Disorders - suicide or self-harm behaviours
Ougrin, D., Zundel, T., Kyriakopoulos, M., Banarsee,
R., Stahl, D., Taylor, E.
Self-harm is one of the best predictors of death by
suicide, but few studies directly compare adolescents with suicidal versus nonsuicidal self-harm. Seventy adolescents presenting with self-harm (71%
young women, ages 12-18 years) who participated in a randomized controlled trial were divided into suicidal and nonsuicidal self-harm categories
using the Columbia Classification Algorithm of Suicide Assessment. Adolescents with suicidal self-harm were more likely than those with nonsuicidal
self-harm to be young women, 22/23 (96%) versus 34/47 (72%), odds ratio (OR) = 8.33, 95% confidence interval (CI) [1.03, 50.0]; had a later age of
onset of self-harm, 15.4 years vs. 13.8 years, mean difference = 1.6, 95% CI [.8, 2.43]; and used self-poisoning more often, 18/23 (78%) versus 11/47
(23%), OR = 3.43, 95% CI [2.00, 5.89]. Only those with nonsuicidal self-harm had an improvement on Children's Global Assessment Scale score
following a brief therapeutic intervention, mean difference = 8.20, 95% CI [.97, 15.42]. However, there was no interaction between treatment and
suicidality. There are important differences between adolescents presenting with suicidal and nonsuicidal self-harm. Suicidal self-harm in
adolescence may be associated with a less favorable response to therapeutic assessment. (copyright) 2011 American Psychological Association.
Psychological Assessment, 24(1) : 11-
20
- Year: 2012
- Problem: Non-suicidal self-harm behaviours, 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), Other Psychological Interventions
Kutcher, S., Wei, Y.
PURPOSE OF REVIEW: Addressing youth mental health in secondary schools
has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related
service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future
interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental
health promotion, prevention, early identification and intervention/treatment. RECENT FINDINGS: In contrast to the abundance of school-based mental
health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack
of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration.
SUMMARY: Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be
proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental
health promotion, prevention and intervention. (copyright) 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Current Opinion in Psychiatry, 25(4) : 311-
316
- Year: 2012
- Problem: Depressive Disorders, 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), Other Psychological Interventions, Other service delivery and improvement
interventions
Kidger, J., Araya, R., Donovan, J., Gunnell, D.
BACKGROUND AND
OBJECTIVES: The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We
aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the
school environment in cohort studies. METHODS: Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray
literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional
health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers.
RESULTS: Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found
some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort
papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher
support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological
shortcomings were common. CONCLUSIONS: There is limited evidence that the school environment has a major influence on adolescent mental health,
although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring
schoollevel factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing
effective and feasible interventions compared with complex whole-school programs. Copyright (copyright) 2012 by the American Academy of
Pediatrics.
Pediatrics, 129(5) : 925-949
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Cox, Georgina R., Robinson, Jo, Williamson, Michelle, Lockley, Anne, Cheung, Yee Tak Derek, Pirkis,
Jane
Background: Suicide clusters have commonly
been documented in adolescents and young people.; Aims: The current review conducts a literature search in order to identify and evaluate postvention
strategies that have been employed in response to suicide clusters in young people.; Methods: Online databases, gray literature, and Google were
searched for relevant articles relating to postvention interventions following a suicide cluster in young people.; Results: Few studies have formally
documented response strategies to a suicide cluster in young people, and at present only one has been longitudinally evaluated. However, a number of
strategies show promise, including: developing a community response plan; educational/psychological debriefings; providing both individual and group
counseling to affected peers; screening high risk individuals; responsible media reporting of suicide clusters; and promotion of health recovery
within the community to prevent further suicides.; Conclusions: There is a gap in formal evidence-based guidelines detailing appropriate postvention
response strategies to suicide clusters in young people. The low-frequency nature of suicide clusters means that long-term systematic evaluation of
response strategies is problematic. However, some broader suicide prevention strategies could help to inform future suicide cluster postvention
responses.;
Crisis, 33(4) : 208-
214
- Year: 2012
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Andion, O., Ferrer, M., Matali,
J., Gancedo, B., Calvo, N., Barral, C., Valero, S., Di Genova, A., Diener, M. J., Torrubia, R., Casas, M.
Dialectical behavior therapy (DBT) is an
effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to
logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with
Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency
departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were
examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-
up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment
evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to
confirm the results. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Psychotherapy, 49(2) : 241-250
- Year: 2012
- Problem: Non-suicidal self-harm behaviours, 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: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT)
Ougrin, D., Tranah, T., Leigh, E., Taylor, L., Asarnow, J. R.
Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for
clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic. The
main aim of this article is to review randomised controlled trials (RCTs) reporting efficacy of specific pharmacological, social or psychological
therapeutic interventions (TIs) in reducing self-harm repetition in adolescents presenting with self-harm. Data sources were identified by searching
Medline, PsychINFO, EMBASE, and PubMed from the first available year to December 2010. RCTs comparing specific TIs versus treatment as usual or
placebo in adolescents presenting with self-harm were included. Fourteen RCTs reported efficacy of psychological and social TIs in adolescents
presenting with self-harm. No independently replicated RCTs have been identified reporting efficacy of TIs in self-harm reduction. Developmental
Group Psychotherapy versus treatment as usual was associated with a reduction in repeated self-harm, however, this was not replicated in subsequent
studies. Multisystemic Therapy (MST) versus psychiatric hospitalisation was associated with a reduction of suicidal attempts in a sample of
adolescents with a range of psychiatric emergencies. However, analyses focusing only on the smaller subgroup of adolescents presenting with
deliberate self-harm at the initial psychiatric emergency, did not indicate significant benefits of MST versus hospitalisation. Further research is
urgently needed to develop TIs for treating self-harm in adolescents. MST has shown promise but needs to be evaluated in a sample of adolescents with
self-harm; dialectic behavioural therapy and cognitive behavioural therapy for self-harm require RCTs to evaluate efficacy and effectiveness.
(copyright) 2012 The Authors. Journal of Child Psychology and Psychiatry (copyright) 2012 Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 53(4) : 337-
350
- Year: 2012
- 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), Psychological Interventions
(any)
Wharff, E. A., Ginnis, K. M., Ross, A. M.
The prevailing model of care
for psychiatric patients in the emergency room (ER) is evaluation and disposition, with little or no treatment provided. This article describes the
results of a pilot study of a family-based crisis intervention (FBCI) for suicidal adolescents and their families in a large, urban pediatric ER.
FBCI is an intervention designed to sufficiently stabilize patients within a single ER visit so that they can return home safely with their families.
Of the 100 suicidal adolescents and their families in the sample, 67 met eligibility criteria for FBCI. Demographic and clinical characteristics and
disposition outcomes from the sample were compared with those obtained retrospectively from a matched comparison group (N = 150). Statistical
analyses compared group inpatient admission rates and disposition outcomes. Patients in the pilot cohort were significantly less likely to be
hospitalized than were those in the comparison group (36 percent versus 55 percent). Only two of the patients in the FBCI cohort were hospitalized
immediately after receiving the intervention during their ER visit. FBCI with suicidal adolescents and their families during a single ER visit is
feasible and safely limits the need for inpatient psychiatric hospitalization, thereby avoiding disruption of family, academic, and social activities
and increasing use of less intrusive and more cost-effective psychiatric treatment.
Social Work, 57(2) : 133-
143
- Year: 2012
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Robinson, J., Yuen, H.
P., Gook, S., Hughes, A., Cosgrave, E., Killackey, E., Baker, K., Jorm, A., McGorry, P., Yung, A.
Aim:
Suicide attempt, ideation and deliberate self-harm are common among adolescents. Limited evidence exists regarding interventions that can reduce
risk; however, research indicates that maintaining contact with at-risk adults following discharge from services via letter or postcard can reduce
risk. The aim of the study was to test a postcard intervention among people aged 15-24 who presented to mental health services but were not accepted,
yet were at risk of suicide. Methods: A randomized controlled trial of 3years in duration was used. The intervention consisted of 12 postcards sent
once a month for 12months following presentation to the service. Key outcomes of interest were reduced rates of suicide attempt, suicidal ideation
and deliberate self-harm, assessed at 12 and 18months. Results: Participants reported that they liked receiving the postcard and that they used the
strategies recommended. However, no significant effect of the postcard intervention was found on suicide risk, although participants in both groups
improved on measures of mental health over the course of the study. Conclusions: There remains a need for further research into youth-friendly
interventions for young people at risk of suicide. (copyright) 2012 Blackwell Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 6(2) : 145-152
- Year: 2012
- 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
Rossouw, T. I., Fonagy, P.
Objective: We examined whether mentalization-based treatment for adolescents (MBT-A) is more effective than treatment as
usual (TAU) for adolescents who self-harm. Method: A total of 80 adolescents (85 female) consecutively presenting to mental health services with
self-harm and comorbid depression were randomly allocated to either MBT-A or TAU. Adolescents were assessed for self-harm, risk-taking and mood at
baseline and at 3-monthly intervals until 12 months. Their attachment style, mentalization ability and borderline personality disorder (BPD) features
were also assessed at baseline and at the end of the 12-month treatment. Results: MBT-A was more effective than TAU in reducing self-harm and
depression. This superiority was explained by improved mentalization and reduced attachment avoidance and reflected improvement in emergent BPD
symptoms and traits. Conclusions: MBT-A may be an effective intervention to reduce self-harm in adolescents. Clinical trial registration information:
- The emergence of personality disorder traits in adolescents who deliberately self harm and the potential for using a mentalisation based treatment
approach as an early intervention for such individuals: a randomised controlled trial; http://www.controlled-trials.com; ISRCTN95266816. (copyright)
2012 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 51(12) : 1304-
1313.e3
- Year: 2012
- 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), Mentalization-based
therapy
Vijayakumar, Lakshmi, Umamaheswari, C., Shujaath Ali, Zubaida Sultana, Devaraj, P., Kesavan, K.
Aim: Materials and Methods: Results:
Conclusions: To determine whether brief intervention and contact (BIC) is effective in reducing subsequent suicidal behavior among suicide
attempters.Suicide attempters (n=680) admitted in a general hospital in Chennai were randomly allocated to treatment as usual and BIC whose
components include brief intervention at the time of discharge and contact for 18 months.Completed suicide was significantly lower in the BIC group,
OR 35.4 (CI 18.4 - 78.2) as also attempted suicide, OR 17.3 (CI 10.8 - 29.7).This low-cost intervention which can be readily implemented may be an
important suicide prevention strategy in healthcare settings in India.
Indian Journal of Psychiatry, 53(3) : 244-
248
- Year: 2011
- 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), Psychoeducation, Other service delivery and improvement
interventions
Robinson, J., Hetrick, S. E., Martin, C.
Objective: Risk of
suicide attempt, suicidal ideation and deliberate self-harm is high among young people, yet limited evidence exists regarding effective
interventions, particularly from randomized controlled trials. The aim of this study was to conduct a systematic review and meta-analysis of all
randomized controlled trials testing interventions for adolescents and young adults who have presented to a clinical setting with any of these
behaviours. Methods: The Cochrane Central Register of Controlled Trials, Medline, EMBASE and PsycINFO were searched for articles published from 1980
to June 2010. The following keywords formed the basis of the search strategy: 'self-injurious behaviour', 'attempted suicide', 'suicide',
'suicidal behaviour', 'self-inflicted wounds', 'self-mutilation', 'self-harm'. We also hand searched conference abstracts from two major
suicide prevention conferences and the reference lists of all retrieved articles and previous reviews. Results: There were 15 trials included in the
review, with six ongoing trials also identified. In general, the reporting of the conduct of trials was poor, making it difficult to assess the risk
of bias. The reporting of outcome data was inconsistent. No differences were found between treatment and control groups except in one study that
found a difference between individual cognitive behavioural therapy and treatment as usual. Conclusion: The evidence regarding effective
interventions for adolescents and young adults with suicide attempt, deliberate self-harm or suicidal ideation is extremely limited. Many more
methodologically rigorous trials are required. However, in the meantime CBT shows some promise, but further investigation is required in order to
determine its ability to reduce suicide risk among young people presenting to clinical services. (copyright) 2011 The Royal Australian and New
Zealand College of Psychiatrists.
Australian & New Zealand Journal of Psychiatry, 45(1) : 3-
26
- Year: 2011
- 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)
Asarnow, Joan Rosenbaum, Baraff, Larry J., Berk, Michele, Grob, Charles S., Devich-Navarro, Mona, Suddath, Robert, Piacentini, John C., Rotheram-Borus, Mary Jane, Cohen, Daniel, Tang, Lingqi
Objective: Methods: Results: Conclusions: Suicide is the
third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated
by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared.In a randomized controlled
trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of
two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation
for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency
department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the
emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge.Intervention patients
were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had
significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and
psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory
analyses) was significantly associated with improved clinical or functioning outcomes.Results support efficacy of the enhanced emergency department
intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to
prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments.
Psychiatric Services, 62(11) : 1303-
1309
- Year: 2011
- 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), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)