Cognitive Therapy for Suicidal Older Men

针对有自杀倾向的老年男性的认知疗法

基本信息

批准号：
8108536
负责人：
GREGORY K BROWN
金额：
$ 43.81万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8108536
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 Screening procedure Services Severities Social Problems Suicide Suicide prevention Telephone Testing Treatment Effectiveness United States accomplished suicide blind cognitive training comparative efficacy compliance behavior discontinuation trial efficacy testing experience follow-up high risk improved innovation killings male men mild neurocognitive impairment older men patient safety premature psychologic psychosocial reducing suicide response skills statistics suicidal suicidal behavior suicidal risk treatment as usual

项目摘要

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.

描述（由申请人提供）：迫切需要进行临床试验来测试创新疗法对自杀行为高危人群的疗效。 60 岁及以上的男性是美国自杀风险最高的人群之一。然而，尽管有这些统计数据，专门针对这一群体的自杀预防举措的公共卫生应对措施仍然非常有限。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降低这一人群的自杀风险而开发的创新疗法的评估。因此，本研究的主要目的是比较认知治疗（CT）与强化常规护理（EUC）干预的疗效，以降低自杀意念（SI）的发生率以及抑郁和绝望的严重程度。年长的男人。将从当地医疗保健系统招募 60 岁或以上且在筛查前一个月报告有自杀意图或愿望的男性。总共 122 名登记参与者将被随机分配接受 CT 或 EUC 条件。处于 CT 状态的患者将接受每周 12 至 16 次单独 CT 治疗以及 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、制定降低自杀风险的个性化安全计划、制定自杀的认知概念。提出问题，提高患者解决问题的能力，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 状态的患者每周将接到研究治疗师打来的 12 至 16 次电话，每次持续约 15 至 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都将被允许接受社区常规医疗护理，并将接受项目工作人员提供的评估、转诊和危机干预服务。 SI、抑郁、绝望和其他潜在相关协变量或混杂因素的研究评估将在基线以及 1、3、6、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不知情的评估员进行。假设 CT 条件下的参与者在随访期间的 SI 发生率低于 EUC 控制条件下的参与者。此外，假设 CT 条件下的参与者在随访期间比 EUC 控制条件下的参与者具有较低的绝望和抑郁水平。将进行分析来检验这些假设，并探索基线后因素如何介导或基线因素如何调节 CT 治疗对结果的影响。公共卫生相关性：60 岁及以上的男性是美国自杀风险最高的人群之一。然而，尽管有这些统计数据，专门针对这一群体的自杀预防举措的公共卫生应对措施仍然非常有限。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降低这一人群的自杀风险而开发的创新疗法的评估。