Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment

Abstract

Objectives To examine the relationship of negative emotions with suicidal ideation during 12-weeks of Problem Adaptation Therapy (PATH) vs. Supportive Therapy of Cognitively Impaired Older Adults (ST-CI). We hypothesize that: a) improved negative emotions are associated with reduced suicidal ideation; b) PATH improves negative emotions more than ST-CI; and c) improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation. Design RCT of two home-delivered psychosocial interventions. Setting Weill-Cornell Institute of Geriatric Psychiatry; interventions and assessments were conducted at participants’ home. Participants 74 older participants (65–95 years old) with MDD and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions PATH focuses on improving emotion regulation whereas ST-CI focuses on non-specific therapeutic factors, such as understanding and empathy. Measurements Improved negative emotions are measured as improvement in Montgomery Asberg’s Depression Rating Scales’ (MADRS) observer-ratings of sadness, anxiety, guilt, hopelessness and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item. Results MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F[1, 165]=12.73, p=0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F[1,63.2]=7.02, p=0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F[1, 96]=9.95, p=0.0022). Conclusions Our findings that improvement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation.

Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature

“…Three of these studies originated from Sweden, and two were from Canada, while the rest were from single originations: Netherlands, Netherlands/Germany/Belgium. The theme increased safety (increases a sense of security, increases safety) occurred in 6/68 occurrences (9%) [3,25,30,35,41,57]. These studies all came from single originations: Netherlands, Sweden, Norway, United States, New Zealand, and United Kingdom.…”

“…These studies originated from Germany, Pakistan, New Zealand, and the United States. The theme of improved mood (improved emotional wellbeing, improved negative emotions, enabled greater enjoyment) occurred in 4/69 occurrences (6%) [33,34,41,64]. These studies originated from Germany, Australia, British Columbia, and the United States.…”

Effectiveness of counselling and psychotherapeutic interventions for people with dementia and their families: a systematic review

“…Five studies from the same research group compared face-to-face PATH to face-to-face Supportive Therapy (ST) (Kiosses et al, 2010(Kiosses et al, , 2011(Kiosses et al, , 2015a(Kiosses et al, , 2015b(Kiosses et al, , 2017. PATH aims to reduce depression and disability by facilitating problem solving and adaptive functioning, utilising tools to circumvent the behavioural and functional limitations exacerbated by cognitive impairment (e.g.…”

Advances in Psychotherapy for Depressed Older Adults

“…Recent work suggests that different psychotherapies may be appropriate for different intensities of suicidal ideation. In secondary analyses of the PATH RCT, Kiosses [55, 58] found that for patients with major depression, cognitive impairment, and mild forms of suicidal ideation (i.e., “feeling that life is not worth living”) both PATH and Supportive Therapy led to comparable reductions in suicidal ideation. However, in patients with death ideation or active suicidal ideation, PATH led to greater reductions in suicidal ideation than Supportive Therapy.…”