The purpose of this study is to design a program to prevent suicide in elderly patients by
educating patients, their families, and physicians on depression and suicidal thoughts.
A program to prevent suicide in elderly patients needs to be developed. Since elderly
patients frequently have doctor's visits, it may be best to have a suicide prevention
program based in the patient's doctor's office.
When an older person visits a primary care physician, he/she will check for signs of
depression, including thoughts of suicide. The doctor will speak to the patient about
depression and how to recognize it. If the individual is diagnosed with depression, the
doctor will offer treatment. During this study, the information the doctor collects will be
used to evaluate the effectiveness of the program. The study will last for 2 years.
Eligibility for this study is age of at least 60 years and diagnosis of depression.
(Depression required for 920 of the 1200 patients; 280 patients should have no symptoms of
To investigate the effectiveness of an intervention aimed at improving the recognition of
suicidal ideation and depression in elderly patients and facilitating the implementation of
a treatment algorithm based on the AHCPR (Agency for Health Care Policy and Research)
guidelines. To implement procedures aimed at educating patients, families, and physicians on
depression and suicidal ideation.
There is a need to test models of depression recognition and treatment to prevent and reduce
suicidal behavior in older patients in primary care settings. Elderly suicide most
frequently occurs in the context of mild to moderate depression. In primary care patients,
suicidal ideation is a risk factor for suicide and has been identified almost exclusively in
patients with depressive symptoms and signs. Since most suicide victims are seen by their
primary care physicians within a few weeks prior to their death, intervening at the doctor's
office may be life-saving.
The intervention is offered in 6 primary care practices from 3 geographic areas
(metropolitan and suburban New York, Philadelphia, and Pittsburgh) and its impact is
contrasted to that of 6 comparable practices offering usual care. Patients are selected
through an age-stratified, two-stage sampling design and followed for 2 years. The group
consists of 1,200 subjects and is comprised of patients with depressive symptoms and signs
and a random sample of patients without significant depressive symptomatology. Depression
Specialists (DS) collaborate with physicians and help them increase recognition, offer
timely and appropriately-targeted treatment recommendations, and encourage patients to
adhere to treatment. Beyond direct systematic clinical assessment of patients, information
is obtained on health services utilization from practice-based medical records and on cause
of death from death certificates. Data are also collected to document the impact of
intervention on patient care, and on physician knowledge, attitudes, and satisfaction and
test hypotheses derived from preliminary studies of the three Intervention Research Centers
(IRCs), Cornell, University of Pennsylvania, and University of Pittsburgh, where the study
will be conducted.
Patients must have:
Depressive symptoms and signs. (Required for 920 of the 1200 patients; 280 patients should
have no significant depressive symptomatology.)