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To the Editor: Dr Bruce and colleagues¹ reported that rates of suicidal ideation and depressive symptoms in elderly patients declined more rapidly in those treated with a structured intervention (which included medication treatment, psychotherapy, and care management) than in those treated with usual care. The authors concluded that this structured intervention is effective and that care management should be added to suicidal behavior practice guidelines.

However, it is not clear that the authors' intervention would reduce rates of suicidal ideation or treat depressive symptoms more effectively among this population. First, although the results were statistically significant even after multivariate adjustment for the higher baseline rate of suicidal ideation in the intervention group, this may reflect simple regression to the mean from an anomalously high baseline value. If, on the other hand, the difference in the baseline rate of suicidal ideation reflected a real difference in these groups, then the subsequent . . . [Full Text of this Article]

Jeremy Koppel, MD
Jpsych54@hotmail.com
Division of Geriatric Psychiatry
The Zucker Hillside Hospital
North Shore-Long Island Jewish Health System
Glen Oaks, NY

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