Social Connections and Late Life Suicide

在美国（以及世界上大多数国家），老年人的自杀率高于年轻人，未来几十年老年人人口的规模将急剧上升，使晚年自杀成为紧迫的公共卫生问题。目前还不知道如何预防老年人自杀;经验数据表明，如何预防这一高风险人群中的自杀是明显缺乏。候选人的职业发展目标是成为研究老年人自杀及其预防的领先专家。要实现这一目标，就需要在老年医学研究的三个领域进行培训（见下文），并完成一个将产生实质性基础成果的指导研究项目（见下文）。 初级保健是预防晚年自杀的一个关键场所：三分之二或更多死于自杀的老年人在死亡后一个月内接受初级保健医生的治疗，一周内接受初级保健医生的治疗的人数高达一半。抑郁的老年人不倾向于寻求专业的心理健康治疗。因此，K23提案的培训目标1是获得与初级保健对接的专业知识，作为招募和实施有自杀风险的老年人创新干预措施的场所。 众所周知，抑郁症是晚年自杀的一个重要危险因素，但绝大多数抑郁的老年人并不是死于自杀。此外，越来越多的证据表明，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，相当数量的老年人在干预结束时仍然有自杀倾向。因此，干预研究针对 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。因此，培训目标2是获得实施老年人行为干预方案的专业知识。 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，为了正确描述研究样本并从数据中得出有效的推论，候选人需要知道如何准确评估认知能力下降。因此，培训目标3是获得与年龄相关的认知衰退的知识和技能评估。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，特别是通过她帮助建立的理论和经验证据，表明社会脱节对自杀的重要性。随着改善晚年自杀干预措施的长期研究目标，这里提出的研究的主要目标是 研究增加社会联系--老年人感觉与有价值的关系联系的程度，以及他们是否对这种关系做出了贡献--是否是行为干预降低自杀风险的机制。 为了实现这一目标，候选人需要试点数据证明，手动（因此可复制）的行为干预，事实上，增加连通性，同时调整相关的连通性抑郁症和认知功能。尽管存在这种联系的可能性，但这一问题根本没有得到全面解决。这项研究将招募n = 100名来自初级保健的60岁成年人，他们支持断开连接（即，感到孤独和/或像是他人的负担）和临床上显著的抑郁症。受试者将被随机分配到针对脱节的行为干预（即，人际心理治疗（IPT）或日常护理（CAU）。在基线、3个月和6个月评估时，受试者将报告社会联系、认知下降和抑郁。该项目的研究目标是：目标1：研究手动干预（IPT）是否可以增加老年人之间的联系。目的2：研究针对社会功能（IPT）的干预是否也能降低晚年自杀风险。目的3：研究连接性的增加作为IPT减少抑郁的机制。 K23项目对抑郁和死亡意念的研究结果（即，自杀风险的指标）将作为一项更大的R 01资助的研究的基础，该研究旨在检查自杀意念和行为的结果。这些发现将与候选人的大量试点数据相结合，支持脱节与自杀意念/行为和抑郁症之间的联系。该奖项之后，候选人将建立在这一指导职业发展时期获得的技能，以促进晚年预防自杀方法的发展和完善。

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.