Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial

Abstract

Objectives The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. Methods Data come from the cluster-randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12 months follow-up. Suicidal ideation was measured using the Hamilton Rating Scale for Depression (HAM-D) item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed-effects models. Results A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (OR=0.51, 95% CI; 0.24-1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. Conclusion SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long-term reduction in SI among high-risk patients.

Prevalence of Suicidal Ideation and Associated Risk Factors among Adults with Disabilities

“…There were limited comparison studies in this population, using the same scale. However, this result is higher than the 4.9% of suicidal ideation found in community residents in Taiwan [12], the 10% of Medicare home health patients in the USA [26], but similar to a report of 12.4% for individuals with physical disabilities in Germany [27]. The finding also echoed a result from South Korea, in which Lee, et al [10] reported that the hazard ratio of suicide people with disability was 1.9-fold higher, compared to individuals without disability.…”

Risk factors for suicidal behaviour in late-life depression: A systematic review

“…Moreover, some studies have highlighted a higher risk of suicidal behaviour in women[ 39 , 52 ] and White Caucasian[ 25 ]. In the same vein, Lohman et al [ 47 ] observed lower scores in the HDRS among older adults from ethnic minority groups. On the other hand, the study by Bartels et al [ 41 ] reported higher scores of suicidal ideation among older Americans from Asian ethnic groups (in comparison to those from the African ethnic group).…”

“…Several studies showed an increased risk for suicidal behaviour with higher disability levels[ 20 , 22 , 40 , 42 , 47 , 48 ], poorer health status[ 22 , 39 ], and multimorbidity[ 41 , 47 ]. Almeida et al [ 2 ] studied the relationship of multiple clinical factors with suicide attempt and completed suicide among older men from Australia.…”

Suicide among Veterans receiving Veterans Health Administration Home Based Primary Care and following discharge from Community Living Centers

“…These settings offer opportunities for detecting those at risk and implementing prevention strategies. Indeed, a depression management intervention resulted in a reduction in suicidal ideation for Medicare home health patients (Lohman et al, 2016). In addition, recent VHA clinical innovations have focused on the importance of suicide prevention among HBPC and recently discharged CLC populations (Luci et al, 2020;Mlinac et al, 2021).…”