Adapting interpersonal psychotherapy for older adults at risk for suicide: Preliminary findings.

Abstract

We report preliminary findings of the first ever study testing a 16-week course of Interpersonal Psychotherapy (IPT) modified for older outpatients at elevated risk for suicide. Participants were referred from inpatient and outpatient medicine and mental health services. Psychotherapy sessions took place in a therapist's office in a teaching hospital. Twelve adults 60 years or older (M=70.5, SD=6.1) with current thoughts of suicide (suicide ideation) or a wish to die (death ideation) or with recent self-injurious behavior were recruited into weekly sessions of IPT; one was subsequently excluded due to severe cognitive impairment. Participants completed measures of suicide ideation, death ideation, and depressive symptom severity at pre-treatment, mid-treatment, post-treatment, and at 3-month follow-up periods, and measures of therapeutic process variables. Preliminary findings of this uncontrolled pre-post-treatment study support the feasibility of recruiting and retaining older adults at-risk for suicide into psychotherapy research and suggest that adapted IPT is tolerable and safe. Findings indicate a substantial reduction in participant suicide ideation, death ideation, and depressive symptoms; controlled trials are needed to further evaluate these findings. We discuss implications for clinical care with at-risk older adults. KeywordsSuicide; suicide ideation; suicidal behavior; geriatric; elderly; older adults; psychotherapy; interventions; treatment; IPT; Interpersonal PsychotherapyOlder adults have high rates of suicide (Heisel & Duberstein, 2005). Efficacious interventions for suicidal older adults are needed in order to reduce risk and societal burden; however, treatment data are scarce. Existing clinical recommendations for managing suicide risk have largely drawn on practices not empirically tested with older adults (Joiner, Walker, Rudd, & Jobes, 1999;Kleespies, Deleppo, Gallagher, & Niles, 1999;Rudd, Joiner, Jobes, & King, 1999), necessitating population specific research. The extreme lethality of suicidal behavior among older adults and the increasing rates of suicide with advancing age necessitate preventive interventions targeting at-risk older adults, such as those expressing suicidal thoughts and desires (suicide ideation), preoccupation with death and/or wish to die (death ideation), and/or self-injurious behavior (Heisel & Duberstein, 2005). In one study, many older adults who died by suicide had expressed thoughts of suicide to a clinician (38%) or to a family member or acquaintance (73%) in the final year of life (Waern, Beskow, Runeson, & Skoog, 1999). Nearly half of those who died by suicide had received antidepressant medication and/ NIH Public Access Author ManuscriptProf Psychol Res Pr. Author manuscript; available in PMC 2010 June 22. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript or Electroconvulsive Therapy 6 months prior to death (Waern, Beskow, Runeson, & Skoog, 1996), suggesting that somatic treatments for late-life depression may not be suffici...

Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide

“…IPT participants were provided with 24/7 access to the study therapist by cellular phone if experiencing heightened distress, severe suicide ideation, and/or if imminent self-harm was evident. Participants found this “lifeline” supportive and did not misuse it [9]. …”

“…Older adults are amenable to and respond well to psychological interventions [5-8]; however, only one trial of psychotherapy to date has been conducted exclusively targeting suicidal older adults [9]. We specifically conducted a small focused trial of Interpersonal Psychotherapy (IPT) adapted for older adults at-risk for suicide by virtue of expression of current suicide ideation, death ideation, or recent self-injury.…”

“…We specifically conducted a small focused trial of Interpersonal Psychotherapy (IPT) adapted for older adults at-risk for suicide by virtue of expression of current suicide ideation, death ideation, or recent self-injury. Preliminary findings suggested that this intervention is feasible, tolerable, and safe, and has a positive impact on therapeutic change [9]. Significant reductions were observed in suicide ideation, death ideation, and depressive symptom severity [9].…”

“…Preliminary findings suggested that this intervention is feasible, tolerable, and safe, and has a positive impact on therapeutic change [9]. Significant reductions were observed in suicide ideation, death ideation, and depressive symptom severity [9]. We now extend and expand upon these preliminary findings by reporting complete study findings on primary (suicide ideation and death ideation) and secondary (depressive symptom severity) outcomes and therapeutic process variables (working alliance and treatment satisfaction) across pre- to post-treatment assessments, and investigating the stability of change over a 6-month follow-up period.…”

“…IPT problem areas regarding death, losses, and transitions are consistent with existential concerns that may engender perceptions of meaninglessness [21-23]. We thus adapted IPT from existing treatment manuals [24,25] incorporating lessons learned from reports of suicide during psychotherapy [26,27], by making suicide a central focus of clinical discourse and incorporating safety precautions and ongoing surveillance of suicide risk and resiliency factors, including MIL and additional psychological well-being variables [9]. We further sought to individually tailor treatment to participants’ emotional and existential concerns, helping them attend to remaining sources of MIL, emphasizing enhancing, rebuilding, or cultivating meaningful relationships.…”