患有重度抑郁症和认知障碍的老年人在心理社会治疗期间的负面情绪和自杀意念
Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment.
作者信息
Kiosses Dimitris N, Gross James J, Banerjee Samprit, Duberstein Paul R, Putrino David, Alexopoulos George S
机构信息
Department of Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY.
Department of Psychology, Stanford University, Stanford, CA.
出版信息
Am J Geriatr Psychiatry. 2017 Jun;25(6):620-629. doi: 10.1016/j.jagp.2017.01.011. Epub 2017 Jan 19.
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 = 12.73, p = 0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F = 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 = 9.95, p = 0.0022).
CONCLUSION
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).
目的
探讨问题适应疗法（PATH）与认知障碍老年人支持性疗法（ST-CI）在12周治疗期间负面情绪与自杀意念的关系，假设负面情绪改善与自杀意念减少相关，PATH比ST-CI更能改善负面情绪，且负面情绪改善而非其他抑郁症状可预测自杀意念减少。
方法
在一项针对两种居家心理社会干预措施的随机对照试验中，与社区机构合作招募了74名患有重度抑郁症和认知障碍的老年参与者（65 - 95岁）。样本报告的感受强度低于自杀意图。干预和评估在参与者家中进行。PATH侧重于改善情绪调节，而ST-CI侧重于非特异性治疗因素，如理解和共情。负面情绪改善通过蒙哥马利-艾斯伯格抑郁量表（MADRS）中观察者对悲伤、焦虑、内疚、绝望和快感缺失的评分改善来衡量。自杀意念用MADRS自杀项目进行评估。
结果
在治疗过程中，MADRS负面情绪得分与自杀意念显著相关（F = 12.73，p = 0.0005）。PATH参与者在MADRS情绪方面的改善明显大于ST-CI参与者（治疗组×时间：F = 7.02，p = 0.0102）。最后，在滞后访谈和随访访谈之间负面情绪的改善显著预测了随访访谈时自杀意念的减少（F = 9.95，p = 0.0022）。
结论
负面情绪改善介导自杀意念减少的研究结果可能为减少自杀意念的心理社会干预措施的开发提供指导（clinicaltrials.gov；NCT00368940）。
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