Risk and Protective Factors in Late-Life Suicide

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DESCRIPTION (provided by applicant): This revised application requesting a Mentored Patient-Oriented Research Career Development Award (K23). The candidate is a psychiatrist at the University of Pittsburgh who proposes to develop skills and knowledge to develop and evaluate a theory- and evidence-based intervention to prevent suicide attempts in the elderly. Elderly are at the highest risk for completing suicide among all age groups, and suicide attempt and suicidal ideation are robust predictors of completed suicide. Based on our preliminary studies there is a need to develop a more focused suicide intervention that will target clinical characteristics that are associated with suicidality. Funding of this award would provide time and resources necessary for her to develop into an independent investigator capable of conducting psychosocial intervention studies in high suicide risk elderly. To perform such research the candidate will develop skills in the following areas: clinical intervention research methodology with a special focus on the assessment of suicidal behavior and related risk factors; ethical issues related to studies of suicide; formal training in psychosocial treatment development and treatment trials methodology with a special emphasis on the suicidal depressed elderly; and biostatistics, with emphasis on longitudinal data analysis. Proposed research consists of a longitudinal follow up project of 100 consecutive depressed elderly inpatients who are at high suicide risk (60 with current suicide attempt and 40 with current suicidal ideation) and 40 age/gender and education matched depressed elderly inpatients who are at low suicide risk (no history of suicidal ideation or attempt). The project will characterize risk and protective factors for suicidal relapse with special emphasis on executive control function and its relationship to personality characteristics and problem solving deficits. This will lead to a pilot intervention study with the aim of developing a modified interpersonal psychotherapy, Suicide Prevention-Interpersonal Psychotherapy (SP-IPT) for high-suicide risk patients. SP-IPT seeks to optimize the relationship with a significant other and uses support from significant other to motivate patients to increase compliance with treatment and substance abstinence. It also increases the sense of autonomy by improving problem solving and supports and enhances thinking and behaviors that decrease hopelessness and increases self-esteem. The research studies will take place and be supported by the Intervention Research Center for Late-Life Mood Disorders.