Disorders - suicide or self-harm behaviours
Wei,
Y., Kutcher, S., LeBlanc, J. C.
Introduction: Youth suicide is highly related to mental disorders. While communities and
schools are marketed to with a plethora of suicide prevention programs, they often lack the capacity to choose evidence-based programs. Methods: We
conducted a systematic review of two youth suicide prevention programs to help determine if the quality of evidence available justifies their wide
spread dissemination. We searched Medline, PsycINFO, EMBASE, CINAHL, the Cochrane Library, Campbell Collaboration SPECTR database, SocIndex,
Sociological Abstracts, Social Services Abstracts, ERIC, Social Work Abstracts, Research Library, and Web of Science, for relevant studies. We
included studies/systematic reviews/meta-analysis that evaluated the effectiveness, cost-effectiveness, and/or safety of Signs of Suicide (SOS) and
Yellow Ribbon (YR) suicide prevention programs that target adolescents. We applied the Office of Justice Program What Works Repository (OJP-R) to
evaluate the quality of the included studies as effective, effective with reservation, promising, inconclusive evidence, insufficient evidence, and
ineffective. Two SOS studies were ranked as \"inconclusive evidence\" based on the OJP-R. One SOS study was ranked as having \"insufficient evidence
\" on OJP-R. The YR study was ranked as \"ineffective\" using OJP-R. We only included studies in peer-reviewed journals in English and therefore may
have missed reports in grey literature or non-English publications. Results: We cannot recommend that schools and communities implement either the
SOS or YR suicide prevention programs. Purchasers of these programs should be aware that there is no evidence that their use prevents suicide.
Conclusions: Academics and organizations should not overstate the positive impacts of suicide prevention interventions when the evidence is lacking.
(PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of the Canadian
Academy of Child & Adolescent Psychiatry, 24(1) : 5-16
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions, Other service delivery and improvement
interventions
Salpekar, J. A., Joshi, P. T., Axelson, D. A., Reinblatt, S. P., Yenokyan, G., Sanyal, A., Walkup, J. T., Vitiello,
B., Luby, J. L., Wagner, K. D., Nusrat, N., Riddle, M. A.
Objective: To assess the efficacy of mood-stabilizing medications for depression and
suicidality in pediatric bipolar disorder. Method: The Treatment of Early Age Mania (TEAM) study is a multicenter, prospective, randomized, masked
comparison of divalproex sodium (VAL), lithium carbonate (LI), and risperidone (RISP) in an 8-week parallel clinical trial. A total of 279 children
and adolescents with DSM-IV diagnoses of bipolar I disorder, mixed or manic, aged 6 to 15 years were enrolled. The primary outcome measure was
improvement on the Clinical Global Impression scale for depression (CGI-BP-I-D). Secondary outcome measures included the Children's Depression
Rating Scale (CDRS-R) and suicidality status. Statistics included longitudinal analysis of outcomes using generalized linear mixed models with random
intercept both for the complete data set and by using last observation carried forward. Results: CGI-BP-I-D ratings were better in the RISP group
(60.7%) as compared to the LI (42.2%; p = .03) or VAL (35.0%; p = .003) groups from baseline to the end of the study. CDRS scores in all treatment
groups improved equally by study end. In week 1, scores were lower with RISP compared to VAL (mean = 4.72, 95% CI = 2.67, 6.78), and compared to LI
(mean = 3.63, 95% CI = 1.51, 5.74), although group differences were not present by the end of the study. Suicidality was infrequent, and there was no
overall effect of treatment on suicidality ratings. Conclusion: Depressive symptoms, present in the acutely manic or mixed phase of pediatric bipolar
disorder, improved with all 3 medications, though RISP appeared to yield more rapid improvement than LI or VAL and was superior using a global
categorical outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 54(12) : 999-
1007
- Year: 2015
- Problem: Bipolar Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium), Lithium
Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R., Hadlaczky, G., Kelleher, I., Sarchiapone, M., Apter, A., Balazs, J, Bobes, J., Brunner, R., Corcoran, P., Cosman, D., Guillemin, F., Haring, C., Iosue, M., Kaess, M., Kahn, J-P., Keeley, H., Musa, G. J., Nemes, B., Postuvan, V., Saiz, P., Reiter-Theil, S., Varnik, A., Varnik, P., Carli, V.
Background: Suicidal behaviours in adolescents are a
major public health problem and evidence-based prevention programmes are greatly needed. We aimed to investigate the efficacy of school-based
preventive interventions of suicidal behaviours. Methods: The Saving and Empowering Young Lives in Europe (SEYLE) study is a multicentre, cluster-
randomised controlled trial. The SEYLE sample consisted of 11 110 adolescent pupils, median age 15 years (IQR 14-15), recruited from 168 schools in
ten European Union countries. We randomly assigned the schools to one of three interventions or a control group. The interventions were: (1)
Question, Persuade, and Refer (QPR), a gatekeeper training module targeting teachers and other school personnel, (2) the Youth Aware of Mental Health
Programme (YAM) targeting pupils, and (3) screening by professionals (ProfScreen) with referral of at-risk pupils. Each school was randomly assigned
by random number generator to participate in one intervention (or control) group only and was unaware of the interventions undertaken in the other
three trial groups. The primary outcome measure was the number of suicide attempt(s) made by 3 month and 12 month follow-up. Analysis included all
pupils with data available at each timepoint, excluding those who had ever attempted suicide or who had shown severe suicidal ideation during the 2
weeks before baseline. This study is registered with the German Clinical Trials Registry, number DRKS00000214. Findings: Between Nov 1, 2009, and Dec
14, 2010, 168 schools (11 110 pupils) were randomly assigned to interventions (40 schools [2692 pupils] to QPR, 45 [2721] YAM, 43 [2764] ProfScreen,
and 40 [2933] control). No significant differences between intervention groups and the control group were recorded at the 3 month follow-up. At the
12 month follow-up, YAM was associated with a significant reduction of incident suicide attempts (odds ratios [OR] 0.45, 95% CI 0.24-0.85; p = 0.014)
and severe suicidal ideation (0.50, 0.27-0.92; p = 0.025), compared with the control group. 14 pupils (0.70%) reported incident suicide attempts at
the 12 month follow-up in the YAM versus 34 (1.51%) in the control group, and 15 pupils (0.75%) reported incident severe suicidal ideation in the YAM
group versus 31 (1.37%) in the control group. No participants completed suicide during the study period. Interpretation: YAM was effective in
reducing the number of suicide attempts and severe suicidal ideation in school-based adolescents. These findings underline the benefit of this
universal suicide preventive intervention in schools. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Lancet, 385(9977) : 1536-
1544
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Other service delivery and improvement
interventions
Ougrin,
D., Tranah, T., Stahl, D., Moran, P., Asarnow, J. R.
Objective: Suicidal behavior and
self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite
recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in
reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews
of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized
controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both
suicidal and nonsuicidal self-harm in adolescents. Method: Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and
PubMed databases as of May 2014. RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through
age 18 years) with self-harm were included. Results: Nineteen RCTs including 2,176 youth were analyzed. TIs included psychological and social
interventions and no pharmacological interventions. The proportion of the adolescents who self-harmed over the follow-up period was lower in the
intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p = .02). TIs with the largest effect sizes were dialectical
behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy
of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically
significant. Conclusion: TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a
research priority. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal
of the American Academy of Child & Adolescent Psychiatry, 54(2) : 97-107
- Year: 2015
- Problem: Non-suicidal self-harm behaviours, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Ridani, R., Shand, F. L., Christensen, H., McKay, K., Tighe, J., Burns, J., Hunter,
E.
A review of Aboriginal
suicide prevention programs were conducted to highlight promising projects and strategies. A content analysis of gray literature was conducted to
identify interventions reported to have an impact in reducing suicidal rates and behaviors. Most programs targeted the whole community and were
delivered through workshops, cultural activities, or creative outlets. Curriculums included suicide risk and protective factors, warning signs, and
mental health. Many programs were poorly documented and evaluations did not include suicidal outcomes. Most evaluations considered process variables.
Results from available outcome evaluations suggest that employing a whole of community approach and focusing on connectedness, belongingness and
cultural heritage may be of benefit. Despite the challenges, there is a clear need to evaluate outcomes if prevention is to be progressed.; © 2014
The American Association of Suicidology.
Suicide & Life-Threatening Behavior, 45(1) : 111-140
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Brewer, W.
J., Lambert, T. J., Witt, K., Dileo, J., Duff, C., Crlenjak, C., McGorry, P. D., Murphy, B. P.
Background: The first episode of psychosis is a crucial period when early intervention can alter the
trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early
Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive
outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal
recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment
as usual. Methods: Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk
management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a
naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were
compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case
management referral and discharge. Findings: Referrals were predominately unemployed males with low levels of functioning and educational attainment.
They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and
forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings,
admissions, bed days, and crisis contacts. Interpretation: Characterisation of intensive case management patients validated the clinical research
focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream
within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to
determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs
should reduce the distress associated with pathways to care for patients, their families, and the community. Funding: National Health & Medical
Research Council and the Colonial Foundation.
Lancet Psychiatry, 2(1) : 29-37
- Year: 2015
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Case management
Bennett, K., Rhodes, A. E., Duda, S., Cheung, A. H., Manassis, K., Links, P., Mushquash, C., Braunberger, P., Newton, A. S., Kutcher, S., Bridge, J. A., Santos, R. G., Manion, I. G., McLennan, J. D., Bagnell, A., Lipman, E., Rice, M., Szatmari, P.
Objective: We conducted an
expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based
strategies and nonschool-based interventions designed to prevent repeat attempts. Methods: Systematic review of review methods were applied.
Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review
quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations
derived from the findings. Results: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on
randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of
suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following:
emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training
primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk
in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with
antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further
evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness.
Consensus on 6 recommendations ranged from 73% to 100%. Conclusions: Our EKS facilitates decision maker access to what is known about effective youth
suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and
evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on
death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention. (PsycINFO
Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Canadian Journal of
Psychiatry, 60(6) : 245-257
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
Labelle, Real, Pouliot, Louise, Janelle, Alain
Although cognitive-behavioural (CB) treatments are recognised as evidence-based interventions for depression and other disorders in
adolescents, their efficacy in reducing suicidal and self-harm behaviours in this group remains equivocal. First, a systematic review of the
literature was carried out (N = 25 studies) on CB treatments for adolescents who presented suicidal ideation, had made suicide attempts, or engaged
in self-harm. Results suggest that the scientific quality of past studies is suboptimal. Second, a meta-analysis of the pooled data of 14 CB
treatment studies was conducted using a pre-post control group design. Results indicate a significant treatment effect in reducing suicidal ideation
(n = 13/14 studies; g = -.40, 95% CI [-.30, .49], z = 7.95, p = .001). A significant effect was observed also with respect to self-harm (n = 8/14
studies; g = -.27, 95% CI [-.17, .38], z = 4.96, p = .001). However, no significant effect was found for suicide attempts (n = 6/14 studies; g =
-.01, 95% CI [-.13, .14], z = .07, p = .94). The poor effect observed in this case could be due to low baseline prevalence of suicide attempts in
most studies owing to active exclusion of adolescents at high risk for suicide. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal
abstract).
Canadian Psychology/Psychologie canadienne, 56(4) : 368-
378
- Year: 2015
- 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), Cognitive & behavioural therapies (CBT)
McCay, E., Carter, C., Aiello, A., Quesnel, S., Langley, J., Hwang, S., Beanlands, H., Cooper, L., Howes, C., Johansson, B., MacLaurin, B.
The current study
implemented and evaluated a 12-week Dialectical Behavior Therapy (DBT) intervention across two Canadian service agencies providing drop-in, shelter
and transitional housing to street-involved youth inorder to alleviate mental health challenges and to strengthen resilience. A quasi-experimental
mixed methodsdesign with a wait-list comparison was used. Overall results demonstrate that youth who received the DBT intervention (N = 60)
demonstrated significant improvement in mental health challenges (e.g. depression, hopeless-ness, and anxiety), as well as significant improvement in
resilience, self-esteem, and social connectednessimmediately post-intervention.Participants inthe wait-list control didnot demonstrate significant
improvementon any of the study outcome measures. Furthermore, the gains attained for the intervention group weresustained at four and 10 weeks post-
intervention. The qualitative data substantiates these findings; further shedding light on youth's perspectives regarding the impetus for engaging
in DBT, the experience of DBT and the impact DBT had on their lives. Results of this study suggests that DBT implemented by front-line clinicians
showspromise in meeting the needs of street-involved youth in the community. Moreover, this study demonstratesthat it is possible, with the right
approach and support, for an interdisciplinary team of youth workers, nurses,and social workers to implement an evidenced-based treatment with youth
at community agencies thereby increasing access to needed services to support youth in ultimately exiting the street.
Children & Youth Services Review, 58 : 187-199
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT)
King, C. A., Eisenberg, D., Zheng, K., Czyz, E., Kramer, A., Horwitz, A., Chermack, S.
Objective: This pilot
randomized controlled trial examined the effect of an online intervention for college students at risk for suicide, Electronic Bridge to Mental
Health Services (eBridge), which included personalized feedback and optional online counseling delivered in accordance with motivational interviewing
principles. Primary outcomes were readiness to seek information or talk with family and friends about mental health treatment, readiness to seek
mental health treatment, and actual treatment linkage. Method: Participants were 76 college students (45 women, 31 men; mean age = 22.9 years, SD =
5.0 years) at a large public university who screened positive for suicide risk, defined by at least 2 of the following: suicidal thoughts, history of
suicide attempt, depression, and alcohol abuse. Racial/ethnic self-identifications were primarily Caucasian (n = 54) and Asian (n = 21). Students
were randomized to eBridge or the control condition (personalized feedback only, offered in plain report format). Outcomes were measured at 2-month
follow-up. Results: Despite relatively modest engagement in online counseling (29% of students posted >1 message), students assigned to eBridge
reported significantly higher readiness for help-seeking scores, especially readiness to talk to family, talk to friends, and see a mental health
professional. Students assigned to eBridge also reported lower stigma levels and were more likely to link to mental health treatment. Conclusions:
Findings suggest that offering students personalized feedback and the option of online counseling, using motivational interviewing principles, has a
positive impact on students' readiness to consider and engage in mental health treatment. Further research is warranted to determine the robustness
of this effect, the mechanism by which improved readiness and treatment linkage occurs, and the longer term impact on student mental health outcomes.
(PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of
Consulting & Clinical Psychology, 83(3) : 630-636
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Personalised feedback, normative feedback, Technology, interventions delivered using technology (e.g. online, SMS)
King, C. A., Gipson,
P. Y., Horwitz, A. G., Opperman, K. J.
Objective: Previous research has documented the feasibility of screening in emergency departments for adolescent
suicide risk. This randomized trial examined the effectiveness of Teen Options for Change (TOC), an intervention for adolescents seeking general
medical emergency services who screen positive for suicide risk. Methods: Participants were 49 youths, ages 14 to 19, seeking services for
nonpsychiatric emergencies. They screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus
substance abuse. Youths were randomly assigned to the TOC intervention or to enhanced treatment as usual. Depression, hopelessness, and suicidal
ideation were assessed at baseline and two months later. Results: Adolescents assigned to TOC showed greater reductions in depression than
adolescents assigned to the comparison group (Cohen's d = 1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes
trended positively (nonsignificantly), with small to moderate effect sizes. Conclusions: TOC may be a promising, brief intervention for adolescents
seeking emergency services and at risk of suicide. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Psychiatric Services, 66(1) : 97-
100
- Year: 2015
- 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
Petrova, M., Wyman, P. A., Schmeelk-Cone, K., Pisani, A. R.
Developing science-based communication guidance and positive-themed messages for suicide prevention are important priorities.
Drawing on social learning and elaboration likelihood models, we designed and tested two positive-focused presentations by high school peer leaders
delivered in the context of a suicide prevention program (Sources of Strength). Thirty-six classrooms in four schools (N = 706 students) were
randomized to (1) peer leader modeling of healthy coping, (2) peer leader modeling plus audience involvement to identify trusted adults, or (3)
control condition. Students' attitudes and norms were assessed by immediate post-only assessments. Exposure to either presentation enhanced positive
coping attitudes and perceptions of adult support. Students who reported suicide ideation in the past 12 months benefited more than nonsuicidal
students. Beyond modeling alone, audience involvement modestly enhanced expectations of adult support, congruent with the elaboration likelihood
model. Positive peer modeling is a promising alternative to communications focused on negative consequences and directives and may enhance social-
interpersonal factors linked to reduced suicidal behaviors.; © 2015 The American Association of Suicidology.
Suicide & Life-Threatening Behavior, 45(6) : 651-
663
- Year: 2015
- 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