Poster Number: NR 14 - Socially ENGAGE: Pilot Trial to Demonstrate Feasibility of an Intervention for Social Engagement

Abstract

Introduction: Older adults who are socially isolated—defined as those with restricted social networks and/or loneliness—are at risk for numerous suicide risk factors, including reduced quality of life, physical illness, functional impairment, cognitive impairment, and depression, as well as suicide ideation, attempts, and suicide deaths. The premise of this work is that among depressed older adults, social disconnectedness is both a risk factor for late-life suicide and a potential intervention target. Despite the negative consequences for late-life mental health, little is known about how to reduce social isolation and increase social engagement. Here, we present the rationale and feasibility results of a project testing the use of the ENGAGE intervention (Alexopoulos & Areán, 2014; Alexopoulos, Raue, Kiosses, Seirup, Banerjee, & Areán, 2014) as a means of increasing social engagement, and thereby reducing risk factors for suicide. ENGAGE is designed to work primarily through “reward exposure,” which, in line with RDoC principles (e.g., Insel, 2014), targets the behavioral expression of positive valence systems' dysfunction by having patients re-engage with pleasant, physical, or social activities they may have stopped doing because of depression. For this trial, subjects were focused solely on social activities because the hypothesis of the study is, in line with the Interpersonal Theory of Suicide (Van Orden et al., 2010), that targeting social engagement will increase positive connections and contributions to others, thus reducing two proximal risk factors for suicide—thwarted belongingness and perceived burdensomeness, thereby reducing suicide risk. We report here the experience and outcomes of the first three subjects enrolled, with the objectives of demonstrating that these older adults would complete 10 sessions, develop action plans based exclusively on social engagement, and demonstrate reductions in thwarted belongingness, depression, and suicide risk. We hypothesized that the changes in thwarted belongingness would temporally precede changes in depression and suicide risk.