In the present study, we assessed the feasibility, tolerability, and safety of the first ever study of a 16-week course of IPT adapted for older adults at-risk for suicide, and investigated therapeutic outcomes of suicide ideation, death ideation, and depressive symptom severity. Preliminary findings supported the main study aims, suggesting that adapted IPT can be feasibly delivered to at-risk older adults on an outpatient basis. Findings further indicated that adapted IPT is well-tolerated, safe, and helps reduce and/or resolve suicide ideation, death ideation, and presence and severity of depressive symptoms.
Study findings supported the tolerability of adapted IPT by older adults at-risk for suicide. Participants expressed high levels of treatment satisfaction on a treatment satisfaction scale and in semi-structured study exit interviews. They further reported that the intervention helped improve their interpersonal functioning and decrease and/or resolve their suicide ideation and depressive symptoms. Participant tolerance of the adapted intervention is further suggested by positive ratings of the therapeutic alliance. These findings suggest that older adults are amenable to psychological interventions designed to attend to and reduce suicide ideation and associated risk factors. One participant noted the importance of being able to talk openly about suicidal thoughts in session, without having his experience invalidated by the study therapist.
IPT was adapted to incorporate safety considerations critical to therapeutic intervention with individuals at-risk for suicide. Participants reported feeling comforted by the fact that they could access the study therapist when needed. Those with attachment difficulties may have found the therapeutic relationship reparative. Fear of being unable to access a therapist when needed may trigger risk for suicide during psychotherapy (Pallaskorpi et al., 2005
). Round the clock access to a therapist is one of the components of Dialectical Behavior Therapy, albeit for reinforcing client use of DBT skills and strategies (Linehan, 1993
). The ability to access the study therapist round the clock may have provided participants with a source of social support when in need and a sense of security; however, further research is needed evaluating the importance of this adaptation to standard IPT in reducing suicide risk among at-risk older adults. Clinicians might consider providing at-risk clients with constant access to a therapist and/or a telephone distress line to discourage isolation and encourage provider contact when needed.
Study participants reported a robust reduction in suicide ideation and death ideation, primary study outcomes. These reductions began between the eligibility and pre-treatment assessment points. Although the eligibility assessment was initially intended only to assess for study inclusion and exclusion criteria, it comprised initial clinical contact between a potential study participant and his or her therapist, and involved discussion of sensitive issues to be further explored in therapy. Overall, findings support the initial effectiveness of adapted IPT in helping to resolve thoughts of suicide and the wish to die among at-risk older adults. Randomized controlled intervention data is needed in order to test whether reported gains are primarily due to treatment with IPT. Longer term follow-up and larger samples are additionally needed in order to assess reduction in risk for self-injury.
Participants experienced a significant decline in depressive symptom severity, both on self-report and clinician-rated measures, from a clinical to sub-clinical range of scores. Preliminary findings suggest that adapted IPT remains effective in treating late-life depression and helps reduce or resolve suicide ideation among those at-risk for suicide. Adapting IPT for older adults at-risk for suicide thus does not appear to dilute the intervention’s antidepressant properties. These data suggest that these improvements are not solely attributable to patient self-report, as clinician ratings similarly attest to robust improvements in depressive symptoms.
The present study comprises a small initial pre- to post-treatment pilot study, necessitating extension to a larger sample, and addition of a control group. Additional limitations include the fact that the P.I. served as study recruiter, assessor, and therapist for all participants. Larger-scale future studies will involve separate personnel to follow-up on study referrals, conduct blinded outcome assessments and deliver the adapted intervention. Future studies will also assess therapist adherence to adapted IPT, a variable critical to investigation of treatment integrity (see Perepletchikova, Treat, & Kazdin, 2007
). Given these promising findings, a randomized trial is now warranted, comparing adapted IPT to an enhanced Care As Usual control group. Such a comparison will include attention to methodological concerns of structural equivalence of control conditions, in order to assess specific effects of the study intervention as compared with non-specific treatment effects associated with increased attention and support. These preliminary findings suggest that IPT may be an effective treatment option for at-risk older adults.