Pine Rest Mission Statement
Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity and compassion.

Older Adults: Depression and Suicide Facts

By Scott Halstead, PhD, Neuropsychologist
Manager, Psychological Consultation Center/Senior Care Clinic

Depression, one of the most common conditions associated with suicide in older adults, is a widely under recognized and undertreated medical illness. In fact, several studies have found that many older adults who die by suicide—up to 75 percent—have visited a primary care physician within a month of their suicide. These findings point to the urgency of improving detection and treatment of depression as a means of reducing suicide risk among older persons.

Older Americans are disproportionately likely to die by suicide. Comprising only 13 percent of the U.S. population, individuals age 65 and older accounted for 18 percent of all suicide deaths in 2000. Among the highest rates (when categorized by gender and race) were white men age 85 and older: 59 deaths per 100,000 persons in 2000, more than five times the national U.S. rate of 10.6 per 100,000.

Of the nearly 35 million Americans age 65 and older, an estimated 2 million have a depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder) and another 5 million may have “subsyndromal depression,” or depressive symptoms that fall short of meeting full diagnostic criteria for a disorder. Subsyndromal depression is especially common among older persons and is associated with an increased risk of developing major depression. In any of these forms, however, depressive symptoms are not a normal part of aging. In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, they tend to be persistent and to interfere significantly with an individual's ability to function.

Depression often co-occurs with other serious illnesses such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. Because many older adults face these illnesses as well as various social and economic difficulties, health care professionals may mistakenly conclude that depression is a normal consequence of these problems—an attitude often shared by patients themselves. These factors together contribute to the underdiagnosis and undertreatment of depressive disorders in older people. Depression can and should be treated when it co-occurs with other illnesses, for untreated depression can delay recovery from or worsen the outcome of these other illnesses. The relationship between depression and other illness processes in older adults is a focus of ongoing research.

Research and Treatment
Research has revealed varying patterns of clinical and biological features among older adults with depression. As compared to older persons whose depression began earlier in life, those whose depression first appears in late life are likely to have a more chronic course of illness. In addition, there is growing evidence that depression beginning in late life is associated with vascular changes in the brain.

Both antidepressant medications and short-term psychotherapies are effective treatments for late-life depression. Existing antidepressants are known to influence the functioning of certain neurotransmitters in the brain. The newer medications, chiefly the selective serotonin reuptake inhibitors (SSRIs), are generally preferred over the older medications, including tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), because they have fewer and less severe potential side effects. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another.

Research has shown that certain types of short-term psychotherapy, particularly cognitive-behavioral therapy and interpersonal therapy, are effective treatments for late-life depression. In addition, psychotherapy alone has been shown to prolong periods of good health free from depression. Combining psychotherapy with antidepressant medication, however, appears to provide maximum benefit. In one study, approximately 80 percent of older adults with depression recovered with combination treatment. The combination treatment was also found to be more effective than either treatment alone in reducing recurrences of depression.

More studies are in progress on the efficacy and longer-term effectiveness of SSRIs and specific psychotherapies for depression in older persons. Findings from these studies will provide important data regarding the clinical course and treatment of late-life depression. Further research will be needed to determine the role of hormonal factors in the development of depression in older adults, and to find out whether hormone replacement therapy with estrogens or androgens is of benefit in the treatment of late-life depression.

Older Adults...
Before you say, "I'm fine"...

Ask yourself if you feel:

• nervous or "empty"
• guilty or worthless
• very tired and slowed down
• you don't enjoy things the way you used to
• restless and irritable
• like no one loves you
• like life is not worth living

Or if you are:

• sleeping more or less than usual
• eating more or less than usual
• having persistent headaches, stomach aches, or chronic pain

These may be symptoms of Depression, a treatable medical illness.

But your doctor can only treat you if you say how you are really feeling.

Depression is not a normal part of aging.

Talk to your doctor

Information in this article was researched through NIMH Publication No. 03-4593

Privileged Communication: Talking with Your Child

by David Stoepker, Ed.D., Pine Rest Kalamazoo Clinic

"Why can't I have one, Mom? All the other kids at school have one. I'll be the only one who doesn't."

Social cooperation involves your child's sensitivity to input from peers, relating to a best friend, and team participation. Understanding each of these three aspects can guide you if you're uncertain what you should talk about with your children as well as how to converse with them.

Sensitivity to input from peers means that peer pressure begins to have an impact on your child at this age. While we realize this is necessary to help children gain awareness of others' viewpoints, many parents dread the process of peer pressure. It is frightening because it means the influence of the parent is modified and reduced by what friends say and do. Remember, however, at this age parental opinions still carry the greater weight though your child may question them.

To promote effective communication, acknowledge the differing opinions and, as necessary, explain the reason for your own position briefly and simply. There is no need to argue with your child or expend great effort to convince him/her you are correct.

You should not only respond to your child's inquiries, but may ask what peers are doing or saying about a variety of issues. Although the depth of conversation will be deeper with the twelve-year-old than with the eight-year-old, topics may include drugs, religious beliefs, sex, clothing, music, TV, entertainment, and political choices.

Keep in mind peer pressure; these important talks have the most impact if you carry them out in private. If the talks are done in the presence of your children's peers, they may listen only minimally, be silly, or act belligerently to impress their friends, get their friends' attention, or avoid being embarrassed in front of them.

It is especially important to seek a private place away from your child's friends when you administer discipline. When you discipline, talk in a kind--though firm--tone or voice with love in your eyes and a gentle touch. Avoid name-calling.

Be creative in devising ways to talk with your child one-to-one. Periodically taking your child out to eat--such as a Saturday morning breakfast--provides a great conversation opportunity. Having devotions and praying with your child not only sets up a good habit, but is the perfect chance for meaningful communication alone about very important beliefs. Many children like to go along when a parent runs errands thus creating another time for one-to-one talks.

Relating to a best friend is a second aspect of social cooperation. Harry Stack Sullivan, eminent psychologist, placed great emphasis on this aspect in his personality theory and referred to it as the "chum stage." The child's best friends will be his or her same gender. There will be a wide range of options from which your child can choose when selecting a best friend, therefore it is important that during those special private talks you discuss what your child should consider when picking friends.

To foster an open atmosphere when you and your child talk about friends, it is helpful if you encourage your child to invite the friend over for family meals, for sleep-overs, and to go along for family outings--including church activities. Also attend events such as concerts and other entertainments with the children and their friends to be aware of subjects to discuss later one-on-one.

The third aspect of social cooperation is team participation. Topics of conversation in this case include talks about sportsmanship, making personal sacrifices for the benefit of the team, handling losing, and coping with teasing from peers when your child makes mistakes. Practicing together for the game or driving your child to and from the game are great opportunities to talk about these issues.

(Excerpted from the "Today" magazine titled "Communication—Can We Talk?". You can read the complete article here: http://www.pinerest.org/education/today/communication/talking.asp)

Upcoming Events

Classes and Workshops
January 5, 12, 19, 26
Anger Management Classes
Classes will be led by Jim Bottenhorn, M.A., L.L.P., director of Pine Rest ’s Contact Center.
The six-hour classes will be held over the course of four consecutive Thursday evenings in January, and four consecutive Tuesday evenings in March, from 7:00-8:30 p.m. in the Mulder Center on Pine Rest’s main campus, 300 68th Street SE, Grand Rapids. Classes are geared toward adults and older teens (aged 16 and older), and are open to both men and women.
For more information click here.

January 11
Pine Rest’s Demey Clinic To Host Free Training On How To Conduct An Intervention
Larry Vander Plaats, LMSW, CACI, manager of Pine Rest’s DeMey Clinic, announced today that DeMey Clinic will host a free training session for community members on how to conduct an intervention for loved ones, co-workers, family or congregational members.
For more information click here.

Family Institute
January 14, 21, 28
Secrets for Successful Marriage
Pre-marital workshop taught by experienced marriage professionals for couples who want to grow their relationship in preparation for marriage. Because it is skill-based, it is a valuable addition to traditional pastoral or professional premarital counseling. 9 a.m. to noon. Cost: $95/couple. Call 616/455-5279 or
For more information click here.

Support Groups
January 7, 21
How to Support a Loved One Who Struggles with Addiction
A bi-weekly, confidential support group persons age 18 or older who have a loved one with an addiction (alcohol or other drugs). Group is designed to strengthen families while providing respectful and supportive feedback. 10:00 a.m. – 11:00 a.m. at Pine Rest’s Southwest Clinic, 4375 Canal Street, SW in Grandville. Facilitated by Cindy Freeney, LMSW, CAC I. Cost: Free. Call 616/222-3700 or
For more information click here.

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Disclaimer

Copyright © 2005, Pine Rest Christian Mental Health Services. All rights reserved. The contents of Mental Health News & Information are for informational purposes only. The content is not intended to be a substitute for professional medical or mental health advice, diagnosis, or treatment. It cannot and should not be used as a basis for diagnosis or choice of treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical or mental health condition.