Reducing suicidal ideation in depressed older primary care patients.
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.
Unützer
Jürgen
J
Department of Psychiatry, School of Medicine, University of Washington, Seattle, Washington 98195, USA. unutzer@u.washington.edu
Tang
Lingqi
L
Oishi
Sabine
S
Katon
Wayne
W
Williams
John W
JW
Hunkeler
Enid
E
Hendrie
Hugh
H
Lin
Elizabeth H B
EH
Levine
Stuart
S
Grypma
Lydia
L
Steffens
David C
DC
Fields
Julie
J
Langston
Christopher
C
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