Suicide Intervention Study: A first of its kind involving older adults at risk

July 21, 2009

Lawson Research Publishes Suicide Intervention Study A first of its kind involving older adults at risk

LONDON, Ontario - Growing older is a rite of passage. Those who are fortunate enough to reach their golden years can come to possess experience and wisdom that is often shared with friends and family for generations to come. It is a time for reflection, satisfaction and a plethora of hobbies - or is it? Startling statistics reveal that older adults have the highest rates of suicide of any age group in the U.S., with depression being one of the leading risk factors for suicide.

With many older adults having to deal with significant life transitions such as declining health, loss of a spouse and limited social interaction, it is not surprising that there is a great need for psychological interventions for those struggling with these challenges.

This issue is especially worrisome, given that the Baby Boom cohort has a higher rate of suicide than previous generations. Dr. Marnin Heisel, a clinical psychologist at London Health Sciences Centre (LHSC) and scientist at the Lawson Health Research Institute (Lawson) and Assistant Professor in the Departments of Psychiatry and of Epidemiology & Biostatistics at The University of Western Ontario, has dedicated his research career to suicide prevention among older adults. Heisel’s recent study, published in a special issue of “Professional Psychology: Research and Practice,” focuses on adapting a psychotherapeutic intervention for older adults at risk for suicide.

The study is the first of its kind to test a 16-week course of Interpersonal Psychotherapy (IPT) with older adults at risk for suicide.

Previous research suggests that depressed older adults are amenable to psychological interventions and that many prefer counseling to medications. IPT is a time-limited, interpersonally-oriented psychotherapy that focuses on addressing difficulties in effectively communicating one’s emotional needs to others, and on building interpersonal skills. The intervention is based on the theory that interpersonal factors, such as conflicts, losses, grief and interpersonal deficits, may contribute to psychological problems.

Heisel and his colleagues with the Department of Psychiatry at the University of Rochester Medical Center were curious to adapt this therapy for older adults at-risk for suicide and test this therapy with participants who were referred from inpatient and outpatient geriatric medicine and mental health services. Study participants were 60 years of age or older, and had thoughts of suicide (suicide ideation), a wish to die (death ideation), or had engaged in recent self-injurious behaviour. The research team adapted IPT to enhance the treatment for these older adults, targeting core interpersonal features of suicidal thoughts and behaviour and incorporating lessons learned from previous reports of suicide during psychotherapy. The purpose of the study was to assess the feasibility, tolerability, and safety of IPT adapted for older adults at-risk for suicide, and to initially assess its effectiveness in reducing thoughts of suicide, wishes to die, and depressive symptom severity.

Preliminary findings of this study support the feasibility of recruiting and retaining older adults at-risk for suicide into psychotherapy research and suggest that adapted IPT is tolerable and safe. There was a substantial reduction in participant suicide ideation, death ideation, and depressive symptoms over the course of therapy. Participants expressed high levels of treatment satisfaction and reported that the intervention helped improve their interpersonal functioning.

In addition to his clinical research, Dr. Heisel has also been engaged in knowledge translation activities, helping to translate research findings into clinical practice. Together with an interdisciplinary group of colleagues with the Canadian Coalition for Seniors’ Mental Health, Heisel co-led the creation of a late-life suicide prevention toolkit, which currently includes clinical guidelines for assessing seniors’ suicide risk and intervening with those at-risk for suicide, a quick-reference card, a training DVD, a facilitator’s guide for educators, and an informational guide for family members. These efforts have received primary funding support from the Public Health Agency of Canada since 2005; additional funds have been recently provided by the Betty Havens Award for Knowledge Translation in Aging, a CIHR knowledge translation award of which Heisel is a co-recipient. The toolkits have been distributed to health care providers, university educators and front-line care providers at hospitals and long-term care homes across the country. “Studies of older adults who have died by suicide suggest that as many as 75 per cent had seen their primary health care provider in the month prior to their death,” says Heisel. “This tells us that older adults who are at-risk for suicide do reach out for help - although they may not be very clear about the fact that they are thinking about suicide.” This toolkit has received a warm reception from clinicians and educators; future work will assess its effectiveness in increasing providers’ knowledge about late-life suicide and in influencing their attitudes towards working with at-risk older adults.

Heisel and colleagues are planning a randomized controlled clinical trial to further evaluate the use of adapted Interpersonal Psychotherapy as an effective treatment option for older adults at-risk for suicide.

“I hope that through our research initiatives, we can help combat the negative impact of depression and despair among older adults and help enhance the emotional health and well-being of this important and valued age group,” concludes Heisel.

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About Lawson Health Research Institute
As the research institute of London Health Sciences Centre and St.
Joseph's Health Care, London, and working in partnership with The University of Western Ontario, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world.

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BRITISH COLUMBIANS GET OPTION TO MANAGE HEALTH RECORDS

July 20, 2009

VICTORIA – As of July 17, British Columbians can begin to apply disclosure directives to manage their Electronic Health Record (EHR) in advance of the system going live later this year and throughout 2010.

An EHR is a secure and private record of patient’s health history and care within the health system.

Currently, health professionals face challenges in getting patient information from records held in different places and different electronic and paper formats. The EHR will unify patient information and give authorized health professionals electronic access to secure patient health records when and where they deliver care.

A disclosure directive allows a patient to decide which of their records can be accessed by a health professional who does not have the keyword provided by a patient. If a patient can provide their keyword to the health professionals caring for them, then their records can be temporarily accessed. However, if a patient does not remember their keyword, or a health professional involved with their care does not have it, disclosure directives may result in delays – except in case of an emergency.

eHealth will enable faster, safer and better health care by reducing delays, errors and test duplication and also improve the privacy and security of personal health records. The new regulation coming into effect is part of the legislative framework that governs the collection, use and disclosure of personal health information in electronic health records and comes from the e-Health (Personal Health Information Access and Protection of Privacy) Act, which was introduced in spring 2008.

British Columbians who wish to make a disclosure directive on their EHR can visit www.health.gov.bc.ca/ehealth/dd.html or call Health Insurance B.C. in the Lower Mainland: 604-683-7151 or elsewhere in B.C. at 1-800-663-7100.