OPTIMUM Suicide Supplement

Older adults with depression are at significant risk of suicide. If you are having thoughts of suicide, help is available at the National Suicide Hotline: 1-800-273-8255, or if you are in the Pittsburgh area, ReSolve is available to you at 1-888-796-8226

The aim of the OPTIMUM Suicide Supplement is to examine the relationship between suicide risk and brain health in a large group of patients with treatment-resistant late-life depression (TRLLD).

The OPTIMUM-Neuro trial (link) provides a unique opportunity to examine the relationship between suicide risk and cognitive impairment and decline in a large and well-characterized longitudinal study of community-dwelling older individuals particularly vulnerable to both suicidal behavior and dementia due to TRLLD.

We are particularly interested in whether assessing and including information about neurocognitive functioning improves our prediction of suicide risk and whether a novel measure of real-life decision-making (through the Research Domain Criteria (RDoC) framework) adds to our ability to predict one’s suicide risk, and  whether early-onset and late-onset suicidal ideation and/or risk are associated with specific and different neurocognitive impairments; and (3) whether risk of suicide is higher in people with TRLLD and a diagnosis of Mild Cognitive Impairment than in those with no cognitive diagnosis, and whether it is especially high in those whose impairment is caused by cerebrovascular disease, as compared with Alzheimer’s disease.

Participants complete up to two semi-structured interviews to assess current and lifetime thoughts and behaviors of self-harm, at least 6 months apart, and can be completed in person or via phone. 

Inclusion Criteria

  • 60 years or older
  • DSM-5 Major Depressive Disorder (MDD), single or recurrent, in a current Major Depressive Episode 
  • Failure to respond adequately to two or more antidepressant treatment trials of adequate dosage and duration 
  • Enrolled in OPTIMUM Neuro trial

Exclusion Criteria

  • Dementia, Bipolar I or II Disorder, Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Delusional Disorder, or current psychotic symptoms. 
  • Immediate risk for suicide (i.e., suicidal ideation of such severity that participant cannot be safely managed within the confines of a pragmatic effectiveness trial .
  • Unstable medical illness, including delirium, uncontrolled diabetes mellitus, hypertension, hyperlipidemia, or other cerebrovascular or cardiovascular risk factors that are not under medical management.
  • CNS disorder that could cause significant neurocognitive impairment (e.g., history of clinical stroke, concussion).