Cognitive Therapy for Suicidal Older Men

描述(由申请人提供)：迫切需要进行临床试验，以测试针对自杀行为高危人群的创新治疗的有效性。在美国，60岁及以上的男性是自杀风险最高的人口群体之一。然而，尽管有这样的统计数字，专门针对这一群体的预防自杀举措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针对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，这项拟议研究的主要目的是比较认知疗法(CT)和增强型日常护理(EUC)干预在降低老年男性自杀意念(SI)以及抑郁和绝望严重程度方面的有效性。60岁或以上并在筛查前一个月报告有自杀意图或愿望的男子将从当地卫生保健系统招募。总共122名登记的参与者将被随机分配接受CT或EUC条件检查。患有CT的患者将接受每周12至16次的个人CT治疗，外加3次强化治疗。CT干预是为了减少自杀的SI和其他心理社会危险因素，重点是评估参与者的自杀动机，制定个性化的安全计划来降低自杀风险，发展对所呈现问题的认知概念化，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，并增加参与者的生存理由。处于EUC状态的患者每周将从研究治疗师那里收到12到16个电话，每次大约15到30分钟。这些电话的目的将是确保患者的安全并提供一些支持。在这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，并将接受由项目工作人员提供的评估、转介和危机干预服务。将在基线以及1、3、6、9和12个月的随访点进行SI、抑郁、绝望和其他潜在相关协变量或混淆的研究评估。所有研究评估将由对指定治疗条件视而不见的评估员进行。CT条件下的参与者被假设在随访期内SI的发生率低于EUC控制条件下的参与者。此外，假设接受CT治疗的参与者在随访期内的无望感和抑郁程度低于接受EUC控制的患者。将进行分析以检验这些假说，并探索基线后因素如何调节或基线因素调节CT治疗对结果的影响。 与公共健康相关：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，尽管有这样的统计数字，专门针对这一群体的预防自杀举措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针对这一人群开发的降低自杀风险的创新治疗方法的评估。

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. PUBLIC HEALTH RELEVANCE: 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.