NEW YORK - A collaborative
care program reduces thoughts of suicide, and potentially the risk of actual
suicide, among depressed elderly people, a study shows.
Even 12 months after the year-long program had ended, Dr. Jurgen Unutzer of
the University of Washington School of Medicine in Seattle and colleagues found,
men and women who had participated in the program were less likely to report
thoughts of suicide than those who received standard care.
Finding effective ways to treat depression in elderly people is particularly
important, the researchers note in their article in the Journal of the American
Geriatric Society. Mood disorders are common in older people, and the suicide
rate among the elderly -- particularly white men -- is much higher than average.
Unutzer and his team evaluated at a one-year program called the Improving
Mood: Promoting Access to Collaborative Treatment (IMPACT) trial. In the
intervention, a trained nurse or psychologist worked with the patient's primary
care doctor to manage depression care, discussing treatment options including
antidepressant medications and therapy with the patient.
Patients were also offered the opportunity to participate in a four- to
eight-session series of behavioral treatments designed to improve
problem-solving abilities.
The trial involved 1801 men and women 60 and older who were randomly assigned
to the IMPACT program or to usual care, which involved psychotherapy with the
primary care physician and the option of taking antidepressant medication. More
than half of patients in the usual-care group were prescribed an antidepressant
by their primary care doctor.
At the beginning of the study, 15.3 percent of people in the
collaborative-care arm of the study reported thoughts of suicide, as did 13.3
percent of the comparison group. By six months, the percentage of IMPACT
patients having suicidal thoughts had fallen to 7.5 percent, compared to 12.1
percent for controls; at 12 months it was 9.8 percent vs. 15.5 percent.
Even six to 12 months after treatment had ended, patients in the IMPACT group
were significantly less likely to report suicidal thoughts.
Primary care physician-based care may be particularly effective for older
people, who tend to be reluctant to seek help from a mental health professional,
the researchers note, and programs like IMPACT can be very helpful given how
busy such doctors generally are.
"The benefits of improved care for late-life depression go well beyond
reducing thoughts of suicide and include less emotional and physical pain and
better physical functioning," the researchers add.
SOURCE: Journal of the American Geriatric Society, October,
2006.
