Social Connections and Late Life Suicide

社会关系和晚年自杀

• 批准号: 8580289
• 负责人: Kimberly Allison Van Orden
• 金额: $ 16.75万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8580289
• 关键词: Accounting; Address; Adult; Aftercare; Age; Age-associated memory impairment; Award; Behavior; Behavior Therapy; Caring; Cessation of life; Clinical; Cognition; Country; Coupled; Data; Depressed mood; Development; Elderly; Elderly man; Elements; Feeling; Feeling suicidal; Funding; Goals; Growth; Health; Impaired cognition; Individual; Intervention; Intervention Studies; Knowledge; Link; Loneliness; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Mentors; Outcome; Patients; Population; Prevention; Primary Care Physician; Primary Health Care; Protocols documentation; Provider; Psychologist; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Project Grants; Risk Factors; Role; Sampling; Severities; Site; Social Functioning; Suicide; Suicide attempt; Suicide prevention; Training; Woman; Work; aged; base; career development; clinically significant; cognitive function; depressive symptoms; effective therapy; experience; geriatric depression; high risk; ideation; improved; innovation; medical specialties; men; minor depressive disorder; programs; public health relevance; reducing suicide; research study; skills; social; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; trial comparing

DESCRIPTION (provided by applicant): Older adults have higher rates of suicide than younger individuals in the U.S. (and most countries in the world) and the size of the older adult population will rise dramatically in the coming decades, making suicide in later life an issue of pressing public health concern. It is not known how to prevent suicide among older adults; empirical data indicating how to prevent suicide among this high-risk population are notably lacking. The Candidate's career development goal is to be a leading expert in the study of suicide and its prevention in older adults. Reaching that goal requires training in three domains of geriatric research (described below), as well as completion of a mentored research project that will produce substantive, foundational results (also described below). Primary care is a key site for late life suicide prevention: two-thirds or more of older adults who die by suicide are seen by primary-care physicians within a month of their deaths, and up to half within a week. Depressed older adults do not tend to seek specialty mental health treatment. For this reason, Training Objective 1 for this K23 proposal is to gain expertise interfacing with primary care as a site for both recruitment and implementation of innovative interventions with older adults at risk for suicide. It is also known that depression is a strong risk factor for late-life suicide, but te vast majority of depressed older adults do not die by suicide. Further, evidence is beginning to accumulate suggesting that targeting depression in older adults does not sufficiently lower suicide risk among older adults. For example, in the PROSPECT trial, a significant number of older adults remained suicidal at the end of the intervention. Thus, intervention studies targeting older adults at risk for suicide are needed; in particular, we need to understand how these interventions work to effectively implement and disseminate them. For this reason, Training Objective 2 is to gain expertise in the implementation of behavioral intervention protocols for older adults. Depressed older adults frequently present with cognitive impairment. Further, social functioning deficits are also associated with cognitive impairment. Thus, to properly characterize research samples and draw valid inferences from data, the candidate will need to know how to accurately assess cognitive decline. For this reason, Training Objective 3 is to gain knowledge of, and skills assessing, aging-related cognitive decline. The candidate's program of research will be informed by her training and experience as a clinical psychologist, in particular by theoretical and empirical evidence that she helped establish showing the central importance of social disconnectedness to suicide. With the long-term research goal of improving interventions for late-life suicide, the principal objective of the research study proposed here is to examine whether increasing social connectedness -- the degree to which older adults feel connected to, and as if they contribute to, valued relationships -- is a mechanism by which behavioral interventions reduce risk for suicide. To achieve this objective, the candidate requires pilot data demonstrating that a manualized (thus replicable) behavioral intervention does, in fact, increase connectedness while adjusting for correlates of connectedness-depression and cognitive functioning. Despite the likelihood of this association, the question has simply not been comprehensively addressed. This study will recruit n = 100 adults aged 60 years from primary care who endorse both disconnectedness (i.e., feeling lonely and/or like a burden on others) and clinically significant depression. Subjects will be randomly assigned to a behavioral intervention targeting disconnectedness (i.e., Interpersonal Psychotherapy; IPT) or care-as-usual (CAU). At baseline, 3-month, and 6-month assessments, subjects will report on social connectedness, cognitive decline, and depression. The project's Research Aims are: Aim 1: To examine whether a manualized intervention (IPT) can increase connectedness among older adults. Aim 2: To examine whether an intervention targeting social functioning (IPT) also reduces late-life suicide risk. Aim 3: To examine increases in connectedness as a mechanism whereby IPT decreases depression. The resulting findings of this K23 project on depression and death ideation (i.e., indicators of suicide risk) will function as the basis for a larger R01-funded study powered to examine suicide ideation and behavior as outcomes. These findings will be coupled with the candidate's substantial pilot data supporting the link between disconnectedness and both suicide ideation/behavior and depression. Subsequent to this award, the candidate will build on the skills acquired in this period of mentored career development to contribute to the development and refinement of approaches to suicide prevention in later life.

描述（由申请人提供）：老年人的自杀率比美国的年轻人（以及世界上大多数国家）高，而老年人的规模将在未来几十年中急剧上升，这使得晚期自杀成为紧迫公共卫生问题的问题。尚不知道如何预防老年人自杀。经验数据表明如何在这种高危人群中预防自杀。候选人的职业发展目标是成为自杀研究及其预防老年人的领先专家。达到该目标需要在老年研究的三个领域进行培训（如下所述），并完成了一个指导的研究项目，该项目将产生实质性的基础结果（也描述了下文）。 初级保健是预防后期自杀的关键地点：初级保健医生在死亡后的一个月内看到了三分之二或更多的老年人，而在一周内就会看到一半。沮丧的老年人不倾向于寻求特殊的心理健康治疗。因此，该K23提案的培训目标1是获得与初级保健接口的专业知识，以作为招募和实施具有自杀风险的老年人的创新干预措施的地点。 众所周知，抑郁症是后期自杀的强大危险因素，但绝大多数抑郁的老年人不会因自杀而死。此外，证据开始积累，这表明针对老年人的抑郁症并不能充分降低老年人的自杀风险。例如，在前景试验中，在干预结束时，大量老年人仍然自杀。因此，针对的干预研究 需要有自杀风险的老年人；特别是，我们需要了解这些干预措施如何有效地实施和传播它们。因此，培训目标2是在实施老年人的行为干预方案方面获得专业知识。 抑郁的老年人经常出现认知障碍。此外，社会功能缺陷也与认知障碍有关。因此，为了正确地表征研究样本并从数据中获取有效的推论，候选人将需要知道如何准确评估认知能力下降。因此，培训目标3是要了解与衰老相关的认知能力下降的知识和技能。候选人的研究计划将通过她作为临床心理学家的培训和经验来告知，特别是通过理论和经验证据，她帮助确定了社会脱节对自杀的核心重要性。以改善晚期自杀的干预措施的长期研究目标，此处提出的研究的主要目标是 检查社会联系的增加（老年人与之联系的程度，以及他们对有价值的关系的贡献）是否是行为干预措施降低自杀风险的一种机制。 为了实现这一目标，候选人需要试点数据，表明手动（可复制的）行为干预确实会增加连接性，同时调整连接性抑郁和认知功能的相关性。尽管这种关联很有可能，但这个问题根本没有得到全面解决。这项研究将招募n =从初级保健中60岁的100名成年人招募，他们认可脱节（即感到孤独和/或像其他人一样负担）和临床上显着的抑郁症。受试者将被随机分配到针对脱节性（即人际心理治疗； IPT）或Care-as-as-as-usal（CAU）的行为干预措施。在基线，3个月和6个月的评估时，受试者将报告社会联系，认知能力下降和抑郁症。该项目的研究目的是：目标1：检查手动干预（IPT）是否可以增加老年人之间的联系。目标2：检查针对社会功能（IPT）的干预措施是否也降低了后期自杀风险。 AIM 3：检查连接性的增加，作为IPT降低抑郁症的机制。 该K23关于抑郁和死亡构想的项目的结果（即自杀风险指标）将成为一项较大的R01资助研究的基础，该研究有助于研究自杀的想法和行为作为结果。这些发现将与候选人的大量试点数据相结合，该数据支持断开连接与自杀念头/行为和抑郁之间的联系。在该奖项之后，候选人将基于在这一指导职业发展时期获得的技能，以促进以后的预防自杀方法的发展和完善。