Reducing Suicidal Ideation in Depressed Older Primary Care Patients

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 54; no. 10; pp. 1550 - 1556
• Main Authors: Unützer, Jürgen, Tang, Lingqi, Oishi, Sabine, Katon, Wayne, Williams Jr, John W., Hunkeler, Enid, Hendrie, Hugh, Lin, Elizabeth H.B., Levine, Stuart, Grypma, Lydia, Steffens, David C., Fields, Julie, Langston, Christopher
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.10.2006; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult and adolescent clinical studies; Aged; Antidepressant drugs; Attitude to Death; Biological and medical sciences; Cooperative Behavior; Depression; Depressive Disorder - psychology; Depressive Disorder - therapy; Elderly people; Female; Follow-Up Studies; General aspects; Geriatric psychology; Geriatrics; Humans; Male; Medical sciences; Mental depression; Mood disorders; Primary care; Primary health care; Primary Health Care - methods; Psychological Techniques; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Randomized controlled trials; Suicidal ideation; Suicide; Suicide - prevention & control; Suicide - psychology; Suicides & suicide attempts; Time Factors; United States; United States; Human; Mood disorder; Gerontology; Primary health care; Depression; primary care; Suicide ideation; Suicide; Elderly; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2006.00882.x

OBJECTIVES: To determine the effect of a primary care–based collaborative care program for depression on suicidal ideation in older adults. DESIGN: Randomized, controlled trial. SETTING: Eighteen diverse primary care clinics. PARTICIPANTS: One thousand eight hundred one adults aged 60 and older with major depression or dysthymia. INTERVENTION: Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual. MEASUREMENTS: Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist. RESULTS: At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available. CONCLUSION: Primary care–based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients.