Disorders - suicide or self-harm behaviours
Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef,
K., Levy, S.,
Objective: To evaluate
whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive
symptoms in adolescents. Method: This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary
care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment
occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral
to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were
measured for suicidal ideation and depressive symptoms. Results: Using intent to treat, patients in ABFT demonstrated significantly greater rates of
change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size
(ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on
suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6-99.6) than patients in EUC (51.7%; 95% CI = 32.4-54.32). Benefits were
maintained at follow-up (ABFT, 70%; 95% CI = 52.6-87.4; EUC 34.6%; 95% CI = 15.6-54.2; odds ratio = 4.41). Patterns of depressive symptoms over time
were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus
2.9). Conclusions: ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is
warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study). Clinical Trial Registry
Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097.
(copyright) 2010.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(2) : 122-
131
- 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), Family therapy
Pompili, M., Serafini, G., Innamorati, M., Ambrosi, E., Giordano, G., Girardi, P., Tatarelli, R., Lester, D.
The annual
worldwide suicide rate currently averages approximately 13 per 100,000 individuals per year (0.013% per year), with higher average rates for men than
for women in all but a few countries, very low rates in children, and relatively high rates in elderly men. Suicide rates vary markedly between
countries, reflecting in part differences in case-identification and reporting procedures. Rates of attempted suicide in the general population
average 20-30 times higher than rates of completed suicide, but are probably under-reported. Research on the relationship between pharmacotherapy and
suicidal behavior was rare until a decade ago. Most ecological studies and large clinical studies have found that a general reduction in suicide
rates is significantly correlated with higher rates of prescribing modern antidepressants. However, ecological, cohort and case-control studies and
data from brief, randomized, controlled trials in patients with acute affective disorders have found increases, particularly in young patients and
particularly for the risk of suicide attempts, as well as increases in suicidal ideation in young patients. whether antidepressants are associated
with specific aspects of suicidality (e.g., higher rates of completed suicide, attempted suicide and suicidal ideation) in younger patients with
major affective disorders remains a highly controversial question. In light of this gap this paper analyzes research on the relationship between
suicidality and antidepressant treatment.
Pharmaceuticals (Basel, Switzerland), 3(9) : 2861-2883
- Year: 2010
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any)
Brent, D. A., Greenhill, L. L., Compton, S., Emslie, G., Wells, K., Walkup, J. T., Vitiello, B., et-al
Objective: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with
depression treated in an open treatment trial. Method: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were
either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining
124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n =
93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute
suicidal ideation necessitating emergency referral). Results: The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and
0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of
previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence,
and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the
occurrence of a suicidal event. Conclusions: In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than
those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal
ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and
increased therapeutic contact early in treatment may be warranted. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(10):987-996. (copyright) 2009
American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 48(10) : 987-
996
- Year: 2009
- 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), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Daniel, S.
S., Goldston, D. B.
Suicidal behavior is developmentally mediated, but the degree to which interventions for suicidal behaviors have been
developmentally tailored has varied widely. Published controlled studies of psychosocial treatment interventions for reducing adolescent suicidal
behavior are reviewed, with a particular emphasis on the developmental nuances of these interventions. In addition, developmental considerations
important in the treatment of suicidal adolescents are discussed. There are insufficient data available from controlled trials to recommend one
intervention over another for the treatment of suicidal youth, but interventions that are sensitive to the multiple developmental contexts have
potential for greater effectiveness in reducing adolescent suicidal behavior. (copyright) 2009 The American Association of Suicidology.
Suicide & Life-Threatening Behavior, 39(3) : 252-
268
- Year: 2009
- 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)
Hazell, Philip L., Martin, Graham, McGill, Katherine, Kay, Tracey, Wood, Alison, Trainor, Gemma, Harrington, Richard
Objective: Method: Results: Conclusions: To replicate a study, which found group therapy superior
to routine care in preventing the recurrence of self-harming behavior in adolescents who had deliberately harmed themselves on at least two
occasions.Single blind study with parallel randomized groups undertaken in three sites in Australia. The primary outcome measure was repetition of
self-harm, assessed on average after 6 and 12 months. Secondary outcome measures included suicidal ideation, psychiatric disorder, and service
use.Seventy-two adolescents aged 12 to 16 years (91% female subjects) were randomized to group therapy or routine care. Primary outcome data were
available for 68 of the 72 randomized participants. More adolescents randomized to group therapy than those randomized to routine care had self-
harmed by 6 months (30/34 versus 23/34, chi = 4.19, p =.04), and there was a statistically nonsignificant trend for this pattern to be repeated in
the interval of 6 to 12 months (30/34 versus 24/34, chi = 3.24, p =.07). There were few differences between the treatment groups on secondary outcome
measures, other than a trend for greater improvement over time on global symptom ratings among the experimental group compared with the control
group.Our findings contradict those of the original study. Some differences in participant characteristics between the studies, along with less
experience at the Australian sites in delivering the intervention, may have accounted for the different outcome. The benefit of group therapy for
deliberate self-harm is unproven outside the environment in which it was originally developed.
Journal of the American Academy of Child & Adolescent Psychiatry, 48(6) : 662-
670
- Year: 2009
- 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
King, C. A., Klaus, N., Kramer, A., Venkataraman, S., Quinlan, P., Gillespie, B.
The purpose of this study was to examine the efficacy of the
Youth-Nominated Support Team-Version II (YST-II) for suicidal adolescents, an intervention based on social support and health behavior models, which
was designed to supplement standard treatments. Psychiatrically hospitalized and suicidal adolescents, 13-17 years of age, were randomly assigned to
treatment-as-usual (TAU) + YST-II (n = 223) or TAU only (n = 225). YST-II provided tailored psychoeducation to youth-nominated adults in addition to
weekly check-ins for 3 months following hospitalization. In turn, these adults had regular supportive contact with adolescents. Adolescents assigned
to TAU + YST-II had an average of 3.43 (SD = 0.83) nominated adults. Measures included the Suicidal Ideation Questionnaire-Junior (SIQ-JR; W. M.
Reynolds, 1988), Children's Depression Rating Scale-Revised (E. O. Poznanski & H. B. Mokros, 1996), Beck Hopelessness Scale (A. T. Beck & R. A.
Steer, 1993), and Child and Adolescent Functional Assessment Scale (CAFAS; K. Hodges, 1996). YST-II had very limited positive effects, which were
moderated by history of multiple suicide attempts, and no negative effects. It resulted in more rapid decreases in suicidal ideation (SIQ-JR) for
multiple suicide attempters during the initial 6 weeks after hospitalization (small-to-moderate effect size). For nonmultiple attempters, it was
associated with greater declines in functional impairment (CAFAS) at 3 and 12 months (small effect sizes). YST-II had no effects on suicide attempts
and no enduring effects on SIQ-JR scores. (copyright) 2009 American Psychological Association.
Journal of Consulting & Clinical Psychology, 77(5) : 880-893
- Year: 2009
- 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
Vitiello, Benedetto, Brent, David A., Greenhill, Laurence
L., Emslie, Graham, Wells, Karen, Walkup, John T., Stanley, Barbara, et-al
Objective: Method: Results: Conclusions: To examine the course
of depression during the treatment of adolescents with depression who had recently attempted suicide.Adolescents (N = 124), ages 12 to 18 years, with
a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression
Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused
on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study
participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission
rates were computed with the last observation carried forward.Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths
(n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week
24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28)
rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p <
.0001) and declined in parallel.When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have
recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents
with depression.\rCopyright © 2009 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child & Adolescent
Psychiatry, 48(10) : 997-1004
- Year: 2009
- 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), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Tang, Tze-Chun, Jou, Shaw-Hwa, Ko, Chih-Hung, Huang, Shih-Yin, Yen, Cheng-Fang,
Aim: The aim
of the present study was to examine the intervention effects of intensive interpersonal psychotherapy for depressed adolescents with suicidal risk
(IPT-A-IN) by comparison with treatment as usual (TAU) at schools. Methods: A total of 347 students from one-fifth of the classes of a high school in
southern Taiwan completed the Beck Depression Inventory-II, the Beck Scale for Suicide Ideation, the Beck Anxiety Inventory and the Beck Hopelessness
Scale for screening for suicidal risk. Of them, 73 depressed students who had suicidal risk on screening were randomly assigned to the IPT-A-IN or
TAU group. Analysis of covariance (ANCOVA) was performed to examine the effect of IPT-A-IN on reducing the severity of depression, suicidal ideation,
anxiety and hopelessness. Results: Using the pre-intervention scores as covariates, the IPT-A-IN group had lower post-intervention severity of
depression, suicidal ideation, anxiety and hopelessness than the TAU group. Conclusion: Intensive school-based IPT-A-IN is effective in reducing the
severity of depression, suicidal ideation, anxiety and hopelessness in depressed adolescents with suicidal risk. (PsycINFO Database Record (c) 2010
APA, all rights reserved) (journal abstract)
Psychiatry & Clinical Neurosciences, 63(4) : 463-
470
- Year: 2009
- 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), Interpersonal therapy (IPT)
Slee, N., Garnefski, N., Van Der Leeden, R., Arensman, E., Spinhoven,
P.
Background:
Self-harm by young people is occurring with increasing frequency. Conventional in-patient and out-patient treatment has yet to be proved efficacious.
Aims: To investigate the efficacy of a short cognitive-behavioural therapy intervention with 90 adolescents and adults who had recently engaged in
self-harm. Method: Participants (aged 15-35 years) were randomly assigned to treatment as usual plus the intervention, or treatment as usual only.
Assessments were completed at baseline and at 3 months, 6 months and 9 months follow-up. Results: Patients who received cognitive-behavioural therapy
in addition to treatment as usual were found to have significantly greater reductions in self-harm, suicidal cognitions and symptoms of depression
and anxiety, and significantly greater improvements in self-esteem and problem-solving ability, compared with the control group. Conclusions: These
findings extend the evidence that a time-limited cognitive-behavioural intervention is effective for patients with recurrent and chronic self-
harm.
British Journal of
Psychiatry, 192(3) : 202-211
- Year: 2008
- 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), Cognitive & behavioural therapies (CBT)
Wilcox, H. C., Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S., Wang, W., Anthony, J. C.
Objective: This paper reports the impact of two first- and second-grade classroom based universal preventive
interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at
socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic
achievement. Both were implemented by the teacher. Methods: The design was epidemiologically based, with randomization at the school and classroom
levels and balancing of children across classrooms. The trial involved a cohort of first-grade children in 19 schools and 41 classrooms with
intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with
little mentoring or monitoring. Results: In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation
by age 19-21 years compared to youths in standard setting (control) classrooms regardless of any type of covariate adjustment. A GBG-associated
reduced risk for suicide attempt was found, though in some covariate-adjusted models the effect was not statistically robust. No statistically
significant impact on these outcomes was found for ML. The impact of the GBG on suicide ideation and attempts was greatly reduced in the replication
trial involving the second cohort. Conclusions: A universal preventive intervention directed at socializing children and classroom behavior
management to reduce aggressive, disruptive behavior may delay or prevent onset of suicide ideation and attempts. The GBG must be implemented with
precision and continuing support of teachers. copyright 2008 Elsevier Ireland Ltd. All rights reserved.
Drug & Alcohol Dependence., 95(SUPPL. 1) : S60-
S73
- Year: 2008
- 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
Eskin, M., Ertekin, K., Demir, H.
Short-term and structured
cognitive behavioral problem-solving therapy (PST) is a developmentally relevant mode of action for the treatment of emotional problems in young
people. This study aimed at testing the efficacy of a problem-solving therapy in treating depression and suicide potential in adolescents and young
adults. A total of 46 self-referred high school and university students who were randomly assigned to a problem-solving therapy (n = 27) and a
waiting list control (n = 19) conditions completed a controlled cognitive behavioral problem-solving treatment trial. Participants were administered
the measures of depression, suicide potential, problem solving, self-esteem and assertiveness. Twenty-two of the 27 participants from the PST
condition could be reached after 12-months for follow-up. Participants completed depression and problem-solving measures at follow-up. Results showed
that post-treatment depression and suicide risk scores of participants within the PST condition decreased significantly compared to the pre-treatment
scores but post-waiting and pre-waiting depression and suicide risk scores of participants within the WLC condition were unchanged. Likewise, post-
treatment self-esteem and assertiveness scores of participants within the PST condition increased significantly compared to the pre-treatment scores
while post-waiting and pre-waiting self-esteem and assertiveness scores of participants within the WLC condition were unchanged. At post-treatment,
77.8% of the participants in the PST but only 15.8% of those in the WLC condition achieved full or partial recovery according to BDI scores.
Similarly, 96.3% of participants in the PST but only 21.1% of those in the WLC condition achieved full or partial recovery according to HDRS scores.
The improvements were maintained at 12-months follow-up. Therefore, it is concluded that problem-solving therapy should be considered as a viable
option for the treatment of depression and suicide potential in adolescents and young adults. copyright 2007 Springer Science+Business Media,
LLC.
Cognitive Therapy & Research., 32(2) : 227-245
- Year: 2008
- 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), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Problem solving therapy (PST)
Chanen, AM, McCutcheon, LK, Jovev, M, Jackson,
HJ, McGorry, PD
No accepted intervention exists for borderline personality\rdisorder presenting
in adolescence.\rAims\rTo compare the effectiveness of up to 24 sessions of\rcognitive analytic therapy (CAT) or manualised good clinical\rcare (GCC)
in addition to a comprehensive service model of\rcare.\rMethod\rIn a randomised controlled trial, CAT and GCC were\rcompared in out-patients aged 15
- 18 years who fulfilled two\rto nine of the DSM - IV criteria for borderline personality\rdisorder. We predicted that, compared with the GCC group,
\rthe CAT group would show greater reductions in\rpsychopathology and parasuicidal behaviour and greater\rimprovement in global functioning over 24
months. Results\rEighty-six patients were randomised and 78 (CAT n=41;\rGCC n=37) provided follow-up data. There was no significant\rdifference
between the outcomes of the treatment groups\rat 24 months on the pre-chosen measures but there was\rsome evidence that patients allocated to CAT
improved\rmore rapidly. No adverse effect was shown with either\rtreatment.\rConclusions\rBoth CAT and GCC are effective in reducing externalising
\rpsychopathology in teenagers with sub-syndromal or fullsyndrome\rbipolar personality disorder. Larger studies are\rrequired to determine the
specific value of CAT in this\rpopulation.
British Journal of Psychiatry, 193 : 477-
484
- Year: 2008
- Problem: 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), Cognitive analytic therapy (CAT)