Risk and Protective Factors in Late-Life Suicide

描述(由申请者提供)：这份修改后的申请书要求颁发以患者为导向的研究职业发展奖(K23)。这位候选人是匹兹堡大学的精神病学家，他建议发展技能和知识，以开发和评估基于理论和证据的干预措施，以防止老年人自杀企图。在所有年龄段中，老年人完成自杀的风险最高，自杀未遂和自杀意念是完全自杀的有力预测因素。根据我们的初步研究，有必要开发一种更有针对性的自杀干预措施，针对与自杀相关的临床特征。资助这一奖项将为她提供必要的时间和资源，使她能够发展成为一名能够对自杀风险较高的老年人进行心理社会干预研究的独立调查员。 为了进行这样的研究，候选人将在以下领域培养技能：临床干预研究方法，特别侧重于自杀行为和相关风险因素的评估；与自杀研究有关的伦理问题；心理社会治疗发展和治疗试验方法方面的正式培训，特别侧重于自杀的抑郁症老年人；以及生物统计学，重点是纵向数据分析。 建议的研究包括对100名连续住院的高自杀风险抑郁症老年患者(60名目前有自杀企图，40名目前有自杀意念)和40名年龄/性别和教育程度匹配的低自杀风险抑郁症老年住院患者(没有自杀意念或自杀未遂病史)的纵向随访项目。该项目将描述自杀复发的风险和保护因素，特别强调执行控制功能及其与个性特征和问题解决缺陷的关系。这将导致一项初步的干预研究，目的是为高自杀风险患者开发一种改进的人际心理疗法--自杀预防-人际心理疗法(SP-IPT)。SP-IPT寻求优化与重要他人的关系，并利用重要他人的支持来激励患者增加对治疗的依从性和物质戒断。它还通过改善解决问题来增加自主感，支持和加强减少绝望和增强自尊的思想和行为。这项研究将由老年情绪障碍干预研究中心进行并提供支持。

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.