Reducing Suicidal Ideation in Depressed Older Primary Care Patients

doi:10.1111/j.1532-5415.2006.00882.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 54 Issue 10, Pages 1550 - 1556

Published Online: 8 Sep 2006

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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Reducing Suicidal Ideation in Depressed Older Primary Care Patients

Jürgen Unützer, MD, MPH ^* , Lingqi Tang, PhD ^† , Sabine Oishi, MSPH ^† , Wayne Katon, MD ^* , John W. Williams, Jr., MD, MHS ^‡ , Enid Hunkeler, MA ^§ , Hugh Hendrie, MD ^∥ , Elizabeth H.B. Lin, MD, MPH ^¶ , Stuart Levine, MD, MHA ^# , Lydia Grypma, MD ^** , David C. Steffens, MD, MHSc ^†† , Julie Fields, BA ^‡‡ , and Christopher Langston, PhD ^§§ , for the IMPACT Investigators

From the ^*Department of Psychiatry, School of Medicine, University of Washington, Seattle, Washington; ^†Health Services Research Center, Neuropsychiatric Institute, University of California at Los Angeles, Los Angeles, California; ^‡Department of Medicine, Duke University, Durham, North Carolina; ^§Division of Research, Kaiser Permanente of Northern California, Oakland and Hayward, California; ^∥Department of Psychiatry, Indiana University, Indianapolis, Indiana; ^¶Center for Health Studies, Group Health Cooperative, Seattle, Washington; ^#SCAN Health Plan, Long Beach, California; ^**Kaiser Permanente of Southern California, San Diego, California; ^††Department of Psychiatry, Duke University, Durham, North Carolina; ^‡‡Department of Psychiatry, Division of Psychology, Southwestern Medical Center, University of Texas, Dallas, Texas; and ^§§The Atlantic Philanthropies, New York, New York.

Address correspondence to Jürgen Unützer, MD, MPH, Professor, Vice-Chair, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195. E-mail: unutzer@u.washington.edu

KEYWORDS

depression • suicide • primary care

ABSTRACT

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.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2006.00882.x About DOI