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）：迫切需要临床试验，以测试具有自杀行为风险高风险的人的创新治疗方法。 60岁及以上的男性构成了美国自杀的最高风险人群群体之一。然而，尽管有这样的统计数据，但公共卫生的反应非常有限，该反应专门针对该组进行自杀计划。解决这一深刻的公共卫生问题的主要障碍之一是缺乏评估创新治疗方法，这些治疗方法是为了降低该人群的自杀风险而开发的。因此，拟议的研究的主要目的是将认知疗法（CT）的功效与增强的常规护理（EUC）干预的功效进行比较，以降低自杀率（SI）的速度（SI）以及抑郁症的严重程度以及老年男性的抑郁症的严重程度。 60岁以上的男性将从当地的医疗保健系统中招募筛查前一个月的意图或渴望自杀的人。共有122名参与者将被随机分配以接收CT或EUC条件。处于CT状态的患者将接受12至16个每周的单个CT课程以及3个助推器会议。开发了CT干预措施是为了减少自杀的SI以及其他心理社会风险因素，并着重于评估参与者自杀的动机，制定了减轻自杀风险的个性化安全计划，发展的认知概念化，发展出出现的问题，使患者的问题解决问题，并促进其他策略，使其逐步解决其他策略，并促进其他行为，并使行为促进了行为，行为既定，并且行为不断地行动，并将其施加参与者的生活理由。研究治疗师的EUC状况患者将接收12至16个每周电话，每次电话约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。在这两个研究条件下的患者将被允许接受社区实践的常规医疗服务，并将获得项目人员提供的评估，推荐和危机干预服务。 SI，抑郁，绝望和其他潜在相关的协变量或混杂的研究评估将在基线时进行，并在1、3、6、9、9和12个月的随访点进行。所有研究评估将由对指定治疗条件视而不见的评估者进行管理。假设处于CT条件的参与者在随访期间比在EUC控制条件下的参与者的SI率较低。此外，假设处于CT条件的参与者在随访期间比在EUC控制条件下的参与者具有较低的绝望和抑郁水平。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子适应CT治疗对结局的影响。