Cognitive Therapy for Suicidal Older Men

针对有自杀倾向的老年男性的认知疗法

• 批准号: 8918021
• 负责人: GREGORY K BROWN
• 金额: $ 42.39万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8918021
• 关键词: Accident and Emergency department; Address; Age-Years; Behavioral; Caring; Clinical Trials; Cognitive; Cognitive Therapy; Communities; Crisis Intervention; Development; Diagnosis; Effectiveness; Enrollment; Ensure; Evaluation; Event; Feeling hopeless; Feeling suicidal; Grief reaction; Healthcare Systems; Individual; Intervention; Intervention Studies; Life; Mediating; Mediation; Medical; Mental Depression; Modeling; Modification; Motivation; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Problem Solving; Psychiatric Diagnosis; Public Health; Quality of life; Randomized; Recruitment Activity; Reporting; Risk Factors; Safety; Sampling; Services; Severities; Social Problems; Suicide; Suicide prevention; Telephone; Testing; Treatment Effectiveness; United States; accomplished suicide; blind; cognitive training; comparative efficacy; compliance behavior; discontinuation study; efficacy testing; experience; follow-up; high risk; improved; innovation; killings; male; men; mild cognitive impairment; older men; patient safety; premature; psychologic; psychosocial; reducing suicide; response; screening; skills; statistics; suicidal; suicidal behavior; suicidal risk; treatment as usual

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.

描述（由申请人提供）：迫切需要进行临床试验，以测试自杀行为高危人群创新治疗的疗效。60岁及以上的男性是美国自杀风险最高的人口群体之一。然而，尽管有这些统计数据，但专门针对这一群体采取自杀预防措施的公共卫生反应非常有限。解决这一深刻的公共卫生问题的主要障碍之一是缺乏对专门为这一人群开发的降低自杀风险的创新治疗方法的评估。因此，本研究的主要目的是比较认知疗法（CT）与增强型常规护理（EUC）干预在降低老年男性自杀意念（SI）发生率、抑郁和绝望严重程度方面的疗效。将从当地医疗保健系统招募60岁或以上的男性，并在筛选前一个月内报告有自杀意图或愿望。共122名入组受试者将被随机分配接受CT或EUC治疗。CT条件下的患者将接受12至16次每周一次的单独CT治疗加上3次加强治疗。CT干预旨在减少SI以及其他自杀的心理社会风险因素，重点是评估参与者的自杀动机，制定个性化的安全计划以减轻自杀风险，发展对当前问题的认知概念化，提高患者解决问题的技能，促进治疗依从性，应用其他认知和行为策略来减少自杀危机，并增加参与者的生活理由。处于EUC状态的患者将每周接受12 - 16次研究治疗师的电话呼叫，每次持续约15-30分钟。这些电话的目的是确保患者安全并提供一些支持。两种研究条件下的患者将被允许接受社区实践中的常规医疗护理，并将接受项目工作人员提供的评估、转诊和危机干预服务。将在基线和1、3、6、9和12个月随访时对SI、抑郁、绝望和其他潜在相关协变量或混淆进行研究评估。所有研究评估将由对分配的治疗条件不知情的评估者进行。假设CT条件下的参与者在随访期间的SI发生率低于EUC对照条件下的参与者。此外，假设CT条件下的参与者在随访期间的绝望和抑郁水平低于EUC对照条件下的参与者。将进行分析以检验这些假设，并探索基线后因素如何介导或基线因素如何缓和CT治疗对结局的影响。