (B-IPQ) and somatic symptom severity (PHQ-15) were assessed in 304 patients with diabetes, rheumatological disorders and COPD attending an Accident and Emergency Department (AED) in Greece over a one year period. The presence of mental illness was determined by the Mini International Neuropsychiatric Interview. A Generalized Linear Model (Negative Binomial) regression was used to determine the associations of illness perceptions with AED use after adjusting for mental illness, somatic symptom severity, disease parameters and demographics. RESULTS: Eighty-six patients (28.3%) reported at least one visit to the AED during the previous year and 75 (24.7%) twice or more. 124 patients (40.8%) had some form of mental disorder with 85 (28.0%) meeting criteria for major depressive disorder. The degree to which the patients had an understanding of their illness (illness comprehensibility) (p<0.01) along with younger age (p<0.05), additional comorbidities (p<0.05) and greater somatic symptom burden (p<0.001) was strongly associated with AED use; AED visits were expected to be reduced by 9.1% for each unit increase in illness comprehensibility. CONCLUSIONS: The way people perceive their illness influences urgent healthcare seeking behavior independent of somatic symptom burden. This finding indicates that information provision may prove effective in reducing urgent healthcare use and encourage the design of psycho-educational interventions targeting disease-related cognitions in an attempt to prevent unnecessary healthcare utilization.