Disorders - suicide or self-harm behaviours
Garraza, L. G., Walrath, C., Goldston, D.
B., Reid, H., McKeon, R.
IMPORTANCE Youth suicide
prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the
number of nonlethal suicide attempts have been sparse. OBJECTIVE To determine whether a reduction in suicide attempts among youths occurs following
the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the
reduction in mortality documented previously. DESIGN, SETTING, AND PARTICIPANTS We conducted an observational study of community-based suicide
prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006
and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers
of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group.We used propensity score-based techniques
to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not.We combined
information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources.
The data analysis was performed between April and August 2014. P < .05 was considered statistically significant. EXPOSURES Comprehensive,
multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities,
improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines. MAIN OUTCOMES AND MEASURES Suicide
attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were
implemented.We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample
between 2008 and 2011. RESULTS Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years
of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer
attempts per 1000 youths [95%CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during
the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older
than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates. CONCLUSIONS AND RELEVANCE
Comprehensive GLS program activitieswere associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may
be needed to maintain the reduction in suicide attempt rates.
JAMA Psychiatry, 72(11) : 1143-1149
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H., Brent, D. A., Birmaher, B.
Objective: The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial
treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP). Methods: We recruited participants 12-18 years of age with a primary
BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned
using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-
affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach
consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed
outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly
over 1 year. Results: Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly
reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents
receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more
likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among
adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents
receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation.
Conclusions: DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents
with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to
establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.
Journal of Child & Adolescent Psychopharmacology, 25(2) : 140-
149
- 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: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT)
Guille, C., Zhao, Z., Krystal,
J., Nichols, B., Brady, K., Sen, S.
Importance: In the United States, approximately 1 physician dies
by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing more than 4-fold during the first 3 months
of internship year. Despite this increase, to our knowledge, very few efforts have been made to prevent the escalation of suicidal thoughts among
training physicians. Objective: To assess the effectiveness of a web-based cognitive behavioral therapy (wCBT) program delivered prior to the start
of internship year in the prevention of suicidal ideation in medical interns. Design, Setting, and Participants: A randomized clinical trial
conducted at 2 university hospitals with 199 interns from multiple specialties during academic years 2009-2010 or 2011-2012. The current study was
conducted from May 2009 to June 2010 and May 2011 to June 2012, and data were analyzed using intent-to-treat principles, including last observation
carried forward. Interventions: Interns were randomly assigned to 2 study groups (wCBT and attention-control group [ACG]), and completed study
activities lasting 30 minutes each week for 4 weeks prior to starting internship year. Participants assigned to wCBT completed online CBT modules and
those assigned to ACG received emails with general information about depression, suicidal thinking, and local mental health professionals. Main
Outcomes and Measures: The Patient Health Questionnaire-9was used to assess suicidal ideation (ie, \"thoughts that you would be better off dead or
hurting yourself in some way\") prior to the start of intern year and at 3-month intervals throughout the year. Results: A total of 62.2% of interns
(199 of 320) agreed to take part in the study; 100 were assigned to the wCBT group and 99 to the ACG. During at least 1 point over the course of
internship year, 12% of interns (12 of 100) assigned to wCBT endorsed suicidal ideation compared with 21.2%of interns (21 of 99) assigned to ACG.
After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation, interns assigned to wCBT
were less likely to endorse suicidal ideation during internship year (relative risk, 0.40; 95%CI, 0.17- 0.91; P = .03) compared with those assigned
to ACG. Conclusions and Relevance: This study demonstrates that a free, easily accessible, brief wCBT program is associated with reduced likelihood
of suicidal ideation among medical interns. Prevention programs with these characteristics could be easily disseminated to medical training programs
across the country. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
JAMA
Psychiatry, 72(12) : 1192-1198
- Year: 2015
- 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: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Hassanian-Moghaddam, H., Sarjami, S., Kolahi, A-A., Lewin, T., Carter, G.
This study reports the outcomes, during follow-up, of a low-cost postcard
intervention in a Randomized Control Trial of hospital-treated self-poisoning (n = 2300). The intervention was 9 postcards over 12 months (plus usual
treatment) versus usual treatment. Three binary endpoints at 12-24 months (n = 2001) were: any suicidal ideation, suicide attempt, or self-cutting.
There was a significant reduction in any suicidal ideation (RRR 0.20 CI 95% 0.13-0.27), (NNT 8, 6-13), and any suicide attempt (RRR 0.31, 0.06-0.50),
(NNT 35, 19-195), in this non-western population. However, there was no effect on self-cutting (RRR -0.01, -1.05-0.51). Sustained, brief contact by
mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase.;
Archives of
Suicide Research, : 1-17
- 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: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Hatcher, S., Sharon, C., House, A., Collins,
N., Collings, S., Pillai, A.
Background: The problem of people presenting to
hospitals with self-harm is important because such presentations are common, there is a clear link to suicide and a high premature mortality.
However, the best treatment for this population is unclear.; Aims: To see whether a package of measures, that included regular postcards and
problem-solving therapy, improved outcomes at 1 year compared with usual care in people who presented to hospital with self-harm (the ACCESS study:
trial registration Australian and New Zealand Clinical Trials Registry ACTRN12609000641291).; Method: The design of the study was a Zelen randomised
controlled trial. The primary outcome was re-presentation to hospital with self-harm within 12 months of the index episode.; Results: There were no
significant differences in the primary outcome and most of the secondary outcomes between the two groups. About half the people offered problem-
solving therapy did not receive it, for various reasons.; Conclusions: The package as offered had little effect on the proportion of people re-
presenting to hospital with self-harm. The dose of problem-solving therapy may have been too small to have an effect and there was a difficulty
engaging participants in active treatment.; Royal College of Psychiatrists.
British Journal of
Psychiatry, 206(3) : 229-236
- 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: Service Delivery & Improvement, Psychological Interventions
(any), Problem solving therapy (PST), Other Psychological Interventions, Other service delivery and improvement
interventions
Glenn, C. R., Franklin, J. C., Nock, M. K.
The
purpose of this study was to review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and
behaviors (SITBs) in youth. We reviewed major scientific databases (HealthSTAR, MEDLine, PsycINFO, PubMed) for relevant studies published prior to
June 2013. The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions
currently meet the Journal of Clinical Child and Adolescent Psychology standards for Level 1: well-established treatments. Six treatment categories
were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety
of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious
treatments included family skills training (e.g., family communication and problem solving), parent education and training (e.g., monitoring and
contingency management), and individual skills training (e.g., emotion regulation and problem solving). Several treatments have shown potential
promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only
a single randomized controlled trial. Future research should focus on replicating studies of promising treatments, identifying active treatment
ingredients, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g., following
hospital discharge).;
Journal of Clinical Child & Adolescent Psychology, 44(1) : 1-
29
- 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)
Hom, M. A., Stanley, I. H., Joiner, T. E., Jr.
Connecting
suicidal individuals to appropriate mental health care services is a key component of suicide prevention efforts. This review aims to critically
discuss the extant literature on help-seeking and mental health service utilization among individuals at elevated risk for suicide, as well as to
outline challenges and future directions for research in this area. Across studies, the rate of mental health service use for those with past-year
suicide ideation, plans, and/or attempts was approximately 29.5% based on weighted averages, with a lack of perceived need for services, preference
for self-management, fear of hospitalization, and structural factors (e.g., time, finances) identified as key barriers to care. Studies also revealed
facilitators to care, which include mental health literacy, positive views of services, and encouragement from family or friends to seek support. To
address these low rates of help-seeking and barriers to care, a number of interventions have been developed, including psychoeducation-based
programs, peer and gatekeeper training, and screening-based approaches. Despite these efforts, it appears that work is still needed to gauge the
impact of these interventions on behavioral outcomes and to more rigorously test their effectiveness. Additional implications for future research on
help-seeking among suicidal individuals are discussed.; Copyright © 2015 Elsevier Ltd. All rights reserved.
Clinical Psychology Review, 40 : 28-
39
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Hamilton, E., Klimes-
Dougan, B.
Background: There are well-documented gender differences in
adolescent suicidal behavior; death by suicide is more common in males, while nonfatal suicide attempts are more common among females. Over the past
three decades, researchers have documented the effectiveness of a myriad of suicide prevention initiatives. However, there has been insufficient
attention to which types of suicide prevention interventions are effective in changing attitudes and behaviors for young males and females. In this
review of the literature, we consider common examples of primarily universal suicide prevention programs from three implementation settings: school-
based, community-based, and healthcare-based. Our purpose is to delineate how the potential gender bias in such strategies may translate into youth
suicide prevention efforts.; Methods: Research in which gender was found to moderate program success was retrieved through online databases.;
Results: The results that feature programming effects for both males and females are provocative, suggesting that when gender differences are
evident, in almost all cases, females seem to be more likely than males to benefit from existing prevention programming.; Conclusions: We conclude by
considering recommendations that may benefit males more directly. Implications for adolescent suicide prevention in particular are discussed.
Personalization of suicide intervention is presented as a promising solution to reduce suicide rates.;
International Journal of Environmental Research &
Public Health, 12(3) : 2359-2372
- 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: Psychological Interventions
(any)
Hawton, K., Witt, K. G., Taylor-Salisbury, T. L., Arensman, E., Gunnell, D., Townsend, E., van-Heeringen, K., Hazell, P.
Background: Self-harm (SH;
intentional self-poisoning or self-injury) is common in children and adolescents, often repeated, and strongly associated with suicide. This is an
update of a broader Cochrane review on psychosocial and pharmacological treatments for deliberate SH first published in 1998 and previously updated
in 1999. We have now divided the review into three separate reviews; this review is focused on psychosocial and pharmacological interventions for SH
in children and adolescents.; Objectives: To identify all randomised controlled trials of psychosocial interventions, pharmacological agents, or
natural products for SH in children and adolescents, and to conduct meta-analyses (where possible) to compare the effects of specific treatments with
comparison types of treatment (e.g., treatment as usual (TAU), placebo, or alternative pharmacological treatment) for children and adolescents who
SH.; Search Methods: For this update the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Trials Search Co-ordinator searched the CCDAN
Specialised Register (30 January 2015).; Selection Criteria: We included randomised controlled trials comparing psychosocial or pharmacological
treatments with treatment as usual, alternative treatments, or placebo or alternative pharmacological treatment in children and adolescents (up to 18
years of age) with a recent (within six months) episode of SH resulting in presentation to clinical services.; Data Collection and Analysis: Two
reviewers independently selected trials, extracted data, and appraised study quality, with consensus. For binary outcomes, we calculated odds ratios
(OR) and their 95% confidence intervals (CI). For continuous outcomes measured using the same scale we calculated the mean difference (MD) and 95%
CI; for those measured using different scales we calculated the standard mean difference (SMD) and 95% CI. Meta-analysis was only possible for two
interventions: dialectical behaviour therapy for adolescents and group-based psychotherapy. For these analyses, we pooled data using a random-effects
model.; Main Results: We included 11 trials, with a total of 1,126 participants. The majority of participants were female (mean = 80.6% in 10 trials
reporting gender). All trials were of psychosocial interventions; there were none of pharmacological treatments. With the exception of dialectical
behaviour therapy for adolescents (DBT-A) and group-based therapy, assessments of specific interventions were based on single trials. We downgraded
the quality of evidence owing to risk of bias or imprecision for many outcomes.Therapeutic assessment appeared to increase adherence with subsequent
treatment compared with TAU (i.e., standard assessment; n = 70; k = 1; OR = 5.12, 95% CI 1.70 to 15.39), but this had no apparent impact on
repetition of SH at either 12 (n = 69; k = 1; OR 0.75, 95% CI 0.18 to 3.06; GRADE: low quality) or 24 months (n = 69; k = 1; OR = 0.69, 05% CI 0.23
to 2.14; GRADE: low quality evidence). These results are based on a single cluster randomised trial, which may overestimate the effectiveness of the
intervention.For patients with multiple episodes of SH or emerging personality problems, mentalisation therapy was associated with fewer adolescents
scoring above the cut-off for repetition of SH based on the Risk-Taking and Self-Harm Inventory 12 months post-intervention (n = 71; k = 1; OR =
0.26, 95% CI 0.09 to 0.78; GRADE: moderate quality). DBT-A was not associated with a reduction in the proportion of adolescents repeating SH when
compared to either TAU or enhanced usual care (n = 104; k = 2; OR 0.72, 95% CI 0.12 to 4.40; GRADE: low quality). In the latter trial, however, the
authors reported a significantly greater reduction over time in frequency of repeated SH in adolescents in the DBT condition, in whom there were also
significantly greater reductions in depression, hopelessness, and suicidal ideation.We found no significant treatment effects for group-based therapy
on repetition of SH for individuals with multiple episodes of SH at either the six ( = 430; k = 2; OR 1.72, 95% CI 0.56 to 5.24; GRADE: low quality)
or 12 month (n = 490; k = 3; OR 0.80, 95% CI 0.22 to 2.97; GRADE: low quality) assessments, although considerable heterogeneity was associated with
both (I(2) = 65% and 77% respectively). We also found no significant differences between the following treatments and TAU in terms of reduced
repetition of SH: compliance enhancement (three month follow-up assessment: n = 63; k = 1; OR = 0.67, 95% CI 0.15 to 3.08; GRADE: very low quality),
CBT-based psychotherapy (six month follow-up assessment: n = 39; k = 1; OR = 1.88, 95% CI 0.30 to 11.73; GRADE: very low quality), home-based family
intervention (six month follow-up assessment: n = 149; k = 1; OR = 1.02, 95% CI 0.41 to 2.51; GRADE: low quality), and provision of an emergency card
(12 month follow-up assessment: n = 105, k = 1; OR = 0.50, 95% CI 0.12 to 2.04; GRADE: very low quality). No data on adverse effects, other than the
planned outcomes relating to suicidal behaviour, were reported.; Authors' Conclusions: There are relatively few trials of interventions for children
and adolescents who have engaged in SH, and only single trials contributed to all but two comparisons in this review. The quality of evidence
according to GRADE criteria was mostly very low. There is little support for the effectiveness of group-based psychotherapy for adolescents with
multiple episodes of SH based on the results of three trials, the evidence from which was of very low quality according to GRADE criteria. Results
for therapeutic assessment, mentalisation, and dialectical behaviour therapy indicated that these approaches warrant further evaluation. Despite the
scale of the problem of SH in children and adolescents there is a paucity of evidence of effective interventions. Further large-scale trials, with a
range of outcome measures including adverse events, and investigation of therapeutic mechanisms underpinning these interventions, are required. It is
increasingly apparent that development of new interventions should be done in collaboration with patients to ensure that these are likely to meet
their needs. Use of an agreed set of outcome measures would assist evaluation and both comparison and meta-analysis of trials.;
Cochrane Database of Systematic
Reviews, (12) : CD012013
- Year: 2015
- 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), Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any)
Harrod, Curtis. S., Goss, Cynthia. W., Stallones, Lorann., DiGuiseppi, Carolyn.
Background: Suicide is a leading cause of death among post-secondary students worldwide. Suicidal thoughts and
planning are common among post-secondary students. Previous reviews have examined the effectiveness of interventions for symptomatic individuals;
however, many students at high risk of suicide are undiagnosed and untreated.; Objectives: We evaluated the effect on suicide and suicide-related
outcomes of primary suicide prevention interventions that targeted students within the post-secondary setting.; Search Methods: We searched the
following sources up to June 2011: Specialised Registers of two Cochrane Groups, Cochrane Central Register of Controlled Trials, and nine other
databases, trial registers, conference proceedings, and websites of national and international organizations. We screened reference lists and
contacted authors of included studies to identify additional studies. We updated the search in November 2013; we will include these results in the
review's next update.; Selection Criteria: We included studies that tested an intervention for the primary prevention of suicide using a randomized
controlled trial (RCT), controlled before-and-after (CBA), controlled interrupted time series (CITS), or interrupted time series (ITS) study design.
Interventions targeted students within the post-secondary setting (i.e. college, university, academy, vocational, or any other post-secondary
educational institution) without known mental illness, previous suicide attempt or self-harm, or suicidal ideation. Outcomes included suicides,
suicide attempts, suicidal ideation, changes in suicide-related knowledge, attitudes and behavior, and availability of means of suicide.; Data
Collection and Analysis: We used standardized electronic forms for data extraction, risk of bias and quality of evidence determination, and analysis.
We estimated standardised mean differences (SMD) with 95% confidence intervals (CIs). We analysed studies by intervention type and study design. We
summarized RCT effect sizes using random-effects models meta-analyses; and analysed statistical heterogeneity using the Chi(2) test and I(2)
statistic. We described narratively the results from studies that used other study designs.; Main Results: Eight studies met inclusion criteria. They
were heterogeneous in terms of participants, study designs, and interventions. Five of eight studies had high risk of bias. In 3 RCTs (312
participants), classroom-based didactic and experiential programs increased short-term knowledge of suicide (SMD = 1.51, 95% CI 0.57 to 2.45;
moderate quality evidence) and knowledge of suicide prevention (SMD = 0.72, 95% CI 0.36 to 1.07; moderate quality evidence). The effect on suicide
prevention self-efficacy in one RCT (152 participants) was uncertain (SMD = 0.20, 95% CI -0.13 to 0.54; low quality evidence). One CBA analysed the
effects of an institutional policy that restricted student access to laboratory cyanide and mandated professional assessment for suicidal students.
The incidence of student suicide decreased significantly at one university with the policy relative to 11 control universities, 2.00 vs. 8.68 per
100,000 (Z = 5.90; P < 0.05). Four CBAs explored effects of training 'gatekeepers' to recognize and respond to warning signs of emotional crises
and suicide risk in students they encountered. The magnitude of effect sizes varied between studies. Gatekeeper training enhanced short-term suicide
knowledge in students, peer advisors residing in student accommodation, and faculty and staff, and suicide prevention self-efficacy among peer
advisors. There was no evidence of an effect on participants' suicide-related attitudes or behaviors. One CBA found no evidence of effects of
gatekeeper training of peer advisors on suicide-related knowledge, self-efficacy, or gatekeeper behaviors measured four to six months after
intervention.; Authors' Conclusions: We found insufficient evidence to support widespread implementation of any programs or policies for primary
suicide prevention in post-secondary educational settings. As all evaluated interventions combined primary and secondary prevention components, we
were unable to determine the independent effects of primary preventive interventions. Classroom instruction and gatekeeper training increased short-
term suicide-related knowledge. We found no studies that tested the effects of classroom instruction on suicidal behavior or long-term outcomes.
Limited evidence suggested minimal longer-term effects of gatekeeper training on suicide-related knowledge, while no evidence was found evaluating
its effect on suicidal behavior. A policy-based suicide intervention reduced student suicide, but findings have not been replicated. Our findings are
limited by the overall low quality of the evidence and the lack of studies from middle- and low-income countries. Rigorously designed studies should
test the effects of preventive interventions on important health outcomes, including suicidal ideation and behavior, in varying post-secondary
settings.;
Cochrane Database of Systematic Reviews, 10 : CD009439
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any)
Husain, Nusrat., Afsar, Salahuddin., Ara, Jamal., Fayyaz, Hina., Rahman, R. U., Tomenson, Barbara., Hamirani, Munir., Chaudhry, Nasim., Fatima, Batool., Husain, Meher., Naeem,
Farooq., Chaudhry, Imran. B.
Background: Self-harm is a major risk factor for completed suicide.;
Aims: To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) -
delivered following an episode of self-harm compared with treatment as usual (TAU).; Method: The study was a randomised controlled assessor-masked
clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days
to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were
screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months
(end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary
outcome measures included hopelessness, depression, coping resources and healthcare utilisation.; Results: A total of 108 patients were randomised to
the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide
Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in
symptoms of depression compared with patients receiving TAU.; Conclusions: The positive outcomes of this brief psychological intervention in patients
attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.; Royal College of Psychiatrists.
British Journal of Psychiatry, 204(6) : 462-
470
- Year: 2014
- 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), Problem solving therapy (PST)
Ghaziuddin, N., Merchant, C., Dopp, R., King, C.
Objective: Describe suicidal ideation and suicide related/other emergencies (SRE), among
depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization. Methods: One hundred twenty adolescents,
who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent
medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication
groups: SSRI antidepressant only (n = 71); SSRI plus mood stabilizer (n = 17); SSRI plus antipsychotic (n = 20); and SSRI plus antipsychotic and mood
stabilizer (n = 12). Standardized instruments were used. Results: Mean age = 15.5 (plus or minus) 1.3, Caucasian = 80.8%, female = 74.2%, mean CDRS-R
= 61.7 (plus or minus) 12.1, suicide attempt during month prior to hospitalization = 58.6%. During the 3-month post-hospitalization period: (1) there
were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity
was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were
associated with greater reduction in suicidal ideation at 3-months. Conclusion: Declines in suicidal ideation, depression severity, and suicide
attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in
combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify
medication adherence is a study limitation.
Asian Journal of Psychiatry, 11 : 13-
19
- Year: 2014
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium)