Negative Emotions and the Course of Depression During Psychotherapy in Suicidal Older Adults With Depression and Cognitive Impairment

Abstract

Objective: The study examines the relationship of negative emotions with: 1) non-emotional symptoms (e.g., vegetative and physical symptoms) and 2) the course of depression in suicidal older adults with Major Depressive Disorder (MDD) and cognitive impairment treated with psychotherapy.

Design: The authors identified a subgroup of participants (N = 26) who expressed suicidal ideation at Baseline or Week 12 from a randomized controlled trial (RCT) of two psychosocial interventions, Problem Adaptation Therapy (PATH) and Supportive Therapy for Cognitively Impaired. The authors assessed negative emotions, non-emotional symptoms of depression, depression severity, and suicidal ideation at entry, week 4, week 8, and week 12.

Participants: Participants were 65 years and older and had a diagnosis of unipolar depression, varying degrees of cognitive impairment (up to moderate dementia) and suicidal ideation.

Setting: The study was conducted in the Outpatient Department of New York Presbyterian/Weill Cornell Medicine in Westchester, NY.

Measurements: Negative emotions and non-emotional items were identified with the 24-item Hamilton Depression Rating Scale (Ham-D).

Results: Among participants with suicidal ideation, the reduction in negative emotions from baseline to week 4, week 4 to week 8, and week 8 to week 12 was significantly associated with the reduction in non-emotional symptoms of depression at weeks 4, 8, and 12 (F(1, 35) = 6.20, p = 0.02) and with the reduction in overall depression severity at weeks 4, 8, and 12 (F(1, 35) = 26.63, p <0.0001) after controlling for depression severity at baseline (HAM-D total score) and time trends.

Conclusion: Our findings may guide the treatment of older patients with depression and suicidal ideation to help reduce depression and suicide risk.

Trial registration: ClinicalTrials.gov NCT00368940.

Keywords: Suicide/self-harm; cognitive impairment; depression; elderly; negative emotions.

Conflict of interest statement

Conflicts of Interest and Source of Funding: The authors of the article declared no conflicts of interest.

Copyright © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1.

Hierarchical clustering of improvement in negative emotional HAM-D items from baseline to week 12. Each row represents each subject and each rectangle reflects the changes of negative emotions scores from Baseline to Week 12. Specifically, darker colored rectangles denote less improvement in negative emotions from Baseline to Week 12 than lighter colored rectangles. Each column represents a negative emotion. There are two clusters (subgroups of suicidal patients): “Resistant Group” (Red) versus “Non-Resistant Group” (Green).