title: Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction.
abstract: OBJECTIVE
  To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, sex, and additional cognitive impairment load (e.g., memory impairments) were related to changes in suicidal ideation over time.
  
  
  METHODS
  Secondary data analysis using data from a randomized clinical trial allocating participants to PST or ST at 1:1 ratio. Raters were blind to patients' assignments.
  
  
  METHODS
  University medical centers.
  
  
  METHODS
  221 people aged 65 years old and older with major depression determined by Structured Clinical Interview for DSM-III-R diagnosis and executive dysfunction as defined by a score of 33 or less on the Initiation-Perseveration Score of the Mattis Dementia Rating Scale or a Stroop Interference Task score of 25 or less.
  
  
  METHODS
  12 weekly sessions of PST or ST.
  
  
  METHODS
  The suicide item of the Hamilton Depression Rating Scale.
  
  
  RESULTS
  Of the 221 participants, 61% reported suicidal ideation (SI). The ST group had a lower rate of improvement in SI after 12 weeks (44.6%) than did the PST group (60.4%, Fisher's exact test p = 0.031). Logistic regression showed significantly greater reductions in SI in elders who received PST at both 12 weeks (OR: .50, Z = -2.16, p = 0.031) and 36 weeks (OR: 0.5, Z = -1.96, p = 0.05) after treatment.
  
  
  CONCLUSIONS
  PST is a promising intervention for older adults who are at risk for suicide. ClinicalTrials.gov Identifier: NCT00052091.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Gustavson
authors.affiliation: Department of Psychiatry, Weill-Cornell Medical College, New York, NY, USA.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Grace C
authors.initials: GC
authors.lastname: Niu
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: McCulloch
authors.affiliation: School of Social Sciences and Psychology, University of Western Sydney, Australia.
authors.forename: Tanya
authors.initials: T
authors.lastname: Meade
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Electronic address: parean@uw.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000523:psychology; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D059020:Suicidal Ideation; D016896:Treatment Outcome
keywords: Depression; executive dysfunction; older adults; problem-solving therapy; suicide ideation