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Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction.

ABSTRACT: To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, sex, and additional cognitive impairment load (e.g., memory impairments) were related to changes in suicidal ideation over time.Secondary data analysis using data from a randomized clinical trial allocating participants to PST or ST at 1:1 ratio. Raters were blind to patients' assignments.University medical centers.221 people aged 65 years old and older with major depression determined by Structured Clinical Interview for DSM-III-R diagnosis and executive dysfunction as defined by a score of 33 or less on the Initiation-Perseveration Score of the Mattis Dementia Rating Scale or a Stroop Interference Task score of 25 or less.12 weekly sessions of PST or ST.The suicide item of the Hamilton Depression Rating Scale.Of the 221 participants, 61% reported suicidal ideation (SI). The ST group had a lower rate of improvement in SI after 12 weeks (44.6%) than did the PST group (60.4%, Fisher's exact test p = 0.031). Logistic regression showed significantly greater reductions in SI in elders who received PST at both 12 weeks (OR: .50, Z = -2.16, p = 0.031) and 36 weeks (OR: 0.5, Z = -1.96, p = 0.05) after treatment.PST is a promising intervention for older adults who are at risk for suicide. ClinicalTrials.gov Identifier: NCT00052091.

SUBMITTER: Gustavson KA

PROVIDER: S-EPMC5730069 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction.

Gustavson Kristen A KA Alexopoulos George S GS Niu Grace C GC McCulloch Charles C Meade Tanya T Areán Patricia A PA

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20150730 1

<h4>Objective</h4>To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, sex, and additional cognitive impairment load (e.g., memory impairments) were related to changes in suicidal ideation over time.<h4>Design</h4>Secondary data analysis using data from a randomized clinical trial alloc ...[more]

PMID: 26743100

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Project description:ContextOlder patients with depression and executive dysfunction represent a population with significant disability and a high likelihood of failing pharmacotherapy.ObjectivesTo examine whether problem-solving therapy (PST) reduces disability more than does supportive therapy (ST) in older patients with depression and executive dysfunction and whether this effect is mediated by improvement in depressive symptoms.DesignRandomized controlled trial.SettingWeill Cornell Medical College and University of California at San Francisco.ParticipantsAdults (aged >59 years) with major depression and executive dysfunction recruited between December 2002 and November 2007 and followed up for 36 weeks. Intervention Twelve sessions of PST modified for older depressed adults with executive impairment or ST. Main Outcome Measure Disability as quantified using the 12-item World Health Organization Disability Assessment Schedule II.ResultsOf 653 individuals referred to this study, 221 met the inclusion criteria and were randomized to receive PST or ST. Both PST and ST led to comparable improvement in disability in the first 6 weeks of treatment, but a more prominent reduction was noted in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and more previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was, in part, due to greater reduction in disability by PST. Although disability increased during the 24 weeks after the end of treatment, the advantage of PST over ST was retained.ConclusionsThese results suggest that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.Trial registrationclinicaltrials.gov Identifier: NCT00052091.

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Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction.

Publications

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction.

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