Disorders - Suicide or self-harm with comorbid mental disorder
Zhao, Y., He, Z., Luo, W., Yu, Y., Chen, J., Cai, X., Gao,
J., Li, L., Gao, Q., Chen, H., Lu, F.
BACKGROUND: Suicidal
ideation is a serious symptom of major depressive disorder (MDD). Intermittent theta burst stimulation (iTBS) is a safe, effective brain stimulation
treatment for alleviating suicidal ideation in adults with MDD. This study aimed to examine the clinical efficacy of iTBS on reducing suicidal
ideation in adolescent MDD with suicide attempt.\rMETHODS: In a randomized, sham-controlled protocol, a total of 10 sessions of iTBS was
administrated to the left dorsolateral prefrontal cortex (DLPFC) in patients once a day for two weeks. The suicidal ideation and depressive symptoms
were assessed using Beck Scale for Suicide Ideation-Chinese Version (BSI-CV), Hamilton Rating Scale for Depression (HAMD-24), and Self-rating
Depression Scale (SDS) at baseline and after 10 treatment sessions.\rRESULTS: Forty-five patients were randomized assigned to either active iTBS (n =
23) or sham group (n = 22). The suicidal ideation and depressive symptoms of the active iTBS group were significantly ameliorated over 2 weeks of
treatment. Further, higher baseline SDS, HAMD-24 and BSI-CV scores in the active iTBS group were associated with greater reductions.\rLIMITATIONS: A
larger sample size and double-blinded clinical trial should be conducted to verify the reliability and reproducibility.\rCONCLUSIONS: The current
study suggested that daily iTBS of the left DLPFC for 2 weeks could effectively and safely alleviate suicidal ideation and mitigate depression in
adolescent MDD, especially for individuals with relatively more severe symptoms. Although caution is warranted, the findings could provide further
evidence for the effectiveness and safety of iTBS in clinical practice.
, 325 : 618-
626
- Year: 2023
- 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: Biological Interventions
(any), Other biological interventions
Pan, F., Mou, T., Shao, J., Chen, H., Tao, S., Wang, L., Jiang, C., Zhao, M., Wang, Z., Hu, S., Xu, Y., Huang, M.
Background: Neuronavigation-guided high-dose repetitive
transcranial magnetic stimulation (rTMS) could\rrapidly treat depressive patients with suicidal ideation. But the mechanism of rTMS still needs to be
elucidated.\rThis study aims to investigate if rTMS improves suicidal ideation and depressive symptoms by influencing brainderived neurotrophic
factor (BDNF), tropomysin receptor kinase B (TrkB) and VGF levels.\rMethods: In the present 1-week study, 59 treatment-naive depressive patients with
suicidal ideation were\rrandomly assigned to the active (n = 31) or sham (n = 28) rTMS group. The severity of suicidal ideation and\rdepression were
measured by the Beck Scale for Suicide Ideation, the Hamilton Depression Rating Scale and\rMontgomery - Asberg Depression Rating Scale. Fasting
venous blood samples were collected at baseline and after\rtreatment. Serum protein concentrations of BDNF, TrkB and VGF were measured by enzyme
linked immunosorbent assay.\rResults: We found after treatment the levels of BDNF in the active rTMS group were higher than the sham group\r(p =
0.011), TrkB levels were decreased in the active group (p < 0.001), VGF levels were increased in the active\rgroup (p = 0.005). Post-treatment VGF
levels in the active group were higher than the sham group (p = 0.008).\rHowever, there were no significant correlation between changes in BDNF, TrkB
and VGF levels and the changes\rin clinical variables.\rLimitations: Participants taking medication may affect the results.\rConclusions: Our results
suggest that the BDNF-TrkB pathway and VGF may be implicated in the mechanisms\runderlying neuronavigation-guided rTMS for treating depressive
patients with suicidal ideation.
, 323 : 617-623
- Year: 2023
- 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), Antidepressants
(any), Transcranial magnetic stimulation
(TMS)
Zhang, Y., Huang, K., Cong, H., Wang, M.
Background: The
depression of college students requires psychological intervention based on clinical drug treatment. Group psychological counseling is an effective
psychological intervention. This study aims to explore the effect of group psychological counseling on negative emotions and Nonsuicidal Self-injury
(NSSI) behaviors of college students with depression. Subjects and methods: A total of 84 students with depression by screening diagnosis at Qingdao
University in March 2018 were divided into the control group (n=42) and the intervention group (n=42). Students in the control group only received
drug therapy, whereas the intervention group underwent group psychological counseling intervention based on drug therapy. A comparison between
depression, self-injury behaviors, and sense of life purpose of the two groups before and after the intervention was performed. Result(s): The post-
test Self-Rating Depression Scale (SDS) standard score of students in both groups was significantly lower than the pre-test SDS standard score
(P<0.05). The SDS standard scores of the post-test and the trace test in the intervention group were significantly lower than those in the control
group (P<0.05). Compared with the pre-test value, the total scores in the Meaning in Life Questionnaire (MLQ) of the post-test in both groups
significantly increased. The intervention group received significantly higher scores in the MLQ of the post-test and trace test compared with the
control group (P<0.05). Both groups also received significantly higher scores in the post-test in the Quality System Audit (QSA) compared with the
pre-test (P<0.05). The intervention group also received higher scores on the post-test and trace test in some dimensions in the QSA compared with
those of the control group (P<0.05). Conclusion(s): Group psychological counseling intervention for college students with depression can alleviate
their depressive symptoms, improve their sense of life meaning, reduce the risk of suicide, and control their NSSI behaviors. Copyright © 2022
Medicinska Naklada Zagreb. All rights reserved.
Psychiatria Danubina, 34
(2) : 229-235
- Year: 2022
- Problem: Depressive Disorders, Non-suicidal self-harm behaviours, 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), Antidepressants
(any), Psychological Interventions
(any), Other Psychological Interventions
Scott, K., Becker, S. J., Helseth, S. A., Saldanha, I. J., Balk, E. M., Adam, G. P., Konnyu, K. J., Steele, D. W.
BACKGROUND: Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents
who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the pharmacological treatment of mental
health disorders among adolescents, however, little is known about the impact of these treatments on SU outcomes. OBJECTIVE(S): This systematic
review summarizes the evidence regarding commonly used pharmacotherapy interventions for mental health and their impact on adolescent SU. METHOD(S):
Literature searches were conducted across five databases as part of a larger systematic review of adolescent SU interventions. Studies were screened
for eligibility by two researchers, and study data were extracted regarding study design, patient and treatment characteristics and results. Risk of
bias analyses and qualitative syntheses were completed to evaluate the strength of the evidence and the impact of pharmacotherapy on SU outcomes.
RESULT(S): Ten randomized controlled trials exploring seven pharmacotherapies met criteria for inclusion. All studies had low to moderate risk of
bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, three evaluated attention deficit hyperactivity disorder and SU, and
three evaluated bipolar disorder and SU. Five of the 10 studies also included a behavioural intervention. We found no evidence that pharmacotherapy
for co-occurring mental health diagnoses impacted SU. CONCLUSION(S): Family medicine clinicians prescribing pharmacotherapy for mental health should
be aware that additional interventions will likely be needed to address co-occurring SU. Copyright © The Author(s) 2021. Published by Oxford
University Press. All rights reserved.For permissions, please e-mail: [email protected].
Family Practice, 39(2) : 301-310
- Year: 2022
- Problem: Bipolar Disorders, Depressive Disorders, Suicide or self-harm with comorbid mental disorder, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium), Lithium, Medications used to treat substance abuse
Weinstein, S., Gruhn, M., West, A.
Aims: Suicide risk in pediatric bipolar disorder (BD) is a significant public health problem. To guide the development of targeted
suicide interventions for this at-risk population, this study examined (1) psychosocial correlates of suicidal ideation (SI) in youth with BD that
may dictate targets for intervention; (2) SI response to manualized psychotherapy for pediatric BD (Child-and Family-Focused Cognitive Behavioral
Therapy, CFF-CBT) versus treatment-as- usual (TAU); and (3) psychosocial factors corresponding to SI treatment response. Method(s): Participants
included 72 youth aged 7-13 (M = 9.19, SD = 1.61) with DSM-IV- TR bipolar I, II, or NOS and a parent/caregiver participating in a randomized trial
examining CFF-CBT versus TAU. Both treatments consisted of 11 weekly and 6 monthly sessions. Current SI and psychosocial correlates were assessed at
baseline, post-treatment, and 6-month follow-up. Result(s): Current ideation was prevalent: 41% endorsed any ideation, and 31% endorsed planful
ideation. Higher family rigidity and lower self-esteem were significant predictors of planful ideation at baseline (OR = 1.19, 0.89, respectively; p
< 0.05). Models examined changes in SI likelihood and intensity across treatment. All youth improved in SI across treatment (p < 0.05), but group
differences (CFF-CBT v. TAU) were not significant. Mediation analyses explored mechanisms of SI improvement across conditions; improvement in family
rigidity, self-esteem, and family functioning corresponded to reduction in SI across treatment (p < 0.05). Conclusion(s): Early intervention for
youth with BD may reduce SI even in a nonspecialized treatment. Results also highlight child self-esteem and family rigidity as key treatment targets
to reduce suicide risk in pediatric BD.
Bipolar Disorders, 23(SUPPL
1) : 47
- Year: 2021
- Problem: Bipolar 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), Cognitive & behavioural therapies (CBT)
Waraan, L.
Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression,
including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-
child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed
adolescents. Sixty adolescents (86.7% girls), aged 13 to 18years (M=14.9), with major depressive disorder referred to two CAMHS were randomized to
receive 16weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the
Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16weeks. Linear mixed models were fitted to test our hypothesis, time was the only
factor to have a significant effect on suicidal ideation t(31.05)=-3.32, p<.01. Participants in both treatment groups reported significantly reduced
suicidal ideation, but the majority were still in the clinical range after 16weeks of treatment. ABFT was not associated with more favorable outcomes
than TAU. Findings must be interpreted with caution given the study limitations.
Clinical child psychology and
psychiatry, 26(2) : 464-474
- Year: 2021
- 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)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Ramsey, W. A.
Background: The Benefits and
Barriers Model proposes both benefits and barriers associated with nonsuicidal self-injury (NSSI) and that a negative association with the self plays
a key role in the initial selection of and acute motivation for NSSI. The current investigation builds upon previous findings by assessing the added
benefit of targeting self-criticism in the treatment of NSSI. Method(s): Sample included 40 participants (30 females; Mage = 14.92)
enrolled in dialectical behavior therapy for adolescents within a partial hospitalization program. All study participants received dialectical
behavior therapy for adolescents, and those randomized to the experimental condition received an additional brief cognitive intervention developed to
decrease self-criticism. Result(s): There was no evidence of an indirect effect of targeting self-criticism upon NSSI at post-treatment via post-
treatment self-criticism (b = -0.98, p =.543); however, there was evidence of a significant interaction between treatment condition and self-
criticism at pretreatment in the prediction of NSSI at post-treatment (b = 0.33, p =.030). Analyses of simple slopes indicated the conditional direct
effect of targeting self-criticism varied as a function of patient's level of self-criticism at the onset of treatment, such that individuals -1 SD
below the mean (b = -5.76, p =.037) and at average pretreatment levels of self-criticism (b = -4.09, p =.042), but not + 1 SD above the mean (b = -
2.42, p =.056), experienced fewer incidents of NSSI at post-treatment. Conclusion(s): The results of this investigation support the added benefit of
targeting self-criticism in the treatment of NSSI for adolescents. Copyright © 2021 Association for Child and Adolescent Mental Health
Child and Adolescent Mental
Health., :
- Year: 2021
- Problem: Non-suicidal self-harm behaviours, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Dialectical behavioural therapy
(DBT), Other Psychological Interventions
Hurzeler,
T., Giannopoulos, V., Uribe, G., Louie, E., Haber, P., Morley, K. C.
Objective: We aimed to provide a synthesis and evaluation of psychosocial interventions to prevent suicide and reduce self-harm, as well
as alcohol intake, for patients with alcohol problems. Method(s): The systematic review was carried out according to the PRISMA guidelines and
considered articles published in English from all countries. Terms relating to suicidality and alcohol problems were used to search Medline, EMBASE
and PsycINFO databases. Randomized controlled trials of psychosocial interventions targeted for outpatient settings were included. Result(s): Six
studies with a total of 400 participants were included. Two investigated dialectic behavioural therapy (DBT), one internet-delivered DBT, one dynamic
deconstructivist psychotherapy (DDP) and two integrated cognitive behavioural therapy (CBT). Face to face and online DBT was significantly associated
with abstinence and reductions in consumption with only a trend for a reduction in suicide attempts in one study relative to treatment at usual
(TAU). DDP yielded significant reductions in alcohol consumption and suicide attempts versus community care. CBT was significantly effective relative
to TAU in reducing alcohol use and suicide attempts in one trial with adolescents but not in another trial in an adult population. Conclusion(s):
Integrated CBT has promise for adolescents, DBT may be helpful for alcohol patients with borderline personality disorder and iDBT may be useful for
the wider community with heavy alcohol use. However, given the paucity of studies and the exploratory nature of these trials, there is currently no
strong evidence for an effective psychosocial intervention to reduce alcohol consumption and suicidal behaviour in adults with problematic alcohol
use. Copyright © The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved.
Alcohol and Alcoholism, 56(1) : 17-
27
- Year: 2021
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder, Alcohol
Use
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Herres, J., James, K. M., Bounoua, N., Ewing,
E. S. K., Kobak, R., Diamond, G. S.
Although
treatments for youth at risk for suicide have been successful, they are not similarly effective for everyone. Anxiety may interfere with
adolescents' ability to engage with therapy and explain why some adolescents do not respond as well as others to treatment. The current study tested
whether an anxiety diagnosis predicted treatment outcome among a sample of adolescents with suicidal ideation and depressive symptoms participating
in either attachment-based family therapy or family-enhanced nondirective supportive therapy (N = 129; Mage = 14.87, SD = 1.68; 81.9%
female). The data set that the current study used had a high representation of Black/African American adolescents (48.8% of sample), which is
valuable, as few studies have included adequate representation of this population. A significant indirect effect (.88; 95% confidence interval [.01,
2.64]) showed that across both treatment conditions, participants who met criteria for an anxiety disorder had greater difficulties engaging in
goal-directed behavior midtreatment, and these difficulties, in turn, predicted more posttreatment suicidal ideation. The effect of anxiety on
treatment outcome via difficulties with goal-directed behavior was nonspecific to the treatment condition. However, attachment-based family therapy
was superior to family-enhanced nondirective supportive therapy in improving this aspect of emotion regulation among adolescents who did not have
anxiety. In addition, difficulties with goal-directed behavior on treatment outcome were worse for adolescents' who reported greater attachment
avoidance to their parents. Future research should test whether targeting goal-directed behavior and attachment avoidance would result in better
treatment outcome for adolescents with suicidal ideation and anxiety. Copyright © 2021. American Psychological Association
Psychotherapy, 58(4) : 523-532
- Year: 2021
- 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), Family therapy, Supportive
therapy
Gruhn, M. A., West, A., Hamlat, E., Weinstein, S.
OBJECTIVE: Suicidal ideation (SI) is significantly higher for youth with pediatric bipolar
disorder (PBD), yet clinical correlates of suicidality remain poorly understood in this population. The current study investigates how change in risk
factors for SI relate to change in SI intensity over a 6-month period of treatment. METHOD(S): Children ages 9 to 13 (N=71; 41% female; 54%
Caucasian; Mean age=9.17) engaged in one of two psychotherapy treatment conditions and completed assessments of SI risk factors and psychopathology
symptoms at baseline (pre-treatment), 4 and 8weeks (during treatment), 12weeks (post-treatment), and 39weeks (follow-up assessment at 6months post-
treatment). Children also completed assessments of SI intensity at baseline, post-treatment (12weeks), and 6months post-treatment. RESULT(S): Mixed-
effects regression models indicate that increases in health-related quality of life in the family, mobilization of the family to acquire/accept help
for PBD, and child self-concept were associated with decreased SI intensity over time. CONCLUSION(S): Findings highlight the importance of family and
child level factors in influencing longitudinal change in SI intensity in youth with PBD. Clinical implications and future directions are
discussed.
Clinical
child psychology and psychiatry, : 1359104521996762
- Year: 2021
- Problem: Bipolar 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), Cognitive & behavioural therapies (CBT), Family therapy
Grigoroglou, C.
To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with
usual care, and whether study and patient factors moderate treatment effects. Method(s): We searched Medline, Embase, PubMed, PsycINFO, CINAHL,
CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed
adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants
within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. Result(s): We extracted data from 28 RCTs
(11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care
(SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0.47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were
associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among
patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). Conclusion(s): Primary care based CC with an embedded psychological intervention is
the most effective CC framework for reducing suicidal ideation and older patients may benefit the most. Copyright © 2021
General Hospital Psychiatry, 71 : 27-
35
- Year: 2021
- 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), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Goldston, D. B.
Depression, suicidal behaviors and substance use problems frequently co-occur, and treatment for youth with these co-occurring problems
is often fragmented and challenging. An integrated cognitive-behavioral treatment approach that builds upon a relapse prevention framework and
applies common core skills, language, and approach for treating these related problems may be clinically beneficial. Following a description of the
integrated approach, we present results of a pilot trial (n = 13) to examine the acceptability and feasibility of the Cognitive-Behavioral Therapy-
Relapse Prevention (CBT-RP) intervention plus enhanced treatment as usual (TAU) compared to enhanced TAU alone. The feasibility of the CBT-RP + TAU
intervention was reflected by high rates of retention (86%). The acceptability was reflected in positive evaluations regarding the helpfulness of the
intervention by adolescents and families. The majority of youth in both CBT-RP + TAU and TAU alone groups evidenced reductions in depression and
suicide ideation from study entry to Week 20. Patterns of reduction were more consistent, however, for youth receiving CBT-RP + TAU, and reductions
were slower to emerge for some youth receiving TAU alone. Reductions in alcohol and marijuana problems were similar, but half of the youth in TAU
alone (and none in the CBT-RP + TAU group) had emergency department visits related to psychiatric crises or substance-related problems. These
findings, although based on a small sample, underscore the feasibility and acceptability of an integrated cognitive-behavioral relapse prevention
approach for youth with depression, suicide attempt histories, and substance use problems. Copyright © 2021 Society of Clinical Child & Adolescent
Psychology.
Evidence-Based Practice in Child and Adolescent Mental Health, 6(2) : 155-
172
- Year: 2021
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)