Evaluating an Intervention for the Elderly at Increased Risk of Suicide

Abstract

This article presents an evaluation of Link-Plus, a social work service provided over the telephone under the auspices of a suicide prevention hot line agency. The program targets the elderly at increased risk of suicide by virtue of depression, social isolation, and unmet needs. A two-group pretest-posttest design with randomization was used to test its effectiveness After receiving standard crisis intervention, 31 participants provided a wait-list control group, whereas 30 participants received immediate treatment. At 4 months, the amount of social contact was improved, and there was a trend toward the reduction of depressive symptomatology. At an 8-month observation, the difference between the clients' pretest scores and posttest scores on unmet needs was marginally significant, with clients having fewer unmet needs after receiving services. This outreach strategy and telephone intervention is moderately effective in treating older adults with depressive symptomatology, social isolation, and unmet needs. Life Crisis, a well-established crisis hot line program in St. Louis, is dedicated to the prevention of suicide. Over the past 5 years, Life Crisis has developed a new program, Link-Plus, which serves the elderly at increased risk of suicide. Link-Plus provides a free clinical social work service over the telephone. Services include a multidimensional assessment, service arrangement, and supportive therapy. The emphasis is on helping clients access mental health services available in the community.

A Systematic Review of Elderly Suicide Prevention Programs

“…Four studies implemented telephone counseling outreach programs (De Leo, Carollo, & Dello Buono, 1995; De Leo, Dello Buono, & Dwyer, 2002; Fiske & Arbore, 2000; Morrow-Howell, Becker-Kemppainen, & Judy, 1998). De Leo’s team evaluated the long-term impact on suicide rates of a telephone service that included (1) Tele-Help, a 24 h emergency service for elders to call for help, and (2) Tele-Check, a twice-weekly telephone support.…”

“…According to Jones (2002), telephone counseling outreach programs (such as TeleHelp-TeleCheck services) seem to give the essential elements to the prevention of suicide, that is, a regular, confiding relationship with a helping person, and a method of increasing the person’s sense of mastery, in spite of the physical distance with the health care staff. One of the important findings of the telecommunication studies is that face-to-face contact may not be required for successful mental health care interventions (De Leo et al, 2002; Fiske & Arbore, 2000; Morrow-Howell et al, 1998). Many elderly patients find medical centers intimidating and their services difficult to negotiate or inconvenient.…”

Characteristics and Effects of Suicide Prevention Programs: Comparison between Workplace and Other Settings

“…• Education and training of individuals: providing suicide prevention education by professionals [54][55][56][57][58][59] , raising awareness about suicide prevention 58,60) • Development of a support network: developing a community network 54,61) • Cooperation from internal and external resources: establishing a network of various support facilities [62][63][64][65][66][67][68][69] 54,60,62,67,70) • Reducing access to lethal means of committing suicide 54,71,72) The characteristic contents of suicide prevention programs in the community consisted in educating professionals who provide suicide prevention education [73][74][75][76] , increasing the efficacy of consultation systems and medical facilities in the community 70,71,72,[77][78][79][80][81][82][83][84] , educating the media 85,86) and developing suicide prevention manuals 63) .…”

“…Results indicate that a great number of callers appear to benefit from calls, based on the observed decreased ratings for depression and suicidal urgency, as well as the promise at the end of the call not to commit suicide, which was confirmed at followup. Another program examined the effectiveness of suicide prevention hotlines for the elderly, provided as a social work service in the community 75) . After receiving standard crisis intervention, 31 participants were assigned to a four-month waiting list (control group), whereas 30 received immediate treatment.…”

Studies of the Cost-Effectiveness of Social Work Services in Aging: A Review of the Literature

“…Anker-Unnever & Netting (1995) Coordinated Care Partnership (CCP) Claiborne (2003) GEM Engelhardt et al (1996) Multidisciplinary GEM Rubin, Sizemore, Loftis, Adams-Huet, & Anderson (1992)* Multidisciplinary GEM Toseland et al (1996) Multidisciplinary GEM Toseland, O'Donnell, et al (1997) (1993) Social work group intervention Hussian & Lawrence (1981) Social reinforcement of activity; problem-solving training McCallion, Toseland, & Freeman (1999) Family visit education program Morrow-Howell & Becker-Kemppalssen (1998) Link-Plus program Naleppa & Reid (1998) Task-centered case management Toseland, Diehl, et al (1997) Validation therapy; social contact group *included cost measures and cost outcomes investigators of two more caregiver support group projects, which targeted both caregiver or care recipient pairs, reported a reduction in nursing home placement rates for individuals receiving the interventions when compared to those receiving usual care (Mittelman et al, 1993;Montgomery & Borgotta, 1989). Last, the results of the health education program-included as a separate article in this special issue-revealed total cost savings to both caregivers and care recipients during 2 years.…”