Cognitive Therapy for Suicidal Older Men

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DESCRIPTION (provided by applicant): There is a pressing need for clinical trials to test the efficacy of innovative treatments for persons at high risk for suicidal behavior. Men, 60 years of age and older, constitute one of the highest risk demographic groups for suicide in the United States. Yet, despite such statistics, there has been a very limited public health response that has specifically targeted this group for suicide prevention initiatives. One of the major roadblocks to addressing this profound public health problem involves the lack of evaluating innovative treatments that have been developed to reduce suicide risk specifically for this population. Therefore, the primary aim of the proposed study is to compare the efficacy of cognitive therapy (CT) with the efficacy of an enhanced usual care (EUC) intervention for reducing the rate of suicide ideation (SI) and the severity of depression and hopelessness among older men. Men who are 60 years or older and have reported an intent or desire to commit suicide in the month prior to screening will be recruited from the local health care systems. A total of 122 enrolled participants will be randomly assigned to receive either the CT or EUC condition. Patients in the CT condition will receive 12 to 16 weekly individual CT sessions plus 3 booster sessions. The CT intervention was developed to reduce SI as well as other psychosocial risk factors for suicide and focuses on an assessment of the participants' motivation for suicide, the development of an individualized safety plan to mitigate suicide risk, the development of a cognitive conceptualization of the presenting problems, improving patients' problem solving skills, facilitating treatment compliance, applying other cognitive and behavioral strategies to reduce suicidal crises, and increasing participants' reasons for living. Patients in the EUC condition will receive 12 to 16 weekly telephone calls, each approximately 15-30 minutes in duration, from the study therapists. The purpose of these calls will be to ensure patient safety and to provide some support. Patients in both study conditions will be allowed to receive usual medical care as practiced in the community and will receive assessment, referral, and crisis intervention services provided by the project staff. Study assessments of SI, depression, hopelessness, and other potentially relevant covariates or confounds will be conducted at baseline, and at 1, 3, 6, 9, and 12 months follow-up points. All study assessments will be administered by assessors who are blind to the assigned treatment condition. Participants in the CT condition are hypothesized to have lower rates of SI during the follow-up period than participants in the EUC control condition. In addition, participants in the CT condition are hypothesized to have lower levels of hopelessness and depression during the follow-up period than participants in the EUC control condition. Analyses will be conducted to test these hypotheses as well as to explore how post-baseline factors mediate or baseline factors moderate the effect of the CT treatment on outcomes.