Disorders - suicide or self-harm behaviours
Vaslamatzis, G., Theodoropoulos, P., Vondikaki, S., Karamanolaki, H., Miliatsanira, M., Gourounti, K.
The aim of this study was to compare the effectiveness of combined
treatment - medication plus psychodynamic psychotherapy - and psychodynamic psychotherapy alone on the outcome variables of suicidality and
impulsivity in a population of adult inpatients with severe personality disorder (SPD). This is a naturalistic-empirical (observational) study under
the conditions of clinical practice (an intensive specialized inpatient psychotherapeutic program [SIPP]). The sample consisted of 33 inpatients with
SPD who were allocated to two subgroups (groups A and B). The patients in group A received psychodynamic psychotherapy and adjunctive
pharmacotherapy, whereas the patients in group B received multimodal psychodynamic psychotherapy only. A statistically significant reduction in
suicidality score was observed in the patients in group A, whereas a tendency for significant reduction in impulsivity score was observed in group B
after the SIPP termination. Pharmacotherapy combined with multimodal psychodynamic psychotherapy, always within the SIPP, seems more effective in the
case of suicidality rather than impulsivity.©2014 Lippincott Williams & Wilkins.
Journal of Nervous & Mental Disease, 202(2) : 138-
143
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Psychodynamic/Psychoanalysis
Schilling, E. A., Lawless, M., Buchanan, L., Aseltine, R. H., Jr.
Although the Signs of Suicide (SOS)
suicide prevention program has been implemented at both the middle and high school levels, its efficacy has been demonstrated previously only among
high school students. The current study evaluated SOS implemented in high military impact middle schools. Compared to controls, SOS participants
demonstrated improved knowledge about suicide and suicide prevention, and participants with pretest ideation reported fewer suicidal behaviors at
posttest than controls with pretest ideation. These results provide preliminary evidence for SOS's efficacy as a suicide prevention program for
middle school students.; © 2014 The American Association of Suicidology.
Suicide & Life-Threatening
Behavior, 44(6) : 653-667
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions, Other service delivery and improvement
interventions
Shek, D. T. L., Ma, C. M. S.
Adopting a static group comparison design, this study examined the effectiveness of Project P.A.T.H.S. (Positive Adolescent Training
through Holistic Social Programs) using social survey data. In a longitudinal study, 3328 students were recruited from 28 secondary schools for the
wave 1 data, with 16 participating schools (P group) and 12 nonparticipating schools (NP group). The data were collected roughly 4 months after the
inception of Project P.A.T.H.S., and the data collection time for the two groups was similar. Results showed that the two groups did not differ in
their school characteristics, with the exception of student age, length of stay in Hong Kong and family functioning. Analyses of covariance were
conducted with the removal of the effects of age, length of stay in Hong Kong and family functioning. Compared with students in the nonparticipating
schools, students participating in the Project P.A.T.H.S. had better positive youth development and displayed less adolescent risk behavior.
Acknowledging the limitations of a static group comparison as a pre-experimental design, the present study provides supplementary evidence on the
effectiveness of the Project P.A.T.H.S. in Hong Kong.
International Journal on Disability & Human Development, 13(4) : 489-
496
- Year: 2014
- Problem: 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
Townsend, E.
Self-harm is a common problem among young people with many presenting
to clinical services via general hospitals, but many more do not come to the attention of clinical services at all. Self-harm is strongly associated
with completed suicide so it is extremely important that patients are assessed and treated for this problem effectively. Despite the scale of the
problem in young people, there is a very limited evidence base on what interventions may help them to recover from self-harm. The evidence is
discussed here and some recommendations are made about how to engage clinically with young people who self-harm from assessment to therapeutic
intervention.
Evidence-Based
Mental Health, 17(4) : 97-99
- Year: 2014
- 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)
Robinson, J., Cox, G., Hetrick, S.
Background: Suicide-related behaviours are common among young people. At least 100,000 adolescents complete suicide every year, and
worldwide, suicide ranks in the top five causes of mortality among 15 - 19 year olds. Suicide attempt and suicidal ideation are more common, with
just under 10% of adolescents reporting lifetime rates of attempted suicide, and almost 30% reporting a lifetime prevalence of suicidal ideation. A
number of countries have developed national suicide prevention strategies with youth as one of the groups to be targeted, yet despite this, and
despite the extent of this problem, little is known about the effectiveness of interventions to reduce risk, in both general and clinical
populations. Thus the aims of this paper are to briefly describe the rates and risk factors associated with suicide-related behaviour in young people
and the to examine in more detail the evidence for a range of interventions designed to reduce risk that could inform both clinical practice and
government policy. Methods: Three systematic reviews, and one narrative review, were conducted in order to examine the range, and effectiveness, of
interventions designed to reduce suicide risk among young people, in clinical, schoolbased and online settings. For each of the reviews conducted
suicide-related behaviour had to be a primary outcome of interest. Results: Suicide prevention in clinical settings: Fifteen published trails were
included. Of them two targeted young people with mood disorders, one targeted young people with borderline personality disorder and one study
targeted young people with a psychotic disorder. Interventions included (but are not restricted to): medication, a family-based intervention,
dialectical behavioural therapy, problem-solving therapy, cognitive behavioural therapy and group therapy. No differences were found between
treatment and control groups except in one study that found a difference in rates of suicidal ideation between individual cognitive behavioural
therapy and treatment as usual. Suicide prevention in school settings: Forty-three studies were included here, of which 15 reported on universal
education or awareness programs, 23 reported on selective interventions (e.g. gatekeeper training and screening programs), 3 reported on targeted
interventions, and 2 examined a postvention response in schools. Of these studies the most promising appeared to be gatekeeper training and screening
programs, although more research is necessary. Suicide prevention in online settings: These reviews found that, despite the number, and potential
effectiveness of, online programs for young people with depression and/or anxiety disorders, there are currently no published studies reporting on
the effects of online therapy for suicidal youth. Similarly a number of studies have been found that discuss the relationship between suicide and
social media, however despite the popularity and the potential reach of social media, no actual interventions studies were identified. Discussion:
Overall it is concluded that whilst we know much about the epidemiology of suicide among youth, there is a dearth of well-conducted studies that
provide adequate evidence regarding what works in youth suicide prevention. This has implications both clinically and at a policy level. A greater
emphasis on intervention studies - including novel interventions would lead to better practice in terms of detecting and supporting suicidal young
people, and could also contribute to a better informed, and more evidence-based, policy agenda around the world.
Schizophrenia Research, 153 : S10-S11
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- 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)
York, J., Lamis, D. A., Friedman, L., Berman, A. L., Joiner, T. E., McIntosh, J. L., Silverman, M. M., Konick, L., Gutierrez, P. M., Pearson, J.
The Guide to Community Preventive Services
(Guide), one of the most rigorous methods of systematic reviews, was adopted to evaluate the effectiveness of 16 community, primarily youth, suicide
prevention interventions, through a multisectoral collaboration. The Guide steps for obtaining and evaluating evidence on effectiveness include:
forming a multidisciplinary team; developing a conceptual approach to organizing, grouping, selecting, and evaluating the interventions; selecting
the interventions; searching for and retrieving evidence; assessing the quality of and summarizing the body of evidence; translating the evidence of
effectiveness into recommendations; considering additional evidence; and identifying and summarizing research gaps. The intervention effects were
calculated using Hedge's g-type (standardized mean differences) effect sizes. The strength of the body of evidence was characterized on the basis of
suitability of the study design for assessing effectiveness and quality of study execution. Results indicated that student curriculum, combined
curriculum and gatekeeper training, and competence programs have a positive effect on adolescent's knowledge and attitudes about suicide, but only a
negligible effect on suicidal behaviors. Five of 7 studies with moderate to large effect sizes on outcomes were also those with both good quality of
execution and the greatest suitability of the design. Policy recommendations are offered for the improved evaluation of the effectiveness of suicide
prevention programs in youth. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Journal of Community Psychology, 41(1) : 35-
51
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Robinson, Jo., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., O’Brien, M.
Background: Suicide, in
particular among young people, is a major public health problem, although little is known regarding effective interventions for managing and
preventing suicide-related behavior. Aims: To review the empirical literature pertaining to suicide postvention, prevention, and early intervention,
specifically in school settings. Method: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CCRCT) as well as citation lists
of relevant articles using terms related to suicide and schools were searched in July 2011. School-based programs targeting suicide, attempted
suicide, suicidal ideation, and self-harm where intent is not specified were included. No exclusion was placed on trial design. All studies had to
include a suicide-related outcome. Results: A total of 412 potentially relevant studies were identified, 43 of which met the inclusion criteria, as
well as three secondary publications: 15 universal awareness programs, 23 selective interventions, 3 targeted interventions, and 2 postvention
trials. Limitations: Overall, the evidence was limited and hampered by methodological concerns, particularly a lack of RCTs. Conclusions: The most
promising interventions for schools appear to be gatekeeper training and screening programs. However, more research is needed. (PsycINFO Database
Record (c) 2013 APA, all rights reserved). (journal abstract)
Crisis, 34(3) : 164-
182
- Year: 2013
- 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: Service Delivery & Improvement, Psychological Interventions
(any)
Palmer, R., Nascimento, L. N., Fonagy, P.
This article
reviews outcomes of psychodynamic psychotherapy (PP) for children and adolescents reported in articles identified by a comprehensive review of the
literature on treatment evaluations of psychological and medical interventions for mental disorders in pediatric populations. The review identified
48 reports based on 33 studies. While there is evidence of substantial clinical gains associated with PP, in almost all the studies, when contrasted
with family-based interventions, PP fares no better and appears to produce outcomes with some delay relative to family-based therapies. Further
rigorous evaluations are needed, but evidence to date suggests that the context in which PP is delivered should be extended from the traditional
context of individual therapy and parents should be included in the treatment of children. (copyright) 2013 Elsevier Inc.
Child & Adolescent Psychiatric Clinics of North America, 22(2) : 149-
214
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any), Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
Alavi, A., Sharifi, B., Ghanizadeh, A., Dehbozorgi, G.
Objective: To evaluate the effectiveness of a Cognitive-Behavioral therapy (CBT) for suicide prevention in decreasing suicidal ideation
and hopelessness in a sample of depressed 12 to 18 year-old adolescents who had at least one previous suicidal attempt.; Methods: In a clinical
trial, 30 depressed adolescents who attempted suicide in the recent 3 months were selected using simple sampling method and divided randomly into
intervention and wait-list control groups. Both groups received psychiatric interventions as routine. The intervention group received a 12 session
(once a week) of CBT program according to the package developed by Stanley et al, including psychoeducational interventions and individual and family
skills training modules. All of the patients were evaluated by Scale for Suicidal Ideation, Beck's hopelessness Inventory, and Beck's Depression
Inventory before the intervention and after 12 weeks.; Findings: There were significant differences between the two groups regarding the scores of
the above mentioned scales after 12 weeks. Fifty-four to 77 percent decreases in the mean scores of the used scales were observed in the invention
group. There were no significant changes in the scores of the control wait-list group. The differences between pre- and post-intervention scores in
the intervention group were significant.; Conclusion: CBT is an effective method in reducing suicidal ideation and hopelessness in the depressed
adolescents with previous suicidal attempts.;
Iranian Journal of Pediatrics, 23(4) : 467-
472
- Year: 2013
- 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)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Parker, B., Turner, W.
Background: The sexual abuse of
children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical
consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only
in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and
psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for such victims. In this review, we set out to find the
evidence for its effectiveness specifically in children and adolescents who have been sexually abused. Objectives: To assess the effectiveness of
psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. Search methods: We searched the following
databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings
Citation Index - Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant
studies and contacted known experts. Selection criteria: Randomised and quasi-randomised trials comparing psychoanalytic/psychodynamic psychotherapy
with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any
time prior to the intervention. Data collection and analysis: The review authors (BP and WT) independently screened search results to identify
studies that met eligibility criteria. Main results: No studies were identified that met the inclusion criteria for this review. Authors'
conclusions: There are no randomised and quasi-randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no
treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the
effectiveness of psychoanalytic/psychodynamic psychotherapy for this population. This important gap emphasises the need for further research into the
effectiveness of psychoanalytic/psychodynamic psychotherapy in this population. Such research should ideally be in the form of methodologically
high-quality, large-scale randomised controlled trials. If these are not conducted, future systematic reviews on this subject may need to consider
including other lower quality evidence in order to avoid overlooking important research. Copyright © 2013 The Cochrane Collaboration.
Cochrane Database of Systematic Reviews, 2013 (7) (no
pagination)(CD008162) :
- Year: 2013
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
De Silva, S., Parker, A., Purcell, R., Callahan, P., Liu, P., Hetrick, S.
Background: Suicide and self-harm (SSH) in young people is a major cause of disability-adjusted life years. Effective
interventions are of critical importance to reducing the mortality and morbidity associated with SSH. Aims: To investigate the extent and nature of
research on interventions to prevent and treat SSH in young people using evidence mapping. Method: A systematic search for SSH intervention studies
was conducted (participant mean age between 6 - 25 years). The studies were restricted to high-quality evidence in the form of systematic reviews,
meta-analyses, and controlled trials. Results: Thirty-eight controlled studies and six systematic reviews met the study inclusion criteria. The
majority (n = 32) involved psychological interventions. Few studies (n = 9) involved treating young people with recognized mental disorders or
substance abuse (n = 1) which also addressed SSH. Conclusion: The map was restricted to RCTs, CCTs, systematic reviews, and meta-analyses, and thus
might have neglected important information from other study designs. The effectiveness of interventions within the trials was not evaluated. The
evidence base for SSH interventions in young people is not well established, which hampers best-practice efforts in this area. Promising
interventions that need further research include school-based prevention programs with a skills training component, individual CBT interventions,
interpersonal psychotherapy, and attachment-based family therapy. Gaps in the research exist in evaluations of interventions for SSH in young people
with identifiable psychopathology, particularly substance use disorder, and research that classifies participants on the basis of their suicidal
intent. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Crisis, 34(4) : 223-
232
- Year: 2013
- Problem: Non-suicidal self-harm behaviours, 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), Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Crowe, M., Inder, M., Moor, S., Luty, S. E., Carter, J.
Objective: Rates of attempting and
completing suicide are high in Bipolar Disorder (BD) with death due to suicide in 10-15% of patients (Simon, Hunkeler et al. 2007), up to 60-fold
higher than in the general population (Neves, Malloy-Dinez et al. 2009). The high lethality of suicidal acts in bipolar disorders is suggested by a
much lower ratio of attempts: suicide (approximately 3:1) than in the general population (approximately 30:1) (Baldessarini, Tondo et al. 2006). The
association between BD and suicide attempts is wellestablished, however there is fairly limited prospective data reported and many studies exclude
patients who have alcohol and/ or drug abuse/dependence, other Axis 1 comorbidity or suicidal ideation (Crowe, Whitehead et al. 2010). Methods: One
hundred young people (15-36 years) were recruited to take part in an 18-month randomised controlled trial of Interpersonal and Social Rhythm Therapy
(IPSRT) and Specialist Supportive Care (SSC). Participants were randomised to each therapy in addition to medication management from a psychiatrist.
Data on lifetime suicide attempts was collected as baseline weeks 26, 52, 78, 104, 130, and 156, with additional questions on suicidal behaviour.
Descriptive analyses including frequencies, percentages, means and standard deviations were undertaken on demographic, clinical and suicide data.
Chi-square analyses and independent t-test were done to compare the characteristics of those participants who completed with those who were non-
completers. Results: At baseline previous suicide attempts were common with 48 participants (7 males, 41 females) assessed by the treating
psychiatrist as having attempted suicide. In the six months preceding the study, a total of 11 (22.9%) individuals, all female, made suicide
attempts. The vast majority of participants at the time of the attempt indicated they wished to die with 2/3rds believing their attempt would result
in death. In the 6 months prior to the study commencement, there were a total of 11 individuals who made attempts with a total of 18 actual attempts
made. Over the course of the intervention and follow up period (156 weeks), 15 individuals made subsequent suicide attempts with a total of 28
attempts. During the course of the study there was one death by suicide. There were no statistical differences found in demographic, clinical or
suicidal behaviour characteristics indicating no significant differences in these groups. Discussion: There were no statistical differences in the
characteristics of suicide risk factors (gender, age, age of onset, previous attempts, substance or alcohol use disorder and anxiety disorder)
between those we were able to follow-up (n = 73) and those that were lost to follow-up (n = 27). While there may be an association between the
psychotherapy interventions and the reduction in suicide attempts, there are also other possible factors that could explain this. Larger numbers
would be required before an association could be made more definitively. However these results add to the growing evidence that adjunctive
psychosocial interventions may contribute to a reduction in suicide risk in bipolar individuals.
Bipolar
Disorders, 15 : 97
- Year: 2013
- 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: Psychological Interventions
(any), Other Psychological Interventions