Gustavson Kristen A, Alexopoulos George S, Niu Grace C, McCulloch Charles, Meade Tanya, Areán Patricia A
Department of Psychiatry, University of California, San Francisco, CA, USA.
Department of Psychiatry, Weill-Cornell Medical College, New York, NY, USA.
Am J Geriatr Psychiatry. 2016 Jan;24(1):11-17. doi: 10.1016/j.jagp.2015.07.010. Epub 2015 Jul 30.
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.
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.
University medical centers.
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.
12 weekly sessions of PST or ST.
The suicide item of the Hamilton Depression Rating Scale.
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.
PST is a promising intervention for older adults who are at risk for suicide. ClinicalTrials.gov Identifier: NCT00052091.
检验以下假设，即问题解决疗法（PST）在降低患有重度抑郁症和执行功能障碍的老年人自杀意念方面比支持性疗法（ST）更有效。我们进一步探讨了患者特征，如年龄、性别和额外的认知障碍负荷（如记忆障碍）是否与自杀意念随时间的变化有关。
使用来自一项随机临床试验的数据进行二次数据分析，该试验以1:1的比例将参与者分配到PST或ST组。评估者对患者的分组情况不知情。
大学医学中心。
221名65岁及以上的老年人，他们通过《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）的结构化临床访谈被诊断为患有重度抑郁症，并且根据马蒂斯痴呆评定量表启动-坚持得分33分及以下或斯特鲁普干扰任务得分25分及以下被定义为存在执行功能障碍。
PST或ST各进行为期12周的每周一次治疗。
汉密尔顿抑郁量表中的自杀项目。
在221名参与者中，61%报告有自杀意念（SI）。12周后，ST组SI改善率（44.6%）低于PST组（60.4%，Fisher精确检验p = 0.031）。逻辑回归显示，接受PST治疗的老年人在治疗后12周（比值比：0.50，Z = -2.16，p = 0.031）和36周（比值比：0.5，Z = -1.96，p = 0.05）时，SI显著降低。
PST对于有自杀风险的老年人是一种有前景的干预措施。ClinicalTrials.gov标识符：NCT00052091。
