Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment

Abstract

Objective: To examine the relationship of negative emotions with suicidal ideation during 12 weeks of Problem Adaptation Therapy (PATH) versus Supportive Therapy of Cognitively Impaired Older Adults (ST-CI), hypothesizing that improved negative emotions are associated with reduced suicidal ideation, PATH improves negative emotions more than ST-CI, and improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation.

Methods: In a randomized controlled trial of two home-delivered psychosocial interventions, 74 older participants (65-95 years old) with major depressive disorder and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions and assessments were conducted in participants' homes. PATH focuses on improving emotion regulation, whereas ST-CI focuses on nonspecific therapeutic factors, such as understanding and empathy. Improved negative emotions were measured as improvement in Montgomery Asberg's Depression Rating Scales' (MADRS) observer ratings of sadness, anxiety, guilt, hopelessness, and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item.

Results: MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F[1,165] = 12.73, p = 0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F[1,63.2] = 7.02, p = 0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F[1, 96] = 9.95, p = 0.0022).

Conclusion: Findings thatimprovement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation (clinicaltrials.gov; NCT00368940).

Keywords: Emotions; cognitive impairment; depression; emotional states; psychosocial treatment; suicidal ideation; suicide.

Conflict of interest statement

Disclosures: Dr. Alexopoulos has received grant support from Forest; served as a consultant to Scientific Advisory Board of Pfizer and Janssen; and has been a member of speakers and bureaus sponsored by Takeda, Lundbeck, Otsuka, and Sunovion. The rest of the authors do not have any financial relationships with commercial interests.

Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. The Course of MADRS Negative Emotions Items During 12 Weeks of PATH vs. ST-CI

MADRS Negative Emotions scores over 12 weeks of PATH vs. ST in in 74 older adults with major depression, cognitive impairment and disability based on the least squares means and standard error of the mixed effects model: treatment, time C12 (centered at 12 weeks), time C12 squared, treatment × time C12, and baseline Whodas-II score.

Figure 2. Predicted Probability of Suicidal Ideation at 4, 8 and 12 Weeks and Increase in MADRS Negative Emotions Item During the Preceding 4 Weeks

Probability of suicidal ideation (SI) predicted by an increase in MADRS Negative Emotions score in the past four weeks. Blue line: Probability of SI at week 4 predicted by an increase in MADRS Negative Emotions score between baseline and week 4; Red line: Probability of SI at week 8 predicted by an increase in MADRS Negative Emotions score between week 4 and week 8; Green line: Probability of SI at week 12 predicted by an increase in MADRS Negative Emotions score between week 8 and week 12.