Disorders - Suicide or self-harm behaviours
Chen, E. Y. H., Tang, J. Y., Hui, C. L., Chiu, C. P., Lam, M. M., Law, C. W., Yew, C. W., Wong, G.
H., Chung, D. W., Tso, S., Chan, K. P., Yip, K. C., Hung, S. F., Honer, W. G.
Aim: Although phase-specific early
intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in
non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early
intervention in first-episode psychosis. Method: In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who
received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior
to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal
behaviour and service utilization from clinical records. Results: Patients in the early intervention group had longer full-time employment or study
(P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P=0.001), fewer suicides
(P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group
experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72).
Conclusions: The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with
respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate
of relapse. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in
Psychiatry, 5(4) : 315-323
- Year: 2011
- 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: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Cusimano, Michael D., Sameem, Mojib
Objective: Data Sources: Review
Methods: Results: Conclusion: To assess the effectiveness of middle and high school-based suicide prevention curricula.The following were searched:
Ovid MEDLINE(R) in-process and other non-indexed citations and Ovid MEDLINE(R), Ovid Healthstar, CINAHL, PsycINFO, all EBM reviews-Cochrane DSR, ACP
Journal Club, DARE, CCTR, CMR, HTA, and NHSEED, and the ISI Web of Science, until October 2009; government web pages for statistics and other
demographic data in countries where they were available; citation lists of relevant articles.Randomised controlled studies, interrupted time series
analyses with a concurrent comparison group, studies with follow-up examinations (post-test questionnaires and monitoring suicide rates), and middle
to high school-based curriculum studies, including both male and female participants, were included.36 potentially relevant studies were identified,
eight of which met the inclusion criteria. Overall, statistically significant improvements were noted in knowledge, attitude, and help-seeking
behaviour. A decrease in self reported ideation was reported in two studies. None reported on suicide rates.Although evidence exists that school-
based programmes to prevent suicide among adolescents improve knowledge, attitudes, and help-seeking behaviours, no evidence yet exists that these
prevention programmes reduce suicide rates. Further well designed, controlled research is required before such programmes are instituted broadly to
populations at risk.
Injury Prevention, 17(1) : 43-49
- Year: 2011
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any)
Corcoran, Jacqueline, Dattalo, Patrick, Crowley, Meghan, Brown,
Emily, Grindle, Lauren
Suicide is a leading cause of death for young people and rates of serious suicidal
thoughts are even higher. Due to these high rates and potential harm to youth, effective interventions are necessary. The purpose of this systematic
review was to determine the impact of interventions designed for suicidal adolescents. Both quasi-experimental and experimental designs in the
published and unpublished literature were included, and a total of 17 studies were located. According to meta-analysis, intervention group
participants were slightly less likely to have suicidal and self-harm events than control group participants. However, when studies assessed outcome
at a later period than immediately after intervention, experimental group participants were slightly more likely to have suicidal and self-harm
events than control group participants. For studies that measured suicidal ideation at posttest, intervention group participants were slightly less
likely to report suicidal ideation than control group participants, both at posttest and at follow-up. These contradictory findings are explored and
discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Children & Youth Services Review, 33(11) : 2112-
2118
- Year: 2011
- 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)
Esposito-
Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., Monti, P.
Objective: This study tested a cognitive-behavioral treatment protocol for
adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial. Method: Forty adolescents (M
age = 15 years; 68 female, 89 White) and their families recruited from an inpatient psychiatric hospital were randomly assigned to an integrated
outpatient cognitive-behavioral intervention for co-occurring AOD and suicidality (I-CBT) or enhanced treatment as usual (E-TAU). Primary measures
include the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Suicide Ideation Questionnaire, Columbia Impairment Scale,
Timeline Followback, Rutgers Alcohol Problem Index, and Rutgers Marijuana Problem Index. Assessments were completed at pretreatment as well as 3, 6,
12, and 18 months postenrollment. Results: In intent-to-treat analyses, I-CBT was associated with significantly fewer heavy drinking days and days of
marijuana use relative to E-TAU but not with fewer drinking days. Those randomized to I-CBT in comparison to E-TAU also reported significantly less
global impairment as well as fewer suicide attempts, inpatient psychiatric hospitalizations, emergency department visits, and arrests. Adolescents
across groups showed equivalent reductions in suicidal ideation. Conclusions: I-CBT for adolescents with co-occurring AOD and suicidality is
associated with significant improvement in both substance use and suicidal behavior, as well as markedly decreased use of additional health services
including inpatient psychiatric hospitalizations and emergency department visits. Further testing of integrated protocols for adolescent AOD and
suicidality with larger and more diverse samples is warranted. (copyright) 2011 American Psychological Association.
Journal of Consulting & Clinical Psychology, 79(6) : 728-
739
- Year: 2011
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Ertl, Verena, Pfeiffer, Anett, Schauer, Anett, Elbert, Thomas, Neuner, Frank
Context: The psychological rehabilitation of former child soldiers and their successful reintegration into
postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility
and efficacy of mental health interventions for former child soldiers. Objective: To assess the efficacy of a community-based intervention targeting
symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals. Design, Setting, and Participants: Randomized controlled trial
recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between
November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy
(n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-
related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International
Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization.
Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention.
Intervention: Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities. Main Outcome Measures: Change
in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation,
feelings of guilt, and perceived stigmatization. Results: PTSD symptom severity (range, 0-148) was significantly more improved in the narrative
exposure therapy group than in the academic catch-up (mean change difference, ‚àí14.06 [95% confidence interval, ‚àí27.19 to ‚àí0.92]) and waiting-
list (mean change difference, ‚àí13.04 [95% confidence interval, ‚àí26.79 to 0.72]) groups. Contrast analyses of the time vó treatment interaction of
the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F
[sub]1,234.1[/sub] = 5.21, P = .02) and wait-listing (F[sub]1,228.3[/sub] = 5.28, P = .02). Narrative exposure therapy produced a larger within-
treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81). Conclusion: Among former Ugandan child
soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing
resulted in greater reduction of PTSD symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
JAMA, 306(5) : 503-
512
- Year: 2011
- Problem: Post Traumatic Stress Disorder, 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), Supportive
therapy, Other Psychological Interventions, Narrative exposure therapy (NET)
Balaji, M., Andrews, T., Andrew, G., Patel, V.
Purpose To evaluate the
acceptability, feasibility, and effectiveness of a population-based intervention to promote health of youth (age: 1624 years) in Goa. Methods Two
pairs of urban and rural communities were selected; one of each was randomly assigned to receive a multi-component intervention and the other wait-
listed. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer
education, and health information materials. Effectiveness was assessed through beforeafter population surveys at baseline and at 18 months. Outcomes
were measured using a structured interview schedule with all eligible youth. Logistic regression compared each pair, adjusted for baseline
differences, on prevalence of outcomes in the domains of reproductive and sexual health (RSH), violence, mental health, substance use, and help
seeking for health concerns. Results In both intervention communities, prevalence of violence perpetrated and probable depression was significantly
lower and knowledge and attitudes about RSH significantly higher (p < .05). The rural sample also reported fewer menstrual complaints and higher
levels of help-seeking for RSH complaints by women, and knowledge and attitudes about emotional health and substance use; and, the urban sample
reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and RSH complaints. Although information materials were
acceptable and feasible in both communities, community peer education was feasible only in the rural community. The institution-based interventions
were generally acceptable and feasible. Conclusions Multicomponent interventions comprising information materials, educational-institution
interventions and, in rural contexts, community peer interventions are acceptable and feasible and likely to be effective for youth health promotion.
(copyright) 2011 Society for Adolescent Health and Medicine.
Journal of Adolescent
Health, 48(5) : 453-460
- Year: 2011
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions
Perera Ramani, E. A., Kathriarachchi, S. T.
Background: Suicidal behaviour
among youth is a major public health concern in Sri Lanka. Prevention of youth suicides using effective, feasible and culturally acceptable methods
is invaluable in this regard, however research in this area is grossly lacking. Objective: This study aimed at determining the effectiveness of
problem solving counselling as a therapeutic intervention in prevention of youth suicidal behaviour in Sri Lanka. Setting and design: This control
trial study was based on hospital admissions with suicidal attempts in a sub-urban hospital in Sri Lanka. The study was carried out at Base Hospital
Homagama. Materials and Methods: A sample of 124 was recruited using convenience sampling method and divided into two groups, experimental and
control. Control group was offered routine care and experimental group received four sessions of problem solving counselling over one month. Outcome
of both groups was measured, six months after the initial screening, using the visual analogue scale. Results: Individualized outcome measures on
problem solving counselling showed that problem solving ability among the subjects in the experimental group had improved after four counselling
sessions and suicidal behaviour has been reduced. The results are statistically significant. Conclusion: This Study confirms that problem solving
counselling is an effective therapeutic tool in management of youth suicidal behaviour in hospital setting in a developing country.
Indian Journal of Psychiatry, 53(1) : 30-
35
- Year: 2011
- 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), Problem solving therapy (PST)
Ougrin, Dennis, Zundel, Tobias, Ng, Audrey, Banarsee,
Reetoo, Bottle, Alex, Taylor, Eric
Objective: Design: Setting:
Participants: Interventions: Main Outcome Measures: Results: Conclusions: Trial Registration: To determine whether Therapeutic Assessment (TA) versus
assessment as usual (AAU) improves engagement with follow-up in adolescents presenting with self-harm.Randomised controlled trial with 3 months
naturalistic follow-up.Child and adolescent mental health services in two London National Health Service Trusts.26 clinicians randomised into TA and
AAU groups recruited 70 newly referred adolescents with self-harm.TA, a manualised procedure including a basic psychosocial assessment and a 30 min
therapeutic intervention; AAU, standard psychosocial assessment.Attendance at the first follow-up session; number of the follow-up sessions attended
and changes in Strengths and Difficulties Questionnaire and Children's Global Assessment Scale scores. All measures were adjusted for clustering,
social class, changes of therapist and previous contact with services.Using the data on all participants (n=70), those in the TA group were
significantly more likely to attend the first follow-up appointment: 29 (83%) versus 17 (49%), OR 5.12, 95% CI (1.49 to 17.55) and more likely to
attend four or more treatment sessions: 14 (40%) versus 4 (11%), OR 5.19, 95% CI (2.22 to 12.10). Three months after the initial assessment there
were no statistically significant differences between the groups on Strengths and Difficulties Questionnaire scores: 15.6 versus 16.0, mean
difference -0.37, 95% CI (-3.28 to 2.53) or Children's Global Assessment Scale scores: 64.6 versus 60.1, mean difference 4.49, 95% CI (-0.98 to
9.96).TA was associated with statistically significant improvement in engagement. TA could be usefully applied at the point of initial assessment for
adolescents with self-harm.ISRCTN 81605131 http://www.controlled-trials.com/ISRCTN81605131/.
Archives of Disease in Childhood, 96(2) : 148-
153
- 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: Psychological Interventions
(any), Other Psychological Interventions
Ougrin, Dennis, Latif, Saqib
Background: Aims: Methods: Results:
Conclusions: Despite recent advances in the understanding and treatment of self-harm, poor engagement with therapy remains a serious problem.To
investigate whether offering specific psychological treatment (SPT) leads to better engagement than offering treatment as usual (TAU) in adolescents
who have self-harmed.Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed for randomized controlled trials comparing SPT
versus TAU in adolescents presenting with self-harm.Seven studies met inclusion criteria, and six were entered into the meta-analysis. There was no
statistically significant difference between the number of subjects not completing four or more sessions of an SPT (27.7%, 70/253) than TAU (43.3%,
106/245), RR = 0.71 (95% CI: 0.49-1.05).Engaging adolescents with psychological treatment is necessary although not sufficient to achieve treatment
goals. Further research is needed to develop tools for maximizing engagement.
Crisis, 32(2) : 74-
80
- Year: 2011
- 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)
Kim, G. H., Kim, K., Park, H.
Depression is increasing among Korean college students. Moreover, it is common for depressed individuals to consider attempting suicide.
The purpose of this study therefore was to develop and examine the effectiveness of an int ived a depression-reducing program in eight 1-hr weekly
sessions. Measures of suicidal ideation and depression were administered. The program has effects on suicidal ideation and depression among female
college students. The findings suggest that the study program may be useful in reducing suicidal ideation and depression among female college
students. (copyright) The Author(s) 2011.
Western Journal of Nursing Research, 33(4) : 560-
576
- Year: 2011
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Green, J. M., Wood, A. J., Kerfoot, M. J., Trainor, G., Roberts, C., Rothwell, J., Woodham, A., Ayodeji, E., Barrett, B., Byford, S., Harrington, R.
Objective: To examine the effectiveness and cost-effectiveness of group therapy for self harm in young
people. Design: Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care,
compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder,
depressive disorder, and severity of psychosocial stress. Participants: Adolescents aged 12-17 years with at least two past episodes of self harm
within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning
difficulties (defined by need for specialist school), current containment in secure care. Setting: Eight child and adolescent mental health services
in the northwest UK. Interventions: Manual based developmental group therapy programme specifically designed for adolescents who harm themselves,
with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered
from participating centres. Main outcome measures: Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes
were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and
criminal justice sector services, plus family related costs and productivity losses, were recorded. Results: 183 adolescents were allocated to each
arm (total n = 366). Loss to follow-up was low (‚Äp4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to
follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant
baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P = 0.95) at 6 months and 0.88 (0.59 to 1.33, P = 0.52) at 1 year. For severity of
subsequent self harm the equivalent odds ratios were 0.81 (0.54 to 1.20, P = 0.29) at 6 months and 0.94 (0.63 to 1.40, P = 0.75) at 1 year. Total 1
year costs were higher in the group therapy arm (£21 781) than for routine care (£15 372) but the difference was not significant (95% CI −1416 to
10782, P = 0.132). Conclusions: The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who
repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current
clinical expectations. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
British Medical Journal, 342(7802) : 1-
12
- 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: Psychological Interventions
(any), Other Psychological Interventions
Bertolote, Jose M., Fleischmann, Alexandra, De Leo, Diego, Phillips, Michael R., Botega, Neury J., Vijayakumar, Lakshmi, De Silva, Damani, Schlebusch, Lourens, Nguyen, Van Tuong, Sisask, Merike, Bolhari, Jafar, Wasserman, Danuta
Background: Aims: Methods: Results: Conclusions: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative
strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings.To evaluate a brief educational
intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India;
Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on
Suicidal Behaviors (SUPRE-MISS).Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were
randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over
the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits.
Subsequent completed suicide - the primary outcome measure - has been reported in a previous paper.Overall, the proportion of subjects with repeated
suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five
sites.This study from five low- and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up
contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.
Crisis, 31(4) : 194-201
- Year: 2010
- 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), Psychoeducation