Disorders - Suicide or self-harm behaviours
Aseltine-Jr, R. H., James, A., Schilling, E. A., Glanovsky, J.
Background. Suicide is a
leading cause of death for children and youth in the United States. Although school based programs have been the principal vehicle for youth suicide
prevention efforts for over two decades, few have been systematically evaluated. This study examined the effectiveness of the Signs of Suicide (SOS)
prevention program in reducing suicidal behavior. Methods. 4133 students in 9 high schools in Columbus, Georgia, western Massachusetts, and Hartford,
Connecticut were randomly assigned to intervention and control groups during the 2001-02 and 2002-03 school years. Self-administered questionnaires
were completed by students in both groups approximately 3 months after program implementation. Results. Significantly lower rates of suicide attempts
and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. Students'
race/ethnicity, grade, and gender did not alter the impact of the intervention on any of the outcomes assessed in this analysis. Conclusion. This
study has confirmed preliminary analysis of Year 1 data with a larger and more racially and socio-economically diverse sample. SOS continues to be
the only universal school-based suicide prevention program to demonstrate significant effects of self-reported suicide attempts in a study utilizing
a randomized experimental design. Moreover, the beneficial effects of SOS were observed among high school-aged youth from diverse racial/ethnic
backgrounds, highlighting the program's utility as a universal prevention program. Trial registration. clinicaltrials.gov NCT000387855. copyright
2007 Aseltine et al; licensee BioMed Central Ltd.
BMC Public
Health, 7 :
- Year: 2007
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
March, John S., Silva, Susan, Petrycki, Stephen, Curry, John, Wells, Karen, Fairbank, John, Burns, Barbara, Domino,
Marisa, McNulty, Steven, Vitiello, Benedetto, Severe, Joanne
CONTEXT: The Treatment
for Adolescents With Depression Study evaluates the effectiveness of fluoxetine hydrochloride therapy, cognitive behavior therapy (CBT), and their
combination in adolescents with major depressive disorder. OBJECTIVE: To report effectiveness outcomes across 36 weeks of randomized treatment.
DESIGN AND SETTING: Randomized, controlled trial conducted in 13 academic and community sites in the United States. Cognitive behavior and
combination therapies were not masked, whereas administration of placebo and fluoxetine was double-blind through 12 weeks, after which treatments
were unblinded. Patients assigned to placebo were treated openly after week 12, and the placebo group is not included in these analyses by design.
PARTICIPANTS: Three hundred twenty-seven patients aged 12 to 17 years with a primary DSM-IV diagnosis of major depressive disorder. INTERVENTIONS:
All treatments were administered per protocol. MAIN OUTCOME MEASURES: The primary dependent measures rated blind to treatment status by an
independent evaluator were the Children's Depression Rating Scale-Revised total score and the response rate, defined as a Clinical Global
Impressions-Improvement score of much or very much improved. RESULTS: Intention-to-treat analyses on the Children's Depression Rating Scale-Revised
identified a significant time x treatment interaction (P < .001). Rates of response were 73% for combination therapy, 62% for fluoxetine therapy, and
48% for CBT at week 12; 85% for combination therapy, 69% for fluoxetine therapy, and 65% for CBT at week 18; and 86% for combination therapy, 81% for
fluoxetine therapy, and 81% for CBT at week 36. Suicidal ideation decreased with treatment, but less so with fluoxetine therapy than with combination
therapy or CBT. Suicidal events were more common in patients receiving fluoxetine therapy (14.7%) than combination therapy (8.4%) or CBT (6.3%).
CONCLUSIONS: In adolescents with moderate to severe depression, treatment with fluoxetine alone or in combination with CBT accelerates the response.
Adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either
monotherapy as a treatment for major depression in adolescents.
Archives of
General Psychiatry, 64(10) : 1132-43
- Year: 2007
- 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: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Steele, Margaret M., Doey, Tamison
OBJECTIVE: To systematically review the
treatment of suicidal behaviour in children and adolescents. METHOD: After discussing the principles of treatment, we review the literature regarding
adequate assessment, hospital-based services and their alternatives, and follow-up. RESULTS: Treatment modalities (including psychotherapy) and
preventive strategies (including school-based interventions, gatekeeper and primary practitioner training, and treatment of psychiatric disorders)
are considered in the light of existing evidence. CONCLUSIONS: The assessment of youth at risk for suicide should include attention to well-
established risk factors, but prediction of risk remains difficult. Treatment of suicidal children and adolescents should be evidence-based and may
include psychotherapy and psychopharmacology. Effective methods of prevention are emerging, but more research is needed. [References: 143]
Canadian Journal of Psychiatry, 52(6 Suppl 1) : 35S-
45S
- Year: 2007
- Problem: 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: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
King, C. A., Kramer,
A., Preuss, L., Kerr, D. C. R., Weisse, L., Venkataraman, S.
In this study, the authors investigated the
efficacy of the Youth-Nominated Support Team - Version 1 (YST-1), a psychoeducational social network intervention, with 289 suicidal, psychiatrically
hospitalized adolescents (197 girls, 92 boys). Adolescents were randomly assigned to treatment-as-usual plus YST-1 or treatment-as-usual only.
Assessments were completed pre- and postintervention (6 months). There were no main effects for YST-1 on suicide ideation or attempts, internalizing
symptoms, or related functional impairment. Relative to other girls, however, those who received YST-1 reported greater decreases in self-reported
suicidal ideation (actually treated analytic strategy) and significantly greater decreases in mood-related functional impairment reported by their
parents (intent to treat and actually treated analytic strategies). This is the first randomized controlled clinical trial to investigate the
efficacy of a social network intervention with suicidal youths. Copyright 2006 by the American Psychological Association.
Journal of Consulting
& Clinical Psychology., 74(1) : 199-206
- Year: 2006
- 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
Kaminer, Y., Burleson, J. A., Goldston, D. B., Burke, R. H.
The objectives of this study are to assess the magnitude and course of suicidal ideation during outpatient treatment and aftercare for
adolescents with alcohol use disorders (AUD). One hundred seventy-seven adolescents meeting eligibility criteria, including no past 30-day suicidal
behavior, participated in 9 weeks of outpatient cognitive-behavioral group therapy. Treatment completers were randomized into: (1) No-Active, (2)
In-Person, or (3) Telephone aftercare conditions for a period of 12 weeks. No specific intervention for suicidal behavior was provided during the
study. The Suicide Ideation Questionnaire (SIQ-JR, Reynolds, 1988) was administered at baseline, end of treatment, and end of aftercare. The results
are as follows, a higher baseline suicidal ideation was associated with higher retention at the end of treatment and through aftercare. The In-Person
Aftercare condition showed a significant decrease in suicidal ideation, relative to the No-Active Aftercare condition. There was a trend for
similarly reduced severity of suicidal ideation in the Telephone Aftercare condition. In conclusion, the type of aftercare and resulting decrease in
AUD may play a role in the reduction in suicidal ideation. The mechanism of change by which suicidal ideation is reduced in adolescents in treatment
for AUD needs to be further explored. Copyright copyright American Academy of Addiction Psychiatry.
American Journal on Addictions., 15(SUPPL. 1) : 43-
49
- Year: 2006
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder, Alcohol
Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Fitzpatrick KK, Witte TK, Schmidt NB
Empirical evaluations suggest that
problem orientation, the\rinitial reaction to problems, differentiates suicidal youth\rfrom nonclinical controls and nonideating psychiatric
controis.\rOne promising area for intervention with suicidal\ryouth relates to enhancing this specific coping skill. Nonclinical\rparticipants (N =
110) with active suicidal ideation were\rrandomly assigned to receive a brief problem-orientation intervention\ror a control procedure. The current
study evaluated\rthe benefits of a brief prevention intervention based on\rthe Problem-Solving Therapy model. Exposure to a brief\rvideo intervention
regarding problem solving and coping\rskills was sufficient to elicit significant decreases in suicidal\rideation and depression, but the
intervention did not elicit\rimprovements in problem orientation or other problemsolving\rabilities. These findings provide preliminary support\rfor
a brief, video-based problem-solving and coping\rskills module. However, considerable work in developing\rsecondary prevention interventions
remains.
Behavior
Therapy, 36(4) : 323-33
- Year: 2005
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Problem solving therapy (PST)
Burns, J., Dudley, M., Hazell, P., Patton, G.
Objective: To examine the evidence for the effectiveness of clinical interventions designed to
reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults. Methods: Electronic databases were searched for papers
describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults
presenting to clinical services following DSH or suicidal ideation. Results: Three RCTs, four clinical control trials and three quasi-experimental
studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of
repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial
of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant
reduction in suicidal ideation. Conclusions: The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young
adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate
self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given
to process evaluation to determine which individual components of any given intervention are effective.
Australian & New Zealand Journal of Psychiatry., 39(3) : 121-
128
- Year: 2005
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Donaldson, D., Spirito, A., Esposito-Smythers, C.
Objective: To compare the efficacy of a skills-based treatment protocol to a supportive relationship therapy for adolescents after a
suicide attempt. Method: Thirty-nine adolescents (12-17 years old) and parents who presented to a general pediatric emergency department or inpatient
unit of a child psychiatric hospital after a suicide attempt were randomized to either a skills-based or a supportive relationship treatment
condition. Follow-up assessments were conducted at intake and 3 and 6 months post-attempt. Results: In contrast to the low rates of treatment
received by adolescent suicide attempters in the community, approximately 60% of this sample completed the entire treatment protocol. Significant
decreases in suicidal ideation and depressed mood at 3- and 6-month follow-ups were obtained, but there were no differences between treatment groups.
There were six reattempts in the follow-up period. Conclusions: When adolescents who attempt suicide are maintained in treatment, significant
improvements in functioning can be realized for the majority of patients.
Journal of the American Academy of
Child & Adolescent Psychiatry., 44(2) : 113-120
- Year: 2005
- 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), Skills training, Supportive
therapy
Wingate, L. R., Van Orden, K. A., Joiner-Jr, T. E., Williams, F. M., Rudd, M. D.,
The current study examined compensation and capitalization treatment models with specific reference to problem-solving appraisal and
problem-solving treatment of suicidal behavior (M. D. Rudd, T. Joiner, & M. H. Rajab, 2000). A sample of 98 young adults (mean age = 22), who had
recently attempted suicide or ideated about suicide to the degree that they came to clinical attention, were randomly assigned to either problem-
solving or control treatment. Participants with poorer problem-solving appraisal at baseline responded better than did participants with greater
problem-solving appraisal to problem-solving treatment at 6-month follow-up, as would be predicted by the compensation model. Results suggest that
treatment of suicidality for individuals with problem-solving skill deficits may be most effective by targeting these deficits rather than
capitalizing on strengths. Copyright 2005 by the American Psychological Association.
Journal of Consulting & Clinical Psychology., 73(4) : 756-762
- Year: 2005
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Problem solving therapy (PST)
Aseltine, Robert H., Jr., DeMartino, Robert
OBJECTIVES: We examined the effectiveness of the Signs of Suicide (SOS) prevention
program in reducing suicidal behavior. METHODS: Twenty-one hundred students in 5 high schools in Columbus, Ga, and Hartford, Conn, were randomly
assigned to intervention and control groups. Self-administered questionnaires were completed by students in both groups approximately 3 months after
program implementation. RESULTS: Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and
suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial
effects of the program. CONCLUSIONS: SOS is the first school-based suicide prevention program to demonstrate significant reductions in self-reported
suicide attempts.
American Journal of Public Health, 94(3) : 446-51
- Year: 2004
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
March,
John, Silva, Susan, Petrycki, Stephen, Curry, John, Wells, Karen, Fairbank, John, Burns, Barbara, Domino, Marisa, McNulty, Steven, Vitiello, Benedetto, Severe, Joanne, TADSTeam
CONTEXT: Initial treatment of major depressive disorder in adolescents may include
cognitive-behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI). However, little is known about their relative or combined
effectiveness. OBJECTIVE: To evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder. DESIGN, SETTING, AND
PARTICIPANTS: Randomized controlled trial of a volunteer sample of 439 patients between the ages of 12 to 17 years with a primary Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder. The trial was conducted at 13 US academic and
community clinics between spring 2000 and summer 2003. INTERVENTIONS: Twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT
with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d). Placebo and fluoxetine alone were administered double-blind; CBT alone
and CBT with fluoxetine were administered unblinded. MAIN OUTCOME MEASURES: Children's Depression Rating Scale-Revised total score and, for
responder analysis, a (dichotomized) Clinical Global Impressions improvement score. RESULTS: Compared with placebo, the combination of fluoxetine
with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT
alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for
fluoxetine with CBT were 71.0% (95% confidence interval [CI], 62%-80%); fluoxetine alone, 60.6% (95% CI, 51%-70%); CBT alone, 43.2% (95% CI, 34%-
52%); and placebo, 34.8% (95% CI, 26%-44%). On the Clinical Global Impressions improvement responder analysis, the 2 fluoxetine-containing conditions
were statistically superior to CBT and to placebo. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline,
improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction (P =.02). Seven (1.6%) of 439 patients attempted
suicide; there were no completed suicides. CONCLUSION: The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and
risk for adolescents with major depressive disorder.
JAMA, 292(7) : 807-
20
- Year: 2004
- 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: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Huey, Stanley J., Jr., Henggeler, Scott W., Rowland, Melisa D., Halliday-Boykins, Colleen A., Cunningham, Phillippe B., Pickrel, Susan G., Edwards, James
OBJECTIVE: To
evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency
psychiatric hospitalization. METHOD: Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted
suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1-year
posttreatment follow-up. RESULTS: Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of
attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST. Also, treatment
differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age. Moreover, treatment
effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation. CONCLUSIONS: Results
generally support MST's effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization
varied based on informant and youth demographic characteristics.
Journal of the American Academy of Child & Adolescent
Psychiatry, 43(2) : 183-90
- Year: 2004
- 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), Multisystemic
therapy