Reducing suicidal ideation in depressed older primary care patients.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Unützer, J; Tang, L; Oishi, S; Katon, W; Williams, JW; Hunkeler, E; Hendrie, H; Lin, EHB; Levine, S; Grypma, L; Steffens, DC; Fields, J; Langston, C; IMPACT Investigators,

Published Date

  • October 2006

Published In

Volume / Issue

  • 54 / 10

Start / End Page

  • 1550 - 1556

PubMed ID

  • 17038073

Pubmed Central ID

  • 17038073

Electronic International Standard Serial Number (EISSN)

  • 1532-5415

International Standard Serial Number (ISSN)

  • 0002-8614

Digital Object Identifier (DOI)

  • 10.1111/j.1532-5415.2006.00882.x

Language

  • eng