Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide

Heisel, Marnin J.; Talbot, Nancy L.; King, Deborah A.; Tu, Xin; Duberstein, Paul R.

doi:10.1016/j.jagp.2014.03.010

Cited by 76 publications

(35 citation statements)

References 66 publications

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“…A number of studies have shown that social support influences treatment outcomes in older adults[43, 44]. Other interventions that address interpersonal problems and social isolation may hold particular promise for older adults with limited social support[45-47]. Finally, while disability predicted to treatment outcome at 12 weeks, that effected was not found at 36 weeks.…”

Section: Discussionmentioning

confidence: 99%

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

Gustavson

Alexopoulos

Niu

et al. 2016

The American Journal of Geriatric Psychiatry

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Objective 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, gender and additional cognitive impairment load (eg: memory impairments) were related to changes in suicidal ideation over time. Design 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. Setting University medical centers. Participants 221 people aged 65 years old and older with major depression determined by SCID 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 Stroop Interference Task score of 25 or less. Interventions 12 weekly sessions of Problem Solving Therapy or Supportive Therapy. Main Outcome Measures The suicide item of the Hamilton Depression Rating Scale (HDRS). Results 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. Conclusion PST is a promising intervention for older adults who are at risk for suicide.

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Section: Discussionmentioning

confidence: 99%

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

Gustavson

Alexopoulos

Niu

et al. 2016

The American Journal of Geriatric Psychiatry

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“…Patient centered care requires addressing patient's needs and wants (27), in addition to assessing and targeting standard risk factors (e.g., depression), if present. Older adults who attribute their suicidal behavior to thwarted belongingness may benefit from Interpersonal Psychotherapy (IPT), as an adaptation of IPT for suicidal older adults was found to decrease suicide ideation and increase social support (28). …”

Section: Discussionmentioning

confidence: 99%

Reasons for Attempted Suicide in Later Life

Orden

Wiktorsson

Duberstein

et al. 2015

The American Journal of Geriatric Psychiatry

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Objectives Using the Interpersonal Theory of Suicide as a guiding framework, we investigated older adults' causal attributions for suicidal behavior. We hypothesized that older adults who attributed their suicidal behavior to thwarted belongingness or perceived burdensomeness would be more likely to use more immediately lethal means and to re-attempt suicide during the 12-month follow-up. Design Prospective cohort study in western Sweden. Participants A total of 101 older adults who presented to medical emergency rooms for suicide attempts. Measurements Participants were asked why they attempted suicide. Results Attributions included: a desire to escape (n=29), reduced functioning and autonomy (n=24), psychological problems, including depression (n=24), somatic problems and physical pain (n=16), perceived burdensomeness (n=13), social problems that reflected either thwarted belongingness or family conflict (n=13) and lack of meaning in life (n=8); 41 participants provided more than one reason. No specific reason was given by 28 participants, 15 of whom reported not understanding or remembering why they attempted suicide and 13 reported simply wanting to die (or go to sleep and not wake up). As hypothesized, patients who attributed the attempt to thwarted belongingness were more likely to use more immediately lethal means for their index attempt and were more likely to re-attempt during follow-up. This was not the case for those reporting burdensomeness. Conclusions People who attribute suicide attempts to thwarted belongingness use more lethal methods and have a poorer prognosis. Replications across diverse cultural settings are needed to determine whether attributing suicide attempts to thwarted belongingness may warrant increased monitoring.

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“…Cognitive therapy (CT) strategies, which have been adapted for older adults with suicide risk (Bhar & Brown, 2012), could be used to counter the “black and white” thinking that is inherent in labeling oneself a complete burden on others (when in reality our impacts on others are generally mixed and change over time). Interpersonal Psychotherapy (IPT) has also been adapted for older adults with suicide risk (Heisel et al, 2014). IPT’s focus on role transitions could allow older adults who developed perceptions of burdensomeness in the context of increasing functional decline and increasing reliance on others to emotionally process this change in their lives and create more realistic expectations of their interpersonal relationships.…”

Section: Discussionmentioning

confidence: 99%

“…Current approaches to late-life suicide prevention are limited. Several psychotherapies, including cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have been adapted for older adults at risk for suicide (Bhar & Brown, 2012; Heisel, Talbot, King, Tu, & Duberstein, 2014). However, interventions for which the study outcome was suicide deaths, such as the TeleHelp-Tele-Check intervention (De Leo, Dello Buono, & Dwyer, 2002), have been largely effective only for women (Lapierre et al, 2011), while in most countries older men are at substantially higher risk.…”

mentioning

confidence: 99%

A Case Controlled Examination of the Interpersonal Theory of Suicide in the Second Half of Life

Orden

Smith²,

Chen

et al. 2016

Archives of Suicide Research

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The interpersonal theory of suicide proposes that the most proximal cause of suicide is the combination of thwarted belongingness and perceived burdensomeness coupled with a pre-existing vulnerability of reduced fear of death and increased pain tolerance. This pre-existing vulnerability develops in response to painful and provocative life events. According to the theory, empirically demonstrated risk factors for suicide operate by increasing the likelihood of one or more of the theory’s constructs. Objectives The current study examined the relations of the major constructs of the interpersonal theory with suicide case status compared to living controls in the second half of life. Methods The current study used a pre-existing psychological autopsy database to compare suicide decedents to living controls 50 years and older. Theory constructs were measured by composite scores of thwarted belongingness, perceived burdensomeness, and painful and provocative experiences using an a priori selection of items comprising each construct. Results Suicide decedents experienced greater levels of all three of the theory’s constructs when examined independently compared to living controls. When examined simultaneously while also controlling for Major Depression, greater perceived burdensomeness and painful and provocative experiences were associated with suicide case status (vs. control). Conclusions The interpersonal theory is a comprehensive framework that may be useful in understanding risk for death by suicide in the second half of life. Clinical management of suicide risk for adults in the second half of life could include a focus on perceived burdensomeness, as the IPTS proposes that this psychological state is amenable to change via therapeutic intervention.

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Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide

Cited by 76 publications

References 66 publications

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction

Reasons for Attempted Suicide in Later Life

A Case Controlled Examination of the Interpersonal Theory of Suicide in the Second Half of Life

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