Reducing Depression and Suicidal Ideation Among Elder Abuse Victims Using PROTECT

Objective: Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation. Design: Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit. Participants: A sample of 158 depressed EA victims (PHQ-9 >= 10) without cognitive impairment (Tele-MoCA >= 11). Intervention: PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks. Measures: Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment. Results: There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SIat baseline and 5.7% at end of treatment. Conclusions: Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims. (Am J Geriatr Psychiatry 2025; 33:689-701)