Disorders - suicide or self-harm behaviours
Santamarina-Perez, P., Mendez, I., Picado, M., Eiroa, F. J., Font, E., Moreno, E., Martinez, E., Linan, A. M., Cordovilla, C., Romero,
S.
Objectives: Impaired cognitive function is a feature of
suicidal behavior. It also might be considered a risk factor in adolescents with high vulnerability to commit suicide. Previous studies have
suggested that some aspects of cognitive function improve after psychological treatment. However, to our knowledge, there are no studies that have
evaluated the influence of psychological treatment on cognitive functioning in adolescents with suicidal behavior. The aim of this study was to
examine changes on neuropsychological functioning in adolescents with suicidal behavior following a psychological treatment with DBT and supportive
therapy (ST) compared with healthy control subjects. Method(s): A total of 35 adolescents with self-harming behavior and 17 healthy control subjects
between 12 and 18 years of age completed neuropsychological testing at baseline and after 16 weeks. The neuropsychological battery consisted of the
following: 1) Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV); 2) Spain-Complutense Verbal Learning Test; 3) Rey Complex Figure
Test; 4) Trail Making Test; 5) Stroop Effect Test; 6) Controlled Oral Word Association Test (COWAT); and 7) Tower of London test. Patients were
randomized after baseline assessment into 2 psychological groups: DBT and ST. Result(s): t tests were used for baseline comparisons between suicidal
adolescents and control groups, and between repeated measure analyses of variance for the difference in change between the suicidal adolescents and
control groups from baseline and follow-up, for all neuropsychological scores. Significant neuropsychological impairment was evident at baseline in
suicidal participants compared with healthy control subjects. After 16 weeks of psychotherapy, neuropsychological scores showed significant
improvement regardless of the type of therapy. We found effect sizes between 0.10 and 0.18 in intelligence index (verbal comprehension, perceptual
reasoning, and processing speed), in verbal memory (delayed recall and recognition), and in executive functioning (Tower of London-total time).
Conclusion(s): These results suggest that both DBT and ST might improve some cognitive functions associated with adolescents with suicidal behavior.
Additional studies with larger sample groups are needed to confirm these results. COG, S, TREAT Copyright © 2018
Journal of the American
Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S221
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT), Supportive
therapy
King, C. A., Gipson, P. Y., Arango, A., Foster, C. E., Clark, M., Ghaziuddin, N., Stone, D.
This study examined the effectiveness of LET's CONNECT (LC), a community
mentorship program for youths who report peer social problems, which is based on a positive youth development framework. Participants were 218 youths
(66.5% girls), aged 12 to 15 years, who were recruited from an urban medical emergency department and screened positive for bullying victimization,
bullying perpetration, and/or low social connectedness. Youths were randomized to LC (n = 106) or the control condition (n = 112). Six-month outcomes
were assessed with self-report measures of youth social connectedness, community connectedness, thwarted belongingness, depression, self-esteem, and
suicidal ideation. LC was associated with a significant increase in only one of these outcomes, social connectedness (effect size = 0.4). It was
associated consistently with trend-level positive changes for thwarted belongingness (decreased), depression (decreased), community connectedness,
and self-esteem (effect sizes = 0.2). There was no effect on suicidal ideation (effect size = 0.0), and although not a primary outcome, eight youths
in the LC condition and seven youths in the control condition engaged in suicidal behavior between baseline and follow-up. Although LC effect sizes
are consistent with those from previous studies of community mentorship, there were multiple challenges to LC implementation that affected dosage and
intervention fidelity, and that may account for the lack of stronger positive effects. Copyright © 2018 Wiley Periodicals, Inc.
Journal of Community Psychology, 46(7) : 885-
902
- Year: 2018
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Brent, D. A., Kennard, B. D.
Objectives: This presentation will describe and evaluate the impact of a brief inpatient intervention, As Safe As Possible (ASAP), supported by an
emotion-regulation and safety-planning smartphone application (app) called BRITE on postdischarge suicide attempts. Method(s): A total of 66 suicidal
adolescent inpatients were randomized to either ASAP/BRITE + treatment as usual (TAU) versus TAU alone. ASAP was a 2.7-hour inpatient intervention
that emphasized safety planning, emotion regulation, and distress tolerance. The app was personalized to each participant to provide reminders for
reasons for living, distraction, and interventions for distress tolerance and emotion regulation, as well as providing access to a safety plan with
emergency contact numbers. Result(s): Within 6 months, 16% of those assigned to ASAP/BRITE had made suicide attempts versus 31% of those in TAU.
Perceived social support increased in the ASAP/BRITE arm, and the more participants used the app, the greater their increase in reasons for living
(rho = 0.37, p = 0.08). Three participants made suicide attempts while still in the hospital. Excluding these individuals and adjusting for the
baseline variable associated with the time to suicide attempt, participants assigned to ASAP/BRITE had a significantly lower hazard ratio (HR) for
suicide attempt [HR = 0.22 (95% CI 0.05-0.99)]. ASAP/BRITE showed a stronger effect in those with a history of a suicide attempts (N = 53) [test for
moderation, HR = 0.07 (95% CI 0.01-0.79), p = 0.03]. Conclusion(s): In this pilot study, ASAP/BRITE shows promise as a brief inpatient intervention
to decrease postdischarge suicide attempts. SIB, S, PRE Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10
Supplement) : S33
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Iyengar, U., Snowden, N., Asarnow, J. R., Moran, P., Tranah, T., Ougrin, D.
Background: Suicide attempts (SA) and other types of
self-harm (SH) are strong predictors of death by suicide in adolescents, emphasizing the need to investigate therapeutic interventions in reduction
of these and other symptoms. We conducted an updated systematic review of randomized controlled trials (RCTs) from our previous study reporting
therapeutic interventions that were effective in reducing SH including SA, while additionally exploring reduction of suicidal ideation (SI) and
depressive symptoms (DS). Method: A systematic literature search was conducted across OVID Medline, psycINFO, PubMed, EMBASE, and Cochrane
Library from the first available article to October 22nd, 2017, with a primary focus on RCTs evaluating therapeutic interventions in the reduction of
self-harm. Search terms included self-injurious behavior; self-mutilation; suicide, attempted; suicide; drug overdose. Results: Our search
identified 1,348 articles, of which 743 eligible for review, yielding a total of 21 studies which met predetermined inclusion criteria. Eighteen
unique therapeutic interventions were identified among all studies, stratified by individual-driven, socially driven, and mixed interventions, of
which 5 studies found a significant effect for primary outcomes of self-harm and suicide attempts (31.3%), and 5 studies found a significant effect
for secondary outcomes of suicidal ideation and depressive symptoms (29.4%) for therapeutic intervention vs. treatment as usual. Collapsing across
different variations of Cognitive Behavior Therapy (CBT), and classifying Dialectical Behavior Therapy for Adolescents (DBT-A) as a type of CBT, CBT
is the only intervention with replicated positive impact on reducing self-harm in adolescents. Conclusion: While the majority of studies were
not able to determine efficacy of therapeutic interventions for both primary and secondary outcomes, our systematic review suggests that individual
self-driven and socially-driven processes appeared to show the greatest promise for reducing suicide attempts, with benefits of combined self-driven
and systems-driven approaches for reducing overall self-harm. Further RCTs of all intervention categories are needed to address the clinical and
etiological heterogeneity of suicidal behavior in adolescents, specifically suicidal ideation and depressive symptoms.
Frontiers in psychiatry Frontiers Research
Foundation, 9 : 583
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
McManama-O'Brien, K. H., Sellers, C. M., Battalen, A. W., Ryan, C. A., Maneta, E. K., Aguinaldo,
L. D., White, E., Spirito, A.
Alcohol use, both short-term intoxication and longer-term use, is a notable risk factor for
suicide. Despite the strong relationship between alcohol use and suicidal thoughts and behaviors, providers typically treat these two problems
independently. In particular, acute psychiatric care hospitalizations for adolescents are typically brief, and many only cursorily address alcohol
use. Integrating a brief motivational enhancement intervention for alcohol use into an inpatient psychiatric hospitalization treatment protocol has
the potential to enhance motivation to stop or reduce drinking if adolescents can more fully understand how it increases risk for suicidal behavior.
This study tested the feasibility, acceptability, and preliminary effects of the Alcohol and Suicide Intervention for Suicidal Teens (ASIST), a brief
motivational enhancement intervention targeting alcohol use and suicidal thoughts and behaviors for suicidal adolescents receiving inpatient
psychiatric treatment. Results from a randomized pilot trial of ASIST (N = 50) revealed that the intervention was both feasible and acceptable, with
92% of those in the ASIST condition reporting that the intervention helped them to understand how their alcohol use is related to their suicidal
thoughts and behaviors. Study findings suggest a larger randomized controlled trial may be warranted to test the effectiveness of ASIST with
psychiatrically hospitalized adolescents. Copyright © 2018
Journal of Substance Abuse
Treatment, 94 : 105-112
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Personalised feedback, normative feedback
Gabbay, V., Freed, R. D., Alonso, C. M., Senger, S., Stadterman, J., Davison, B.
A., Klein, R. G.
Objective: Reports are mixed on the efficacy of omega-3 fatty acids (O3FA) for the treatment of major depressive disorder (MDD), with
only limited data in adolescents. The present trial aimed to investigate systematically the efficacy of O3FA as a monotherapy, compared to a placebo,
in adolescents with MDD. Secondarily, we explored O3FA effects on anhedonia, irritability, and suicidality-all key features of adolescent MDD.
Method(s): Fifty-one psychotropic medication-free adolescents with DSM-IV-TR diagnoses of MDD (aged 12-19 years; 57% female) were randomized to
receive O3FA or a placebo for 10 weeks. Data were collected between January 2006 and June 2013. O3FA and a placebo were administered on a fixed-
flexible dose titration schedule based on clinical response and side effects. The initial dose of 1.2 g/d was increased 0.6 g/d every 2 weeks, up to
a maximum of 3.6 g/d. Clinician-rated and self-rated depression severity, along with treatment response, served as primary outcome measures.
Additionally, we examined O3FA effects on depression-related symptoms, including anhedonia, irritability, and suicidality. Treatment differences were
analyzed via intent-to-treat analyses. Result(s): O3FA were not superior to a placebo on any clinical feature, including depression severity and
levels of anhedonia, irritability, or suicidality. Additionally, response rates were comparable between treatment groups. Within-treatment analyses
indicated that both treatments were associated with significant improvement in depression severity on self- (O3FA: t= -4.38, P< .001; placebo: t= -
3.52, P= .002) and clinician (O3FA: t= -6.47, P< .001; placebo: t= -8.10, P< .001) ratings. Conclusion(s): In adolescents with MDD, O3FA do not
appear to be superior to placebo. © Copyright 2018 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 79 (4) (no
pagination)(17m11596) :
- Year: 2018
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Williams, C. L., Witte, T. K.
We evaluated the effects of exposure to a suicide news article on a variety of outcome variables and whether
adhering to one specific media guideline (i.e., including psychoeducational information and preventative resources) buffered any of the negative
effects of exposure.
Suicide & Life-
Threatening Behavior, 48(3) : 253-270
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions
Aggarwal, S., Patton, G.
Adolescent self-harm is an emerging public health challenge. It is associated with later psychiatric and substance use disorders,
unemployment and suicide. Family interventions have been effective in a range of adolescent mental health problems and for that reason were reviewed
for their effectiveness in the management of adolescent self-harm. The search identified 10 randomised and 2 non-randomised controlled trial
conducted in the high-income countries. For the most part the evidence is of low quality. The interventions were classified as brief single session,
intermediate-level and intensive family interventions depending on the intensity and duration of treatment. Brief interventions did not reduce
adolescent self-harm. Intermediate interventions such as the Resourceful Adolescent Parent Programme, Safe Alternatives for Teens and Youth Programme
and attachment-based family treatment were effective in reducing suicidal behaviour (effect size 0.72), suicide attempts (P=0.01) and suicidal
ideations (effect size 0.95), respectively in the short-term with an absence of long-term follow-up data. Intensive adolescent interventions such as
dialectical behaviour therapy and mentalisation-based therapy reduced suicidal ideation (effect size 0.89) and self-harm (56% vs 83%, P=0.01),
respectively. The persistence of effects beyond the intervention end point is not known in many interventions. Early involvement of the family, an
evaluation of the risks at the end of an acute crisis episode and a stepped-care model taking into account level of suicide risk and resources
available to an adolescent and her/his family are likely to promote better outcomes in adolescents who self-harm.
Evidence-Based Mental
Health, 21(1) : 16-22
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
Kim, S., Kim,
H., Lee, H., Noh, D.
PURPOSE: This study aimed to examine the effects of a brief stress management
intervention on depression, anxiety, suicidal ideation, and aggression among Korean male college students.\rDESIGN AND METHODS: In a repeated
measures design, participants were assessed before, immediately after, and 3 months after the intervention. Data of 40 experimental and 32 control
participants were analyzed using linear mixed models.\rFINDINGS: There were significant time-by-group interaction effects for depression and trait
anxiety, but not for state anxiety, suicidal ideation, and aggression.\rPRACTICE IMPLICATIONS: The intervention has long-term effects for depression
and trait anxiety. Future research should involve a randomized controlled trial on a larger scale.
Perspectives in Psychiatric Care, 54(1) : 88-94
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Batterham, P. J., Calear, A. L., Farrer, L., McCallum, S. M., Cheng, V. W. S.
Purpose: Online mental health programs can be effective in reducing symptoms of depression, anxiety disorders, substance use and
suicidal ideation. However, most existing e-mental health programs focus on a single domain of mental health, neglecting comorbidity. Furthermore,
few programs are tailored to the symptom patterns of the individual user. FitMindKit was designed to overcome the gaps of existing e-mental health
programs, providing tailored, transdiagnostic therapeutic content to address a range of comorbid mental health symptoms. A trial was conducted to
test the program's efficacy. Methods: Australian adults with elevated symptoms of depression, anxiety, suicidal ideation and/or substance use were
recruited through social media, with n = 194 randomised into a fully-automated trial of a 10-day brief intervention. Participants were randomly
allocated to receive FitMindKit tailored to their symptoms, an untailored generic version of FitMindKit, or an attention control. Results: Mixed
model repeated measures ANOVA indicated that participants in both FitMindKit and the attention control had significant reductions in symptom
composite scores. Effects were not significantly greater in the FitMindKit program relative to control, either at post-test or 3-month follow-up. No
effects were detected for specific decreases in depression, generalized anxiety, social anxiety, panic, suicidal ideation or alcohol/substance use.
There were no significant differences between the tailored and static versions in effectiveness or adherence. Participants in the tailored and static
conditions were more satisfied than in the control condition, with some evidence favouring the tailored condition. High attrition reduced power to
find effects. Conclusions: FitMindKit provides a model for addressing comorbid mental health symptoms in an online program, using automated tailoring
to symptom patterns. Modifications to the program are recommended, along with the need for larger trials to test the effects of tailoring on mental
health outcomes. Copyright © 2017 The Authors
Internet Interventions, 12 : 91-99
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions
Cottrell, D. J., Wright-Hughes, A., Collinson, M., Boston,
P., Eisler, I., Fortune, S., Graham, E. H., Green, J., House, A. O., Kerfoot, M., Owens, D. W., Saloniki, E-
C., Simic, M., Lambert, F., Rothwell, J., Tubeuf, S., Farrin, A. J.
Background: Self-harm in adolescents
is common and repetition occurs in a high proportion of these cases. Scarce evidence exists for effectiveness of interventions to reduce self-harm.
Methods: This pragmatic, multicentre, randomised, controlled trial of family therapy versus treatment as usual was done at 40 UK Child and Adolescent
Mental Health Services (CAMHS) centres. We recruited young people aged 11-17 years who had self-harmed at least twice and presented to CAMHS after
self-harm. Participants were randomly assigned (1:1) to receive manualised family therapy delivered by trained and supervised family therapists or
treatment as usual by local CAMHS. Participants and therapists were aware of treatment allocation; researchers were masked. The primary outcome was
hospital attendance for repetition of self-harm in the 18 months after group assignment. Primary and safety analyses were done in the intention-to-
treat population. The trial is registered at the ISRCTN registry, number ISRCTN59793150. Findings: Between Nov 23, 2009, and Dec 31, 2013, 3554 young
people were screened and 832 eligible young people consented to participation and were randomly assigned to receive family therapy (n = 415) or
treatment as usual (n = 417). Primary outcome data were available for 795 (96%) participants. Numbers of hospital attendances for repeat self-harm
events were not significantly different between the groups (118 [28%] in the family therapy group vs 103 [25%] in the treatment as usual group;
hazard ratio 1.14 [95% CI 0.87-1.49] p = 0.33). Similar numbers of adverse events occurred in both groups (787 in the family therapy group vs 847 in
the treatment as usual group). Interpretation: For adolescents referred to CAMHS after self-harm, having self-harmed at least once before, our family
therapy intervention conferred no benefits over treatment as usual in reducing subsequent hospital attendance for self-harm. Clinicians are therefore
still unable to recommend a clear, evidence-based intervention to reduce repeated self-harm in adolescents. (PsycINFO Database Record (c) 2018 APA,
all rights reserved)
The Lancet
Psychiatry, 5(3) : 203-216
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Cottrell, D. J., Wright-Hughes, A., Collinson, M., Boston, P., Eisler, I., Fortune, S., Graham, E. H., Green, J., House, A. O., Kerfoot,
M., Owens, D. W., Saloniki, E-C., Simic, M., Tubeuf, S., Farrin, A. J.
Background: Self-harm in adolescents is common and repetition rates high. There is limited evidence of the effectiveness of interventions
to reduce self-harm. Objective(s): To assess the clinical effectiveness and cost-effectiveness of family therapy (FT) compared with treatment as
usual (TAU). Design(s): A pragmatic, multicentre, individually randomised controlled trial of FT compared with TAU. Participants and therapists were
aware of treatment allocation; researchers were blind to allocation. Setting(s): Child and Adolescent Mental Health Services (CAMHS) across three
English regions. Participant(s): Young people aged 11-17 years who had self-harmed at least twice presenting to CAMHS following self-harm.
Intervention(s): Eight hundred and thirty-two participants were randomised to manualised FT delivered by trained and supervised family therapists (n
= 415) or to usual care offered by local CAMHS following self-harm (n = 417). Main Outcome Measure(s): Rates of repetition of self-harm leading to
hospital attendance 18 months after randomisation. Result(s): Out of 832 young people, 212 (26.6%) experienced a primary outcome event: 118 out of
415 (28.4%) randomised to FT and 103 out of 417 (24.7%) randomised to TAU. There was no evidence of a statistically significant difference in
repetition rates between groups (the hazard ratio for FT compared with TAU was 1.14, 95% confidence interval 0.87 to 1.49; p = 0.3349). FT was not
found to be cost-effective when compared with TAU in the base case and most sensitivity analyses. FT was dominated (less effective and more
expensive) in the complete case. However, when young people's and caregivers' quality-adjusted life-year gains were combined, FT incurred higher
costs and resulted in better health outcomes than TAU within the National Institute for Health and Care Excellence cost-effectiveness range.
Significant interactions with treatment, indicating moderation, were detected for the unemotional subscale on the young person-reported Inventory of
Callous-Unemotional Traits (p = 0.0104) and the affective involvement subscale on the caregiver-reported McMaster Family Assessment Device (p =
0.0338). Caregivers and young people in the FT arm reported a range of significantly better outcomes on the Strengths and Difficulties Questionnaire.
Self-reported suicidal ideation was significantly lower in the FT arm at 12 months but the same in both groups at 18 months. No significant
unexpected adverse events or side effects were reported, with similar rates of expected adverse events across trial arms. Conclusion(s): For
adolescents referred to CAMHS after self-harm, who have self-harmed at least once before, FT confers no benefits over TAU in reducing self-harm
repetition rates. There is some evidence to support the effectiveness of FT in reducing self-harm when caregivers reported poor family functioning.
When the young person themselves reported difficulty expressing emotion, FT did not seem as effective as TAU. There was no evidence that FT is cost-
effective when only the health benefits to participants were considered but there was a suggestion that FT may be cost-effective if health benefits
to caregivers are taken into account. FT had a significant, positive impact on general emotional and behavioural problems at 12 and 18 months.
Copyright © Queen's Printer and Controller of HMSO 2018.
Health
Technology Assessment, 22(12) :
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy