Article2004

Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients

MARTHA LIVINGSTON BRUCE · Charles F. Reynolds · Ira I. Katz · Herbert C. Schulberg · Benoit H. Mulsant · Gregory K. Brown +3 more

963 citations0/0 files storedJAMA

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Suicide and Self-Harm Studies Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access

Abstract

CONTEXT: Suicide rates are highest in late life; the majority of older adults who die by suicide have seen a primary care physician in preceding months. Depression is the strongest risk factor for late-life suicide and for suicide's precursor, suicidal ideation. OBJECTIVE: To determine the effect of a primary care intervention on suicidal ideation and depression in older patients. DESIGN AND SETTING: Randomized controlled trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) with patient recruitment from 20 primary care practices in New York City, Philadelphia, and Pittsburgh regions, May 1999 through August 2001. PARTICIPANTS: Two-stage, age-stratified (60-74, > or =75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened negative patients. This analysis included patients with a depression diagnosis (N = 598). INTERVENTION: Treatment guidelines tailored for the elderly with care management compared with usual care. MAIN OUTCOME MEASURES: Assessment of suicidal ideation and depression severity at baseline, 4 months, 8 months, and 12 months. RESULTS: Rates of suicidal ideation declined faster (P =.01) in intervention patients compared with usual care patients; at 4 months, in the intervention group, raw rates of suicidal ideation declined 12.9% points (29.4% to 16.5%) compared with 3.0% points (20.1% to 17.1% in usual care [P =.01]). Among patients reporting suicidal ideation, resolution of ideation was faster among intervention patients (P =.03); differences peaked at 8 months (70.7% vs 43.9% resolution; P =.005). Intervention patients had a more favorable course of depression in both degree and speed of symptom reduction; group difference peaked at 4 months. The effects on depression were not significant among patients with minor depression unless suicidal ideation was present. CONCLUSIONS: Evidence of the intervention's effectiveness in community-based primary care with a heterogeneous sample of depressed patients introduces new challenges related to its sustainability and dissemination. The intervention's effectiveness in reducing suicidal ideation, regardless of depression severity, reinforces its role as a prevention strategy to reduce risk factors for suicide in late life.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 1977The CES-D Scale 1960A RATING SCALE FOR DEPRESSION 1962Statistical principles in experimental design.2002Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force 2002Reducing Suicide--A National Imperative 1985Analysis of Messy Data, Volume I: Designed Experiments

Cited by

2006Collaborative Care for Depression 2012Collaborative care for depression and anxiety problems 2022Time for united action on depression: a Lancet–World Psychiatric Association Commission 2014Health Care Contacts in the Year Before Suicide Death 2012Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions Across Primary, Specialty, and Behavioral Health Care Settings: Systematic Review and Meta-Analysis 2011Suicide in Older Adults 2007Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

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