A preliminary investigation of self-reported personality disorders in late life: Prevalence, predictors of depressive severity, and clinical correlates

Previous research suggests that personality disorders, particularly in clusters A and C, persist into late life, are particularly prevalent in late-life depressed samples, and negatively impact treatment of late-life depression. The present study examined the self-reported personality disorder traits of a sample of 65 depressed elders using the Wisconsin Personality Disorder Inventory IV (WISPI IV). As expected, clusters A and C were most prevalent and the presence of a personality disorder predicted the maintenance or re-emergence of depressive symptoms, as did hopelessness and ambivalence regarding emotional expression. No specific personality disorder traits were associated with clinical features of late-life depression (age of onset, number of previous episodes) while some personality disorder traits were associated with psychological correlates of depression (hopelessness, ambivalence regarding emotional expression, thought suppression). A theoretical explanation for the cluster prevalence based on self-verification is discussed along with a profile of elderly patients who may have poor depression treatment course if they exhibit personality disorder traits, particularly interpersonal rigidity or avoidance, chronic hopelessness, and emotional inhibition.<br/

A model predicting suicidal ideation and hopelessness in depressed older adults: The impact of emotion inhibition and affect intensity

The purpose of this study was to begin a preliminary examination of constructs theorized to be related to suicidal behavior by testing a model of the influence of both temperament and emotion regulation on suicidal ideation and hopelessness in a sample of depressed older adults. The model was evaluated using structural equation modeling procedures in a sample of depressed, older adults. Findings supported a temporally predictive model in which negative affect intensity and reactivity lead to emotion inhibition, operationalized as ambivalence over emotional expression and thought suppression, which in turn lead to increased presence of suicidal predictors, operationalized as hopelessness and suicidal ideation. These results suggest that suicide prevention efforts in older adults may be improved by targeting emotion inhibition in treatment, especially among affectively intense and reactive older adults.<br/

Aging and well-being in Goa, India: a qualitative study

Objectives: The population of India is aging rapidly. This demographic shift brings with it a host of challenges to the health and well-being of older adults, including the increased prevalence of non-communicable diseases, among them depressive disorders. In this paper, we report on qualitative research intended to inform the development of a locally acceptable and appropriate intervention to improve the well-being of older adults in Goa, India and, specifically, to prevent late-life depression. Method: Semi-structured interviews with 20 individuals, aged 60 years and older, attending two primary care clinics in Goa, India. Transcripts were reviewed to identify emerging themes, a coding scheme was developed and thematic analyses were conducted. Results: Analyses of the interview transcripts revealed the following key themes: (1) notions of old age tended to be negative and there were widespread fears of becoming widowed or incapacitated; (2) the most frequently reported health conditions were joint pain, diabetes and heart disease; (3) emotional distress was described using the terms ‘tension’, ‘stress’, ‘worry’ and ‘thinking’; (4) family issues often involved financial matters, difficult relationships with daughters-in-law and conflicted feelings about living with the family or independently; (5) other than a pension scheme, participants did not know of community resources available to older adults. Conclusions: Our findings are in general agreement with those of previous research, and with our experiences of working with older adults in Pittsburgh and the Netherlands. This research will inform the development of an intervention to prevent depression in older adults in Goa

Perspectives of postmenopausal breast cancer survivors on adjuvant endocrine therapy-related symptoms.

PURPOSE: To conduct an investigation of women's experiences related to taking AET and managing AET-related symptoms. DESIGN: Qualitative. SETTING: Main campus of the University of Pittsburgh. SAMPLE: Four groups with a total of 14 breast cancer survivors, aged ≥ 50 years with AET-related symptoms. METHODS: Semi-structured discussion guides were used to elicit recollections of conversations with health care providers about starting AET, symptom experiences, symptom management, and suggestions for improving management. Audiotaped discussions were transcribed and analyzed to identify themes. FINDINGS: Women reported that initially AET was not viewed as a choice, but rather as the necessary next step to save their lives. After starting AET, women experienced difficulties making sense of, communicating about, and managing unanticipated AET-related symptoms. Women who experienced persistently bothersome symptoms began weighing the pros and cons of AET in order to decide whether to continue treatment. CONCLUSIONS: Focus group findings suggest multiple opportunities to better prepare patients for AET and to improve assessment and management of AET-related symptoms. IMPLICATIONS FOR NURSING: exploring AET-related symptom experiences, nurses may be able to promote AET adherence in breast cancer survivors, aged ≥ 50 years