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Spiritual Struggle and Religious Coping in Older Adults with Mood Disorders
2013 AAGP Annual Meeting approached significance (p¼ .08). In a separate regression model, onset of depression, white matter lesion, and cortical thickness data were not significantly associated with ILS performance. Conclusions: Our results suggest that within LLD, impairments of financial capacity are common. Further, individuals with impaired financial capacity exhibit worse performance on measures of memory, attention and executive functioning than individuals with no financial capacity impairment but show no difference in language abilities. In contrast to our hypothesis, memory, and not attention and executive functioning, was the only significant cognitive predictor of financial capacity performance. Also cortical atrophy and WML volume was not significantly associated with financial capacity performance and these findings did not support our hypothesis. Taken together however, our findings suggest that impairment of financial capacity in LLD may result from specific cognitive impairments associated with LLD, and may not share the same association with cortical atrophy seen in neurodegenerative diseases of aging. Given our relatively small sample size we interpret these findings cautiously, and future research on the association of cognitive function and cortical atrophy on financial capacity in LLD is warranted. Poster Number: EI 09
Spiritual Struggle and Religious Coping in Older Adults with Mood Disorders Mary C. Malloy, B.A.1,3; David H. Rosmarin, PhD2,3; Brent Forester, MD, M.Sc.1,3 1
Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA Behavioral Partial Program, McLean Hospital, Belmont, MA 3 Harvard Medical School, Cambridge, MA 2
Introduction: Few mental health professionals integrate spiritual screening and practices in clinical care of mood disorder patients. Previous studies have shown that religious practices and beliefs are clinically relevant, both positively and negatively, to the mental wellbeing of patients. Less research focuses on identifying spiritual risk factors for depressed older adults. Merely screening for spiritual factors of depressed patients may help identify individuals who may benefit the most from spiritually integrated care. In this analysis, we examined spiritual coping and religious involvement as a predictor of depressive symptoms within a cohort of geriatric outpatients with Bipolar Disorder (BD) and Major Depressive Disorder (MDD). Methods: Demographic, clinical, and spiritual data were collected from subjects (n¼34), ages 55-86, with a DSM-IV diagnosis of a mood disorder (n¼16 BD, n¼18 MDD) recruited through two treatment and one non-treatment research studies conducted at McLean Hospital. Subjects were all geriatric outpatients and were voluntarily consented to participate in each research protocol prior to data collection. All studies have undergone annual review from McLean Hospital’s Institutional Review Board (IRB). Subjects were excluded from study participation due to serious or unstable medical conditions; inability to speak English or provide consent; history of substance abuse or dependence in the past 12 months; dementia; history of seizures; or primary psychotic disorders, such as schizophrenia. Subjects received clinical assessments, including the Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). Subjects also completed self-report questionnaires, to assess for mood symptoms (Geriatric Depression Scale, GDS) and spiritual/religious factors (belief in God, frequency of prayer, frequency of public religious involvement and positive/negative religious coping). Scales and self-report questionnaires were collected at multiple time points during study participation, although this analysis focuses on the baseline information from each eligible subject. The mean age of the sample was 70.47 years old and 47% of the subjects identified as male. All subjects in the sample were Caucasian, non-hispanic. Although homogeneous in race, the sample of participants was varied in religious affiliation (n¼13 Catholic, n¼3 Jewish, n¼2 Christian, n¼2 Episcopalian, n¼2 Protestant, n¼1 Greek Orthodox, n¼1 Interdenominational, n¼10 non-believers such as Agnostic, Atheist or non-identifiers). Results: (1) General religious involvement: Patients who reported certain belief in God had lower self-reported GDS scores than non-believers (p < .05) and trended towards lower clinically assessed MADRS scores (p ¼ .08). Participants with any religious affiliation had lower MADRS scores (p < .05) but not self-report GDS scores. Individuals who participated in daily or greater private, but not public, religious activity reported MADRS and GDS scores that were below cut-offs for clinical impairment. (2) Religious coping: After controlling for belief, affiliation, public and private religious activity, negative religious coping was associated with greater MADRS, GDS and YMRS scores accounting for 17.6-19.4% of variance in these variables. Positive religious coping was unrelated to affective, cognitive or neurovegetative symptoms (p > .10 for all analyses). Conclusions: Negative religious coping, referred to as spiritual struggle, is an important risk factor for depressive symptoms among geriatric mood disordered patients, irrespective of religious involvement, practice, or belief. On the contrary, utilization of positive religious strategies to cope with distress has no relation to reduced depressive symptoms. This study demonstrates that regular intrinsic (private) religious involvement is associated with better emotional functioning. This finding suggests that using religion as a coping tool in times of distress is insufficient for psychological benefits in a clinical sample. Furthermore, this study also questions whether spiritual struggle and depression have a shared biological diathesis. Further study of spiritual coping is warranted across clinically-matched age groups utilizing magnetic imaging or genetic analyses. Assessing for spiritual
Am J Geriatr Psychiatry 21:3, Supplement 1
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2013 AAGP Annual Meeting risk factors, such as spiritual struggle and religious involvement, may help clinicians and other health care providers identify spiritual stressors associated with depressive symptoms. Care providers can then uniquely tailor treatment plans to meet the medical, psychological, and spiritual needs of patients, particularly those at higher risk for spiritual distress. Poster Number: EI 10
Social Disconnectedness in Primary Care Kimberly A. Van Orden, PhD; Nicole Driffill, BS; Ian H. Stanley, BS; Yeates Conwell, MD University of Rochester Medical Center, Rochester, NY Introduction: Social disconnectedness increases risk for mental illness in later life, including depression, as well as risk for suicide. However, social connectedness is not well characterized among older adult primary care patients, a key gap in the existing literature given that older adults with depression (and other mental health problems) are most likely to seek treatment through primary care. We sought to characterize older adult primary care patients who screened positive on a brief survey assessing social disconnectedness with regards to social network density, depression severity, and suicide risk. Methods: Design/Setting: In-home baseline psychosocial interview for a clinical trial of peer companionship for socially disconnected older adults. Subjects: 120 primary care patients (57% female; age range 60 to 93) who endorsed social disconnectedness (i.e., “I feel lonely” and/or “I feel like a burden on others”) in a screen conducted in primary care offices completed the interview. The Paykel Scale measured "worst point" lifetime suicide ideation and behaviors. The Interpersonal Needs Questionnaire measured low belongingness and perceived burdensomeness. The PHQ-9 measured depressive symptom severity. The National Social Life, Health, and Aging Project’s (NSHAP) social networks module measured social network density. Results: The average PHQ-9 score was 7.97 (std 4.74, range 0-22). Approximately half of the subjects endorsed that there was a time in their life when they felt life was not worth living (50.55%) and approximately 40% (41.76%) endorsed death ideation in their lifetime (wishing they wouldn’t wake up in the morning). A similar proportion (40.66%) endorsed thoughts of suicide in their lifetime (“i.e., thought of taking your own life even if you would not really do it”). A smaller, but still substantial proportion (28.57%) endorsed “seriously considering suicide” including making plans in their lifetime. Finally, 20.88% endorsed a suicide attempt at some point in their lifetimes. A smaller proportion (6.66%) endorsed current death/suicide ideation on the PHQ-9. Data will also be presented on social network density and its association with death/suicide ideation. Conclusions: Older adults who screen positive for social disconnectedness in primary care are characterized by an elevated level of depressive symptom severity and high likelihoods of endorsing suicide ideation and behavior in their lifetimes. A smaller proportion endorsed current death/suicide ideation. These results suggest that social disconnectedness is a form of distress that may detect a population at elevated suicide risk (due to worst point presentations of suicidality). Further, social disconnectedness is malleable via psychosocial intervention; thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behaviors, and indicate a target for intervention.
Poster Number: EI 11
With a little help from my friends?: The role of social support in adherence to antidepressant medication Lauren B. Gerlach, DO1; Janet Kavanagh, MS1; Claire Chiang, PhD2; Hyungjin Kim, Sc.D1; Helen C. Kales, MD1,2 1 2
University of Michigan Department of Psychiatry, Ann Arbor, MI Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI
Introduction: Although detection and treatment rates for geriatric depression have improved, adherence to antidepressant medication remains low among older adults. The powerful positive influence of social support on depression outcomes including lessening time to remission and improving depressive symptomatology has been well studied, but less is known regarding its impact on antidepressant medication adherence. The goal of this study was to evaluate the role of perceived social support on adherence to new antidepressant medication prescriptions in later-life depression. Methods: Data were obtained by combining samples from two concurrent prospective observational studies with subjects recruited from primary care or psychiatry outpatient clinics at the University of Michigan (N¼183) and four Veterans Affairs Medical Centers located in Michigan (N¼279) respectively. Both studies focused on evaluating the effect of various factors on antidepressant medication adherence within the acute treatment phase (first 4 months). Study participants were age 60 or older, diagnosed with clinically significant depression (Geriatric Depression Scale 5), and given a new antidepressant prescription by
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Am J Geriatr Psychiatry 21:3, Supplement 1
Spiritual Struggle and Religious Coping in Older Adults with Mood Disorders Mary C. Malloy, B.A.1,3; David H. Rosmarin, PhD2,3; Brent Forester, MD, M.Sc.1,3 1
Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA Behavioral Partial Program, McLean Hospital, Belmont, MA 3 Harvard Medical School, Cambridge, MA 2
Introduction: Few mental health professionals integrate spiritual screening and practices in clinical care of mood disorder patients. Previous studies have shown that religious practices and beliefs are clinically relevant, both positively and negatively, to the mental wellbeing of patients. Less research focuses on identifying spiritual risk factors for depressed older adults. Merely screening for spiritual factors of depressed patients may help identify individuals who may benefit the most from spiritually integrated care. In this analysis, we examined spiritual coping and religious involvement as a predictor of depressive symptoms within a cohort of geriatric outpatients with Bipolar Disorder (BD) and Major Depressive Disorder (MDD). Methods: Demographic, clinical, and spiritual data were collected from subjects (n¼34), ages 55-86, with a DSM-IV diagnosis of a mood disorder (n¼16 BD, n¼18 MDD) recruited through two treatment and one non-treatment research studies conducted at McLean Hospital. Subjects were all geriatric outpatients and were voluntarily consented to participate in each research protocol prior to data collection. All studies have undergone annual review from McLean Hospital’s Institutional Review Board (IRB). Subjects were excluded from study participation due to serious or unstable medical conditions; inability to speak English or provide consent; history of substance abuse or dependence in the past 12 months; dementia; history of seizures; or primary psychotic disorders, such as schizophrenia. Subjects received clinical assessments, including the Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). Subjects also completed self-report questionnaires, to assess for mood symptoms (Geriatric Depression Scale, GDS) and spiritual/religious factors (belief in God, frequency of prayer, frequency of public religious involvement and positive/negative religious coping). Scales and self-report questionnaires were collected at multiple time points during study participation, although this analysis focuses on the baseline information from each eligible subject. The mean age of the sample was 70.47 years old and 47% of the subjects identified as male. All subjects in the sample were Caucasian, non-hispanic. Although homogeneous in race, the sample of participants was varied in religious affiliation (n¼13 Catholic, n¼3 Jewish, n¼2 Christian, n¼2 Episcopalian, n¼2 Protestant, n¼1 Greek Orthodox, n¼1 Interdenominational, n¼10 non-believers such as Agnostic, Atheist or non-identifiers). Results: (1) General religious involvement: Patients who reported certain belief in God had lower self-reported GDS scores than non-believers (p < .05) and trended towards lower clinically assessed MADRS scores (p ¼ .08). Participants with any religious affiliation had lower MADRS scores (p < .05) but not self-report GDS scores. Individuals who participated in daily or greater private, but not public, religious activity reported MADRS and GDS scores that were below cut-offs for clinical impairment. (2) Religious coping: After controlling for belief, affiliation, public and private religious activity, negative religious coping was associated with greater MADRS, GDS and YMRS scores accounting for 17.6-19.4% of variance in these variables. Positive religious coping was unrelated to affective, cognitive or neurovegetative symptoms (p > .10 for all analyses). Conclusions: Negative religious coping, referred to as spiritual struggle, is an important risk factor for depressive symptoms among geriatric mood disordered patients, irrespective of religious involvement, practice, or belief. On the contrary, utilization of positive religious strategies to cope with distress has no relation to reduced depressive symptoms. This study demonstrates that regular intrinsic (private) religious involvement is associated with better emotional functioning. This finding suggests that using religion as a coping tool in times of distress is insufficient for psychological benefits in a clinical sample. Furthermore, this study also questions whether spiritual struggle and depression have a shared biological diathesis. Further study of spiritual coping is warranted across clinically-matched age groups utilizing magnetic imaging or genetic analyses. Assessing for spiritual
Am J Geriatr Psychiatry 21:3, Supplement 1
S69
2013 AAGP Annual Meeting risk factors, such as spiritual struggle and religious involvement, may help clinicians and other health care providers identify spiritual stressors associated with depressive symptoms. Care providers can then uniquely tailor treatment plans to meet the medical, psychological, and spiritual needs of patients, particularly those at higher risk for spiritual distress. Poster Number: EI 10
Social Disconnectedness in Primary Care Kimberly A. Van Orden, PhD; Nicole Driffill, BS; Ian H. Stanley, BS; Yeates Conwell, MD University of Rochester Medical Center, Rochester, NY Introduction: Social disconnectedness increases risk for mental illness in later life, including depression, as well as risk for suicide. However, social connectedness is not well characterized among older adult primary care patients, a key gap in the existing literature given that older adults with depression (and other mental health problems) are most likely to seek treatment through primary care. We sought to characterize older adult primary care patients who screened positive on a brief survey assessing social disconnectedness with regards to social network density, depression severity, and suicide risk. Methods: Design/Setting: In-home baseline psychosocial interview for a clinical trial of peer companionship for socially disconnected older adults. Subjects: 120 primary care patients (57% female; age range 60 to 93) who endorsed social disconnectedness (i.e., “I feel lonely” and/or “I feel like a burden on others”) in a screen conducted in primary care offices completed the interview. The Paykel Scale measured "worst point" lifetime suicide ideation and behaviors. The Interpersonal Needs Questionnaire measured low belongingness and perceived burdensomeness. The PHQ-9 measured depressive symptom severity. The National Social Life, Health, and Aging Project’s (NSHAP) social networks module measured social network density. Results: The average PHQ-9 score was 7.97 (std 4.74, range 0-22). Approximately half of the subjects endorsed that there was a time in their life when they felt life was not worth living (50.55%) and approximately 40% (41.76%) endorsed death ideation in their lifetime (wishing they wouldn’t wake up in the morning). A similar proportion (40.66%) endorsed thoughts of suicide in their lifetime (“i.e., thought of taking your own life even if you would not really do it”). A smaller, but still substantial proportion (28.57%) endorsed “seriously considering suicide” including making plans in their lifetime. Finally, 20.88% endorsed a suicide attempt at some point in their lifetimes. A smaller proportion (6.66%) endorsed current death/suicide ideation on the PHQ-9. Data will also be presented on social network density and its association with death/suicide ideation. Conclusions: Older adults who screen positive for social disconnectedness in primary care are characterized by an elevated level of depressive symptom severity and high likelihoods of endorsing suicide ideation and behavior in their lifetimes. A smaller proportion endorsed current death/suicide ideation. These results suggest that social disconnectedness is a form of distress that may detect a population at elevated suicide risk (due to worst point presentations of suicidality). Further, social disconnectedness is malleable via psychosocial intervention; thus, screening for social disconnectedness merits further investigation as assessment of loneliness and burdensomeness may allow for early identification of patients at risk for depression and recurrent suicide ideation and behaviors, and indicate a target for intervention.
Poster Number: EI 11
With a little help from my friends?: The role of social support in adherence to antidepressant medication Lauren B. Gerlach, DO1; Janet Kavanagh, MS1; Claire Chiang, PhD2; Hyungjin Kim, Sc.D1; Helen C. Kales, MD1,2 1 2
University of Michigan Department of Psychiatry, Ann Arbor, MI Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI
Introduction: Although detection and treatment rates for geriatric depression have improved, adherence to antidepressant medication remains low among older adults. The powerful positive influence of social support on depression outcomes including lessening time to remission and improving depressive symptomatology has been well studied, but less is known regarding its impact on antidepressant medication adherence. The goal of this study was to evaluate the role of perceived social support on adherence to new antidepressant medication prescriptions in later-life depression. Methods: Data were obtained by combining samples from two concurrent prospective observational studies with subjects recruited from primary care or psychiatry outpatient clinics at the University of Michigan (N¼183) and four Veterans Affairs Medical Centers located in Michigan (N¼279) respectively. Both studies focused on evaluating the effect of various factors on antidepressant medication adherence within the acute treatment phase (first 4 months). Study participants were age 60 or older, diagnosed with clinically significant depression (Geriatric Depression Scale 5), and given a new antidepressant prescription by
S70
Am J Geriatr Psychiatry 21:3, Supplement 1