title: Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment.
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).
  
  
  CONCLUSIONS
  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).
authors.affiliation: Department of Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY. Electronic address: dkiosses@med.cornell.edu.
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.affiliation: Department of Psychology, Stanford University, Stanford, CA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gross
authors.affiliation: Department of Healthcare Policy and Research, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY.
authors.forename: Samprit
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Psychiatry and Family Medicine, University of Rochester Medical Center, Rochester, NY.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Duberstein
authors.affiliation: Department of Rehabilitation Medicine, Weill Cornell Medicine, White Plains, NY; Telemedicine and Virtual Rehabilitation, Burke Medical Research Institute, White Plains, NY.
authors.forename: David
authors.initials: D
authors.lastname: Putrino
authors.affiliation: Department of Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications / Q000628:therapy*; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy*; D004644:Emotions; D006699:Home Care Services; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods; D059020:Suicidal Ideation
keywords: Emotions; cognitive impairment; depression; emotional states; psychosocial treatment; suicidal ideation; suicide