Disorders - suicide or self-harm behaviours
Fox, K. R.
Self-injurious thoughts and behaviors (SITBs) are major public health concerns impacting a wide range of individuals and communities.
Despite major efforts to develop and refine treatments to reduce SITBs, the efficacy of SITB interventions remains unclear. To provide a
comprehensive summary of SITB treatment efficacy, we conducted a meta-analysis of published randomized controlled trials (RCTs) that have attempted
to reduce SITBs. A total of 591 published articles from 1,125 unique RCTs with 3,458 effect sizes from the past 50 years were included. The random-
effects meta-analysis yielded surprising findings: The overall intervention effects were small across all SITB outcomes; despite a near-exponential
increase in the number of RCTs across five decades, intervention efficacy has not improved; all SITB interventions produced similarly small effects,
and no intervention appeared significantly and consistently stronger than others; the overall small intervention effects were largely maintained at
follow-up assessments; efficacy was similar across age groups, though effects were slightly weaker for child/adolescent populations and few studies
focused on older adults; and major sample and study characteristics (e.g., control group type, treatment target, sample size, intervention length)
did not consistently moderate treatment efficacy. This meta-analysis suggests that fundamental changes are needed to facilitate progress in SITB
intervention efficacy. In particular, powerful interventions target the necessary causes of pathology, but little is known about SITB causes (vs.
SITB correlates and risk factors). The field would accordingly benefit from the prioritization of research that aims to identify and target common
necessary causes of SITBs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Psychological bulletin, 146(12) : 1117-1145
- Year: 2020
- Problem: Non-suicidal self-harm behaviours, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Chen, M.
Digital technologies are increasingly used in health-care delivery and are being
introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health
interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and
characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled
trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in
the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and
unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face
interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional
injury, violence, and suicide. Future research should explore DHIs' successful components to facilitate future implementation and wider access.
Trauma Violence &
Abuse, : 1524838020967346
- Year: 2020
- 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: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Wolitzky-Taylor, K., LeBeau, R.T., Perez, M., Gong-Guy, E., Fong, T.
OBJECTIVE: To
examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses.\rMETHODS: College suicide
prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal
behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-
efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed.
\rRESULTS: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that
typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide
prevention programs for at-risk students.\rCONCLUSION: Prevention programs are beneficial for training those likely to come in contact with people
endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal
students as well.
Journal of American College Health, : 1-11
- Year: 2019
- 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), Dialectical behavioural therapy
(DBT)
Siu, A. M. H.
This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide
among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-
harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially
depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional
factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies
identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of
suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online
prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality
mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are
effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make
better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide
and self-harm as well as promoting help seeking behavior among young people. Copyright © 2018 Society for Adolescent Health and Medicine
Journal of Adolescent Health, 64(6 Supplement) : S59-
S64
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions
Rengasamy, M., Sparks, G.
OBJECTIVE:
Brief telephone follow-up for a patient with suicidal tendencies after he or she has been discharged from an emergency room or hospital has been
shown to decrease subsequent suicide attempts. However, despite the high rate of suicidal behavior in adolescents, this intervention has not been
examined in this population. As part of a quality improvement intervention, postdischarge telephone contacts were used to attempt to reduce suicidal
behavior and inpatient rehospitalizations among adolescents.\rMETHODS: Adolescents who were hospitalized for suicidal ideation or attempt (N=142)
were randomly assigned to one of two telephone interventions delivered over a 90-day period: either a single call intervention (SCI) or a multiple
calls intervention (MCI). The intervention consisted of assessment of suicidality, review of safety plan, and discussion of medication and weapon
safety, with up to six telephone contacts in the MCI and up to one contact in the SCI. Primary outcome measures included suicidal behavior and
inpatient rehospitalizations; secondary outcome measures included adolescents' confidence in their safety plan.\rRESULTS: Adolescents receiving the
MCI had a significantly lower rate of suicidal behavior (6%) compared with adolescents receiving SCI (17%; odds ratio [OR]=0.28, p=0.037); results
persisted while the analysis controlled for relevant covariates (OR=0.25, p=0.032). Similarly, adolescents receiving the MCI reported significantly
greater confidence in their safety plan at 90 days (95%vs. 74%; p=0.001), which, in turn, was associated with a lower rate of suicidal behavior
(OR=0.95, p=0.019).\rCONCLUSIONS: A telephone-based intervention for providing recurrent follow-up soon after discharge is feasible in the adolescent
population and may be effective in reducing postdischarge suicidal behavior.
Psychiatric Services, 70(7) : 545-552
- Year: 2019
- 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
Brown, L. A., Belli, G., Suzuki, N., Capaldi, S., Foa, E. B.
OBJECTIVE: Adolescents with posttraumatic stress disorder
(PTSD) are at higher risk for suicide compared to adolescents without PTSD. This study aimed to explore whether PTSD treatment reduces suicidal
ideation in adolescents and whether the degree of reduction in PTSD was associated with reduction in suicidal ideation.\rMETHODS: Adolescent females
with PTSD from a sexual assault (55% Black, 15.3 years, SD = 1.5) were randomized to either prolonged exposure therapy for adolescents (PE-A, n= 31)
or client-centered therapy (CCT, n = 30). They reported on suicidal ideation, depression and PTSD at pre- and post-treatment, every therapy session,
and follow-up, and about 40% endorsed suicidal ideation at baseline.\rRESULTS: There was a significant reduction in a single-item measure of suicidal
ideation during treatment across all participants. The Time in Treatment x Condition interaction was significant (p < .05, d = 0.52), indicating a
significantly steeper reduction in suicidal ideation in PE-A compared to in CCT. The degree of reduction in PTSD (ps < .05, d = 0.26-0.54) and
depression symptoms (ps < .05, d = 0.54-0.81) in treatment and follow-up was associated with the speed of suicidal ideation reduction in treatment
and follow-up.\rCONCLUSIONS: Adolescents randomized to PE-A had significantly faster reductions in suicidal ideation compared to those randomized to
CCT. Greater reduction in PTSD and depression symptoms were associated with faster reduction in suicidal ideation. Clinically, this study
demonstrates that adolescents who have suicidal ideation without current intent may benefit from PE-A.
Journal of Clinical Child & Adolescent Psychology, : 1-
9
- Year: 2019
- Problem: 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), Exposure therapy, Exposure
and response prevention, Other Psychological Interventions
Diamond, G. S., Kobak, R. R., Krauthamer-Ewing, E. S., Levy, S. A., Herres, J. L., Russon, J. M., Gallop, R. J.
Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive
therapy (FE-NST) for decreasing adolescents' suicide ideation and depressive symptoms. Method(s): A randomized controlled trial of 129 adolescents
who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment.
Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and
depressive symptoms. Result(s): There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation
Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a
significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar
significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, >=50% decrease in suicide ideation symptoms
from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion(s): Contrary to expectations, ABFT did not perform better
than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than
those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements,
different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators
and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov;
NCT01537419. Copyright © 2018 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry, 58(7) : 721-
731
- Year: 2019
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Supportive
therapy
Sayal, K., Roe, J., Ball, H., Atha, C., Kaylor-Hughes, C., Guo, B., Townsend, E., Morriss, R.
Background: Self-harm and depression are strong risk factors for repeat self-harm and suicide. We aimed to investigate the
feasibility of a randomised controlled trial (RCT) of remotely delivered problem-solving cognitive behaviour therapy (PSCBT) plus treatment as usual
(TAU) versus TAU in young people with repeat self-harm and depression. Method(s): Single-blind multi-centre RCT with an internal pilot, pre-set
stop-go criteria and qualitative semi-structured interviews. Eligible participants (aged 16-30 years) were recruited from 9 adult or child and
adolescent self-harm and crisis services; had >= 2 lifetime self-harm episodes, one in the preceding 96 h; and Beck Depression Inventory-II (BDI-II)
score >= 17. Participants were randomised (1:1) to either TAU or TAU and 10-12 sessions of PSCBT delivered by mobile phone or video-calling. Result
(s): Twenty-two participants were recruited (11 in each arm), 10 (46%) completed follow-up at 6 months, 9 (82%) started the PSCBT and 4 (36%)
completed it. The study did not meet three of its four stop-go criteria, reflecting considerable barriers to recruitment and retention. Participants
had severe depression symptoms: with mean BDI-II 38.9 in the PSCBT and 37.2 in TAU groups, respectively. Three (14%) unblindings occurred for
immediate safety concerns. Barriers to recruitment and retention included lack of agency for participants, severity of depression, recency of crisis
with burden for participants and clinicians who diagnosed depression according to pervasiveness. Conclusion(s): RCTs of PSCBT for young people with
depression and self-harm are not feasible using recruitment through mental health services that conduct assessments following self-harm
presentations. Clinician assessment following self-harm presentation mainly identifies those with severe rather than mild-moderate depression.
Copyright © 2019 The Author(s).
BMC Psychiatry, 19 (1) (no pagination)(2005) :
- Year: 2019
- 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), Problem solving therapy (PST), Technology, interventions delivered using technology (e.g. online, SMS)
Dardas, L. A.
Purpose: The purpose of this study was to explore whether adolescent-perceived family functioning moderates the depression
treatment effects on suicidal ideations. Method(s): This is a nonpreregistered exploratory secondary analysis of the TADS RCT, which included four
treatment groups: fluoxetine, CBT, their combination, and placebo. A random coefficients regression model with posteriori CONTRAST statements was
conducted to examine the effects of depression treatment on adolescents' suicidal ideations over time (N = 439). Baron and Kenny's (1986) and
Kraemer et al.'s (2002) approach was followed to explore family functioning as a potential moderator of the treatment effects on suicidal ideations
over time. Result(s): Adolescents in the four treatment groups did not differ significantly in their suicidal ideations at initial status; however,
those in the combination group had faster reduction in suicidality. Family functioning moderated the relationship between depression treatment and
adolescents' suicidal ideations. In particular, the results revealed that for adolescents who reported positive family functioning (n = 249),
treatment had a significant impact on their suicidal ideations over time. However, for adolescents who reported negative family functioning (n =
190), type of treatment did not have a differential effect on improvement in severity of suicidal ideation over time. Conclusion(s): Findings
provided evidence that the process by which depression treatment impacts adolescents' suicidality is contingent upon their family environment.
Family-centered approaches to adolescent depression treatment are recommended. Copyright © 2019 Association for Child and Adolescent Mental
Health
Child and Adolescent Mental
Health., :
- Year: 2019
- 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: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Glenn, C. R., Esposito, E. C., Porter, A. C., Robinson, D. J.
The current review
provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was
conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published
prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were
new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first
Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in
youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2:
Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there
are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training
component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT.
Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on
replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop
brief efficacious interventions that may be scalable to reach large numbers of youth. (PsycINFO Database Record (c) 2019 APA, all rights
reserved)
Journal of Clinical Child and Adolescent Psychology, 48(3) : 357-
392
- Year: 2019
- Problem: Non-suicidal self-harm behaviours, 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: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
Griffiths, H., Duffy, F., Duffy, L., Brown, S., Hockaday, H., Eliasson, E., Graham, J., Smith, J., Thomson, A., Schwannauer, M.
Background: Mentalization Based Therapy (MBT) has yielded promising
outcomes for reducing self-harm, although to date only one study has reported MBT's effectiveness for adolescents (Rossouw and Fonagy, J Am Acad
Child Adolesc Psychiatry 51:1304-1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We
sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents. Method(s): The present study is a
randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent
population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm.
Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models
(MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for
harm as the primary outcome variables. Result(s): Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone.
Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm
and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences.
Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a
significant predictor of change over time in self reported self harm and hospital presentation for self-harm. Conclusion(s): It was feasible to carry
out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively
brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the
appropriate format, dosage and intensity of MBT for the adolescent population. Trial registration: NCT02771691; Trial Registration Date: 25/04/2016.
Copyright © 2019 The Author(s).
BMC Psychiatry, 19 (1) (no pagination)(167) :
- Year: 2019
- 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
Xavier, A., Otero, P., Blanco, V., Vazquez, F. L.
OBJECTIVE: The
aim of this study was to evaluate the efficacy of a problem-solving intervention for the prevention of suicidal risk in Brazilian adolescents with
elevated suicidal potential and depressive symptoms.\rMETHODS: A randomized controlled trial was conducted involving 100 participants (mean age 17.2
years, 60% women, 46% mixed race), allocated to the problem-solving intervention (n = 50) or the usual care control group (n = 50). Blinded
interviewers conducted assessments at pretreatment, posttreatment, 1, 3, and 6 months of follow-up. The main outcome was suicidal orientation;
secondary outcomes were suicidal risk, suicidal plans and attempts, depressive symptoms, and problem-solving skills.\rRESULTS: At posttreatment and
up to 6-month follow-up, there was lower suicidal orientation and suicidal risk in the problem-solving group compared to the control group. There
were lower suicidal plans and attempts (0.0% participants vs 2.2% with a suicide plan and 2.2% with both suicide plan and attempt); risk difference
was 0.04 (95% CI: 0.01-0.09) and the number needed to treat was 25 (95% CI: 11-70). Significant effects of the intervention on depressive symptoms
were found at posttreatment and maintained for 6 months. The change in global and functional problem-solving skills mediated the reduction in suicide
orientation.\rCONCLUSIONS: Thus, suicidal risk can be successfully prevented in adolescents.
Suicide & Life Threatening Behavior, : 25
- Year: 2019
- 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)