PREVENTION OF SUICIDE IN THE ELDERLY

这项研究是为了响应NIMH RFA邀请研究， 抑郁症识别和治疗的测试模型，以预防和 减少初级保健机构中老年患者的自杀行为。 老年人自杀最常见于轻度至 中度抑郁 在初级保健患者中，自杀意念是一种 自杀的危险因素，并已确定几乎完全在 有抑郁症状和体征的患者。 因为大多数自杀者 他们的初级保健医生在几周内看到他们的 死亡，在医生的办公室干预可能是挽救生命。 本研究将调查干预的有效性， 提高对自杀意念和抑郁症的认识， 实践和促进治疗算法的实施 根据AHCP指南。 干预的关键是 抑郁症专家（DS）将与 医生，帮助他们提高对抑郁症的认识， 及时和适当的针对性治疗建议， 鼓励患者坚持治疗。 此外，程序 旨在教育患者、家庭和医生了解抑郁症， 自杀意念将被实施。 我们希望这种方法 会导致抑郁症和自杀率的降低 思维和行为，并生成一个实践模型， 结合我们临床科学的进步 该研究将由干预研究中心（IRC）进行 康奈尔大学、宾夕法尼亚大学和匹兹堡大学。 干预将在6个初级保健实践中提供， 地理区域（大都市和郊区纽约、费城和 匹兹堡），其影响将与6个可比 提供常规护理。数据将来自代表 通过年龄选择的60岁及以上患者样本- 分层、两阶段抽样设计，随访两年。 的 组将由1，200名受试者组成，包括以下患者： 抑郁症状和体征（CES-D（11;估计总数N=920;每 中心N=307）和无显著性差异的患者随机样本 抑郁症（CES-D（11;估计总数N=280;每个中心 N=93）。 除了对患者进行直接系统的临床评估外， 关于卫生服务利用情况的信息将从 基于实践的医疗记录和死亡原因 证书. 还将收集数据，以记录 对患者护理的干预，以及对医生知识，态度和 满意度和测试假设来自初步研究的 三个IRC

The study was designed in response to the NIMH RFA inviting research to test models of depression recognition and treatment to prevent and reduce suicidal behavior in older patients in primary care settings . Elderly suicide most frequently occurs in the context of mild to moderate depression. In primary care patients, suicidal ideation is a risk factor for suicide and has been identified almost exclusively in patients with depressive symptoms and signs. Since most suicide victims are seen by their primary care physicians within a few weeks of their death, intervening at the doctor's office may be life saving. This study will investigate the effectiveness of an intervention aimed at improving the recognition of suicidal ideation and depression by the practices and facilitating the implementation of a treatment algorithm based on the AHCP guidelines. The linchpin of the intervention is the use of Depression Specialists (DS) who will collaborate with the physicians and help them to increase recognition of depression, offer timely and appropriately targeted treatment recommendations and encourage patients to adhere to treatment. In addition, procedures aimed at educating patients, families and physicians on depression and suicidal ideation will be implemented. We expect that this approach will lead to a reduction of depressive symptomatology and suicidal ideation and behavior and generate a practice model that has the ability to incorporate the advances of our clinical science. The study will be conducted by the Intervention Research Centers (IRC) of Cornell, University of Pennsylvania, and University of Pittsburgh. The intervention will be offered in 6 primary care practices from 3 geographic areas (metropolitan and suburban New York, Philadelphia, and Pittsburgh) and its impact will be contrasted to that of 6 comparable practices offering usual care. Data will come from a representative sample of patients aged 60 years and older selected through an age- stratified, two-stage sampling design and followed for two years. The group will consist of 1,200 subjects and comprise patients with depressive symptoms and signs (CES-D(11; estimated total N=920; per Center N=307) and a random sample of patients without significant depressive symptomatology (CES-D(11;estimated total N=280; per Center N=93). Beyond direct systematic clinical assessment of patients, information will be obtained on health services utilization from practice-based medical records and on cause of death from death certificates. Data will also be collected to document the impact of intervention on patient care, and on physician knowledge, attitudes, and satisfaction and test hypotheses derived from preliminary studies of the three IRCs.