Reducing suicidal ideation and depressive symptoms in depressed older primary care patients - A randomized controlled trial
Reducing suicidal ideation and depressive symptoms in depressed older primary care patients - A randomized controlled trial
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DOI：
10.1001/jama.291.9.1081
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发表时间：
2004-03-03
影响因子：
120.7
通讯作者：
Alexopoulos, GS
中科院分区：
文献类型：
--
作者：
Bruce, ML;Ten Have, TR;Alexopoulos, GS
自杀率在晚年最高;大多数死于自杀的老年人在前几个月看过初级保健医生。抑郁症是老年自杀和自杀前体自杀意念的最大危险因素。目的探讨初级保健干预对老年患者自杀意念和抑郁症的影响。（预防基层护理长者自杀：协作试验），从1999年5月至2001年8月在纽约市、费城和匹兹堡地区的20个初级保健实践中招募患者。对随机抽样的患者进行年龄分层（60-74岁，大于或等于75岁）的抑郁症筛查;招募包括筛查阳性的患者和筛查阴性患者的随机样本。本分析包括598例诊断为抑郁症的患者。干预治疗指南为老年人量身定制的护理管理与常规护理相比较。主要结果指标评估基线、4个月、8个月和12个月时的自杀意念和抑郁严重程度。（P=.01）干预患者与常规护理患者相比; 4个月时，干预组中，自杀意念的原始发生率下降了12.9%（29.4%至16.5%），而常规治疗为3.0%（20.1%至17.1%）[P=.01]。在报告自杀意念的患者中，干预患者的意念消退更快（P=.03）;差异在8个月时达到峰值（70.7% vs 43.9%消退; P=.005）。干预组患者在症状减轻的程度和速度方面都有更好的抑郁病程;组间差异在4个月时达到峰值。对抑郁症的影响并不显着，，轻度抑郁症患者，除非自杀意念present.Conclusions干预的有效性，以社区为基础的初级保健与抑郁症患者的异质性样本的证据介绍了新的挑战，其可持续性和传播。无论抑郁症的严重程度如何，干预措施在减少自杀意念方面的有效性加强了其作为预防策略的作用，以减少晚年自杀的风险因素。
Context Suicide rates are highest in late life; the majority of older adults who die by suicide have seen a primary care physician in preceding months. Depression is the strongest risk factor for late-life suicide and for suicide's precursor, suicidal ideation.Objective To determine the effect of a primary care intervention on suicidal ideation and depression in older patients.Design and Setting Randomized controlled trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) with patient recruitment from 20 primary care practices in New York City, Philadelphia, and Pittsburgh regions, May 1999 through August 2001.Participants Two-stage, age-stratified (60-74, greater than or equal to75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened negative patients. This analysis included patients with a depression diagnosis (N=598).Intervention Treatment guidelines tailored for the elderly with care management compared with usual care.Main Outcome Measures Assessment of suicidal ideation and depression severity at baseline, 4 months, 8 months, and 12 months.Results Rates of suicidal ideation declined faster (P=.01) in intervention patients compared with usual care patients; at 4 months, in the intervention group, raw rates of suicidal ideation declined 12.9% points (29.4% to 16.5%) compared with 3.0% points (20.1% to 17.1% in usual care [P=.01]). Among patients reporting suicidal ideation, resolution of ideation was faster among intervention patients (P=.03); differences peaked at 8 months (70.7% vs 43.9% resolution; P=.005). Intervention patients had a more favorable course of depression in both degree and speed of symptom reduction; group difference peaked at 4 months. The effects on depression were not significant among,, patients with minor depression unless suicidal ideation was present.Conclusions Evidence of the intervention's effectiveness in community-based primary care with a heterogeneous sample of depressed patients introduces new challenges related to its sustainability and dissemination. The intervention's effectiveness in reducing suicidal ideation, regardless of depression severity, reinforces its role as a prevention strategy to reduce risk factors for suicide in late life.