title: Reducing suicidal ideation in depressed older primary care patients.
abstract: OBJECTIVE
  To determine the effect of a primary care-based collaborative care program for depression on suicidal ideation in older adults.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Eighteen diverse primary care clinics.
  
  
  METHODS
  One thousand eight hundred one adults aged 60 and older with major depression or dysthymia.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, School of Medicine, University of Washington, Seattle, Washington 98195, USA. unutzer@u.washington.edu
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Lingqi
authors.initials: L
authors.lastname: Tang
authors.forename: Sabine
authors.initials: S
authors.lastname: Oishi
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Enid
authors.initials: E
authors.lastname: Hunkeler
authors.forename: Hugh
authors.initials: H
authors.lastname: Hendrie
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Stuart
authors.initials: S
authors.lastname: Levine
authors.forename: Lydia
authors.initials: L
authors.lastname: Grypma
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
authors.forename: Julie
authors.initials: J
authors.lastname: Fields
authors.forename: Christopher
authors.initials: C
authors.lastname: Langston
mesh_terms: D000368:Aged; D001293:Attitude to Death; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D011580:Psychological Techniques; D013405:Suicide / Q000523:psychology; D013997:Time Factors; D014481:United States; D000092864:Suicide Prevention