Disorders - suicide or self-harm behaviours
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
Wharff, E. A., Ginnis, K. B., Ross, A. M., White, E. M., White, M. T., Forbes, P. W.
OBJECTIVE: In current practice, treatment as usual (TAU) for suicidal
adolescents includes evaluation, with little or no intervention provided in the emergency department (ED), and disposition, usually to an inpatient
psychiatry unit. The family-based crisis intervention (FBCI) is an emergency psychiatry intervention designed to sufficiently stabilize suicidal
adolescents within a single ED visit so that they may return home safely with their families. The objective of this article is to report efficacy
outcomes related to FBCI for suicidal adolescents and their families.\rMETHODS: A total of 142 suicidal adolescents (age, 13-18 years) and their
families presenting for psychiatric evaluation to a large pediatric ED were randomized to receive FBCI or TAU. Patients and caregivers completed
self-report measures of suicidality, family empowerment, and satisfaction with care provided at pretest, posttest, and 3 follow-up time points over a
1-month period.\rRESULTS: Patients randomized to FBCI were significantly more likely to be discharged home with outpatient follow-up care compared
with their TAU counterparts (P < 0.001). Families randomized to the FBCI condition reported significantly higher levels of family empowerment and
client satisfaction with care at posttest compared with their TAU counterparts. Gains were maintained over the follow-up period. No completed
suicides were reported during the study period in either condition.\rCONCLUSIONS: Family-based crisis intervention is a model of care for suicidal
adolescents that may be a viable alternative to traditional ED care that involves inpatient psychiatric hospitalization.
Pediatric Emergency Care, 35(3) : 170-175
- 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), Other Psychological Interventions
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)
Lu, R., Zhou, Y., Wu, Q., Peng, X., Dong, J., Zhu, Z., Xu, W.
Background: The population of left-behind children is growing rapidly in China in recent
years. Without parents' company, left-behind children may develop severe emotional problems, which can trigger extreme behaviours such as self-harm
and suicide. Previous literature suggests that mindfulness-based intervention could effectively alleviate a variety of sufferings such as anxiety and
suicide ideation. The current study sought to examine the effectiveness of mindfulness-based intervention on suicide ideation among left-behind
children in China. Methods: This study investigated the effects of an 8-week mindfulness training programme on suicide ideation of left-behind
children in China. Forty-nine left-behind children completed a pretest and posttest on mindfulness level, social anxiety, self-esteem, and suicide
ideation, with 21 in the mindfulness training group and 28 in the waitlist control group. Results: Adjusting for pretest differences analyses of
covariance found that, compared with waitlist control group, the mindfulness training group showed a significant improvement in mindfulness level and
decreases in social anxiety and suicide ideation after the 8-week mindfulness training. Conclusion: The findings from this study support that the use
of mindfulness-based intervention can effectively reduce the suicide ideation and social anxiety of left-behind children in China. (PsycINFO Database
Record (c) 2019 APA, all rights reserved)
Child: Care, Health and
Development, 45(3) : 371-379
- Year: 2019
- Problem: Social phobia (social anxiety disorder), Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Mindfulness based
therapy
Pistone, I., Beckman, U., Eriksson,
E., Lagerlof, H., Sager, M.
BACKGROUND: Suicide is a major public health problem. Educational interventions for preventing suicidal behaviour
are widely used, although little is known regarding the collective effectiveness of these interventions. AIM: We evaluated the existing evidence for
the effectiveness of education interventions in the prevention of suicidal behaviour. METHOD(S): In this systematic review and meta-analysis, we
searched multiple databases using terms related to suicide prevention. The articles were reviewed by two independent reviewers, and the quality of
evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data from individual studies were
combined in meta-analyses. RESULT(S): We identified 41 studies evaluating two different types of interventions: school-based education interventions
and gatekeeper training. Education interventions showed significant gains in terms of knowledge and attitudes, though the effects seem to vary
depending on subjects' personal characteristics. School-based education interventions significantly reduced suicidal ideation and suicide attempts
in youths. Gatekeeper training showed no significant effect on suicide attempts or gatekeeper skills, though the quality of evidence for the
estimate, according to GRADE criteria, was rated as very low. CONCLUSION(S): The results of this study indicate that school-based education
interventions are effective in preventing suicidal ideation and suicide attempts. In clinical practice, as well as in research, the development and
implementation of educational interventions should focus on participants' individual characteristics.
The International journal of social
psychiatry, : 20764019852655
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Other service delivery and improvement
interventions
Witt, K., Boland, A., Lamblin, M., McGorry, P. D., Veness, B., Cipriani, A., Hawton, K., Harvey,
S., Christensen, H., Robinson, J.
QUESTION: A growing body of work suggests that medical
students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to
prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and
provided guidance to improve future intervention efforts.\rSTUDY SELECTION AND ANALYSIS: The authors conducted a systematic review to identify
studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and
PsycINFO databases were searched from their respective start dates until 1 December 2017.\rFINDINGS: Data from 39 studies were included. Most
investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided
meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness
of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was
limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress.
\rCONCLUSIONS: Relatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and
stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a
significant lack of attention on organisational-level stressors associated with medical education and training.
Evidence-Based
Mental Health, 22(2) : 84-90
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)