Citation

Kiosses DN, Gross JJ, Banerjee S, Duberstein PR, Putrino D, Alexopoulos GS. Am. J. Geriatr. Psychiatry 2017; 25(6): 620-629.

Affiliation

Department of Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY.

Copyright

(Copyright © 2017, American Association for Geriatric Psychiatry, Publisher Elsevier Publishing)

DOI

10.1016/j.jagp.2017.01.011

PMID

28223082

Abstract

OBJECTIVE: To examine the relationship of negative emotions with suicidal ideation during 12 weeks of Problem Adaptation Therapy (PATH) versus Supportive Therapy of Cognitively Impaired Older Adults (ST-CI), hypothesizing that improved negative emotions are associated with reduced suicidal ideation, PATH improves negative emotions more than ST-CI, and improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation.

METHODS: In a randomized controlled trial of two home-delivered psychosocial interventions, 74 older participants (65-95 years old) with major depressive disorder and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions and assessments were conducted in participants' homes. PATH focuses on improving emotion regulation, whereas ST-CI focuses on nonspecific therapeutic factors, such as understanding and empathy. Improved negative emotions were measured as improvement in Montgomery Asberg's Depression Rating Scales' (MADRS) observer ratings of sadness, anxiety, guilt, hopelessness, and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item.

RESULTS: MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F[1,165] = 12.73, p = 0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F[1,63.2] = 7.02, p = 0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F[1, 96] = 9.95, p = 0.0022).

CONCLUSION: Findings thatimprovement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation (clinicaltrials.gov; NCT00368940).

Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Language: en

Keywords

Emotions; cognitive impairment; depression; emotional states; psychosocial treatment; suicidal ideation; suicide