Reducing suicidal ideation in depressed older primary care patients

Jürgen Unützer, Lingqi Tang, Sabine Oishi, Wayne Katon, John W. Williams, Enid Hunkeler, Hugh Hendrie, Elizabeth H.B. Lin, Stuart Levine, Lydia Grypma, David C. Steffens, Julie Fields, Christopher Langston

Research output: Contribution to journalArticle

129 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1550-1556
Number of pages7
JournalJournal of the American Geriatrics Society
Volume54
Issue number10
DOIs
StatePublished - Oct 1 2006

Keywords

  • Depression
  • Primary care
  • Suicide

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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    Unützer, J., Tang, L., Oishi, S., Katon, W., Williams, J. W., Hunkeler, E., Hendrie, H., Lin, E. H. B., Levine, S., Grypma, L., Steffens, D. C., Fields, J., & Langston, C. (2006). Reducing suicidal ideation in depressed older primary care patients. Journal of the American Geriatrics Society, 54(10), 1550-1556. https://doi.org/10.1111/j.1532-5415.2006.00882.x