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, gender and additional cognitive impairment load (eg: 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 SCID 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 Stroop Interference Task score of 25 or less.
Interventions
12 weekly sessions of Problem Solving Therapy or Supportive Therapy.
Main Outcome Measures
The suicide item of the Hamilton Depression Rating Scale (HDRS).
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.
Conclusion
PST is a promising intervention for older adults who are at risk for suicide.
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