Therapeutic Alliance is Linked with Suicidality Trajectories in Psychotherapy for Late-Life Depression

Objectives. Late-life suicidality is rapidly increasing; psychotherapy may reduce suicidality, but trajectories of change in suicidality remain unclear. A strong therapeutic alliance may protect against persistent suicidality. We examined the association of alliance with suicidality trajectories during brief, remote interventions for depression.Methods. Sixty middle-aged and older adults with major depression were randomized to brief remote psychosocial interventions. Suicidality and alliance were assessed during treatment. Patients’ suicidality trajectories were classified as: a) absent; b) improved; c) persistent, based on pre- to post-treatment changes. All three groups were included in mixed-effects models to examine the association between suicidality and alliance.Results. At baseline, 53% of patients endorsed suicidality, with 45% in the absent group, 45% improved; and 10% persistent. Patients in the absent and improved groups showed stable, strong alliance while the persistent group showed worsening alliance. Conclusion. Simple, remote psychosocial interventions are promising first-line treatments for late-life suicidality. A strong alliance may reduce suicidality and enhance outcomes, guiding timely, personalized interventions.