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

Abstract

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.

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial

“…However, we do not believe this is the case here: we used a similar screening protocol in our previous work (Arean et al, 2008), ensuring comparable standards between this work. More importantly, PST has already been shown to produce effects greater than a supportive therapy control in numerous studies with depressed older adults (Alexopoulos et al, 2011, 2015, 2016; Alexopoulos, Raue, & Arean, 2003; Alexopoulos, Raue, Kanellopoulos, Mackin, & Arean, 2008; Arean et al, 1993, 2008, 2010, 2015; Chu, Huynh, & Arean, 2012; Crabb, Arean, & Hegel, 2012; Gustavson et al, 2016; Mackin et al, 2014; Mackin, Arean, & Elite-Marcandonatou, 2006; Sharpe et al, 2012). Although, we cannot claim that EVO is not significantly worse than PST, we did find the effect sizes for EVO are similar to those found in the literature and is thus worth further study as a depression intervention.…”

(Emotion‐centered) problem‐solving therapy: An update

“…Conceptually, because stress plays a significant role, either as an etiological and/or maintaining variable regarding many forms of psychopathology and patient problems, its transdiagnostic nature appears logical. To illustrate the wide range of applications, note that PST/EC‐PST has been found to be effective for the following patient populations and psychological and/or medical problems: caregivers of children with autism spectrum disorder (Berry, Elliott, Grant, Edwards, & Fine, ); depressed older adults with executive dysfunction (Gustavson et al, ); depressed geriatric homecare patients (Gellis, Kenaley, & Have, ); distressed US military veterans (Tenhula et al, ); adults with type 2 diabetes (Katon et al, ); distressed cancer patients (Nezu, Nezu, Felgoise, McClure, & Houts, ); adults with insomnia (Pech & O'Kearney, ); adults who previously attempted suicide (Hatcher, Sharon, Parag, & Collins, ); depressed stroke patients (Hadidi, Lindquist, Buckwalter, & Savik, ); young offenders with intellectual disabilities (Langdon, Murphy, Clare, Palmer, & Rees, ); depressed medical patients (Harpole et al, ); Latino adults with cancer (Ell et al, ); haemodialysis patients (Erdley et al, ); children with traumatic brain injury (Wade et al, ); US military service members with traumatic brain injury (Vuletic et al, ); vision‐impaired adults (Rovner et al, ); and distressed early‐stage breast cancer patients (Hirai et al, ; see Nezu & Nezu, for a more comprehensive overview of this literature).…”

Disentangling cognition and emotion in older adults: the role of cognitive control and mental health in emotional conflict adaptation

“…Recent research suggests particular psychotherapies that attempt to scaffold executive function while improving mood, such as Problem-Solving Therapy, may be efficacious in older adults with mental health symptoms and co-occurring deficits in cognitive control (Gustavson et al, 2016;Beaudreau et al, 2015). This association with attention and working memory was not observed with the non-affectivebased gender conflict task.…”