Regular Research Article
Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

https://doi.org/10.1016/j.jagp.2015.07.010Get rights and content

Objective

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.

Design

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.

Setting

University medical centers.

Participants

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.

Interventions

12 weekly sessions of PST or ST.

Main Outcome Measures

The suicide item of the Hamilton Depression Rating Scale.

Results

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.

Conclusions

PST is a promising intervention for older adults who are at risk for suicide.

ClinicalTrials.gov Identifier: NCT00052091

Section snippets

Methods

This a secondary data analysis from a randomized clinical trial that used a parallel design to compare depression severity in participants allocated to PST or ST at a 1:1 ratio. We use the data from this original study to assess the relative impact of these two interventions on suicidal ideation. The procedures for the trial have been published elsewhere,19, 20 and the methods that are specifically relevant to this report are reiterated here.

Participant Flow

Of 653 older persons screened, 183 did not qualify for the study on the screening interview, and an additional 191 did not meet SCID criteria for major depression. Fifty-eight of those who were eligible were not randomized because they did not complete the baseline assessment, leaving 221 randomized to receive PST (N = 110) or ST (N = 111). Recruitment and participant flow (CONSORT table) is detailed elsewhere.19

Participant Characteristics

The randomized participants were 65.5% female (N = 144), had a mean (SD) age of

Discussion

The main finding of this analysis is that older adults suffering from major depression and executive dysfunction had greater reduction in suicidal ideation during treatment with PST than ST. The beneficial effect of PST over ST in suicidal ideation persisted 24 weeks after the end of treatment. Changes in suicidal ideation overtime were most pronounced in participants who were younger and who reported greater disability prior to treatment initiation, whereas those who had never been married

Conclusions

This study demonstrated that participants with late-life depression and executive dysfunction who received PST were more likely to experience a decrease in suicidal ideation than those who received ST, both during treatment and 24 weeks later. Given the reduction in suicidal ideation and other positive outcomes associated with PST for depressed elders with executive dysfunction,19, 20 health and mental health providers are encouraged to consider PST when deciding on a course of treatment for

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