Disorders - Suicide or self-harm with comorbid mental disorder
Asarnow, J. R., Berk, M. S., Bedics, J., Adrian, M., Gallop, R., Cohen, J., Korslund, K., Hughes, J., Avina, C., Linehan, M. M., McCauley, E.
OBJECTIVE: This study evaluated mechanisms, mediation, and secondary/exploratory outcomes
in our randomized controlled trial evaluating dialectical behavior therapy (DBT) compared to individual and group supportive therapy (IGST). We
expand on previously reported results indicating a DBT advantage at posttreatment on planned suicide/self-harm outcomes, and greater self-harm
remission (absence of self-harm, post hoc exploratory outcome) during active-treatment and follow-up periods.\rMETHOD: This was a multi-site
randomized trial of 173 adolescents with prior suicide attempts, self-harm, and suicidal ideation. Randomization was to 6 months of DBT or IGST, with
outcomes monitored through 12 months. Youth emotion regulation was the primary mechanistic outcome.\rRESULTS: Compared to IGST, greater improvements
in youth emotion regulation were found in DBT through the treatment-period [t(498) = 2.36, p = .019] and 12-month study period (t(498) = 2.93, p =
.004). Their parents reported using more DBT skills: posttreatment t(497) = 4.12, p < .001); 12-month follow-up t(497) = 3.71, p < .001). Mediation
analyses predicted to self-harm remission during the 6- to 12-month follow-up, the prespecified outcome and only suicidality/self-harm variable with
a significant DBT effect at follow-up (DBT 49.3%; IGST 29.7%, p = .013). Improvements in youth emotion regulation during treatment mediated the
association between DBT and self-harm remission during follow-up (months 6-12, estimate 1.71, CI 1.01-2.87, p = .045). Youths in DBT reported lower
substance misuse, externalizing behavior, and total problems at posttreatment/6 months, and externalizing behavior throughout follow-up/12 months.
\rCONCLUSION: Results support the significance of emotion regulation as a treatment target for reducing self-harm, and indicate a DBT advantage on
substance misuse, externalizing behavior, and self-harm-remission, with 49.3% of youths in DBT achieving self-harm remission during follow-up.
\rCLINICAL TRIAL REGISTRATION INFORMATION: Collaborative Adolescent Research on Emotions and Suicide; https://www.clinicaltrials.gov/;
NCT01528020.
Journal of the American Academy of Child & Adolescent
Psychiatry, 01 : 01
- Year: 2021
- 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), Dialectical behavioural therapy
(DBT), Supportive
therapy
Haruvi Catalan, L.
In recent years,
suicidal behaviors have shown substantial increase worldwide. This trend is also prominent in Israel and has led to a dramatic increase in mental
health treatment demand resulting in long wait times and low treatment acceptance rate. To address the critical need in crisis intervention for
children and adolescents at suicidal risk we developed an ultra-brief acute crisis intervention, based on Interpersonal Psychotherapy (IPT). IPT is
an evidence-based intervention for various psychopathologies among different age groups. The current adaptation of IPT-A is comprised of five weekly
sessions, followed by monthly follow-up caring email contacts to the patients and their parents, over a period of 3 months. This paper aims to review
the theoretical foundation of this intervention, describe the research design, and present preliminary results of a pilot study. Preliminary Results
from our samples of 26 adolescents indicate meaningful trends for both the suicidal ideation (SIQ) and depression (MFQ) outcome measures. Significant
interaction was found concerning suicidal ideation but not for depression. Main limitations include small sample size and stratified controls. The
treatment appears to be safe, feasible and acceptable and initial results show promising trends to support further study of the approach. © Copyright
© 2020 Haruvi Catalan, Levis Frenk, Adini Spigelman, Engelberg, Barzilay, Mufson, Apter, Benaroya Milshtein, Fennig and Klomek.
Frontiers in Psychiatry, 11 (no
pagination) :
- Year: 2020
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Interpersonal therapy (IPT)
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
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)
Wilksch, S. M., O'Shea, A., Wade, T. D.
Objective: Eating disorders are known to have high comorbidity, and the current report outlines the impact of an online
eating disorder risk reduction program on brief, self-report measures of depressive symptoms, alcohol and other drug use, and suicidality. Method(s):
An online pragmatic, randomized-controlled trial was conducted with N = 316 young-women (M age = 20.80 years) across Australia and New Zealand. Media
Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received positive body image tips. Prevention effects
(asymptomatic at baseline) and treatment effects (symptomatic at baseline) were investigated. Result(s): MS-T participants were 94% and 91% less
likely than controls to develop Moderate or higher depressive symptoms at 6-month (MS-T = 3.3%; controls = 35.4%) and 12-month follow-up (MS-T =
3.4%; controls = 29.4%), respectively. MS-T participants did not commence using recreational drugs at any assessment point, compared to 18.2% of
controls at a least one assessment point. Regarding treatment effects, MS-T participants were 84% more likely to no longer be using recreational
drugs at 12-month follow-up (MS-T = 60%; controls = 21.1%). Mutitvariate logistic regressions revealed group, depressive symptoms and alcohol use to
be significant predictors of elevated suicide risk, where being an MS-T participant, without depressive symptoms and not drinking alcohol,
significantly lowered likelihood of developing elevated suicide risk. Disordered eating at post-program mediated the relationship between group and
depressive symptoms across post-program to 12-mnoth follow-up. Discussion(s): MS-T shows promise as a program with important mental health benefits
in addition to previous reports of lowered eating disorder diagnosis, risk and impairment. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 52(2) : 132-
141
- 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), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
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
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)
Wilksch, S. M., O'Shea, A., Wade, T. D.
Objective: Eating disorders are known to have high comorbidity, and the current report outlines the impact of an online
eating disorder risk reduction program on brief, self-report measures of depressive symptoms, alcohol and other drug use, and suicidality. Method(s):
An online pragmatic, randomized-controlled trial was conducted with N = 316 young-women (M age = 20.80 years) across Australia and New Zealand. Media
Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received positive body image tips. Prevention effects
(asymptomatic at baseline) and treatment effects (symptomatic at baseline) were investigated. Result(s): MS-T participants were 94% and 91% less
likely than controls to develop Moderate or higher depressive symptoms at 6-month (MS-T = 3.3%; controls = 35.4%) and 12-month follow-up (MS-T =
3.4%; controls = 29.4%), respectively. MS-T participants did not commence using recreational drugs at any assessment point, compared to 18.2% of
controls at a least one assessment point. Regarding treatment effects, MS-T participants were 84% more likely to no longer be using recreational
drugs at 12-month follow-up (MS-T = 60%; controls = 21.1%). Mutitvariate logistic regressions revealed group, depressive symptoms and alcohol use to
be significant predictors of elevated suicide risk, where being an MS-T participant, without depressive symptoms and not drinking alcohol,
significantly lowered likelihood of developing elevated suicide risk. Disordered eating at post-program mediated the relationship between group and
depressive symptoms across post-program to 12-mnoth follow-up. Discussion(s): MS-T shows promise as a program with important mental health benefits
in addition to previous reports of lowered eating disorder diagnosis, risk and impairment. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 52(2) : 132-
141
- 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), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
King, C., Arango, A., Kramer, A., Busby, D., Czyz, E., Foster, C. E., Gillespie,
B.
Objectives: The prevalence of suicide among adolescents is rising, yet little is known about effective interventions. No previous
intervention for suicidal adolescents has been shown to reduce mortality. This study was designed to determine whether the Youth-Nominated Support
Team Intervention for Suicidal Adolescentsa\"Version II (YST) was associated with reduced mortality 10a\"12 years after psychiatric hospitalization
for suicide risk. Method(s): We conducted a 10a\"12-year follow-up evaluation, using National Death Index (NDI) data for all participants (N = 448)
in the YST randomized clinical trial (ClinicalTrials.gov: NCT00071617) comparing treatment as usual (TAU) to YST plus TAU (YST). Participants were
inpatients with mental illness, ages 13a\"17 years, who were admitted with suicidal ideation (frequent or with suicidal plan) or a suicide attempt
within the past 4 weeks. Enrollment took place from 2002 to 2005 at 2 mental health hospitals (2002a\"2005). In YST, adolescents nominate aoecaring
adultsa (mean 3.4 support persons per adolescent from family, school, community settings) to serve as support persons after hospitalization. With
parental permission, these adults attend a psychoeducation session to learn about the youthaTMs problem list and treatment plan, suicide warning
signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioral choices. They receive weekly,
supportive telephone calls from YST professional staff for 3 months. The primary study outcome was survival, measured by NDI data, for deaths through
2014. Result(s): NDI records were reviewed for all 448 YST Study participants [72% female; mean age (SD) = 15.6 years (1.3); 83% Caucasian]. There
were 11 deaths in the TAU group and 1 death in the YST group (hazard ratio: 11.2, p < 0.01 [95% CI = 1.5a\"87.0]). No patients were withdrawn from
YST because of adverse effects. Conclusion(s): This is the first intervention for suicidal adolescents to show evidence of reduced mortality. Even at
the lowest end of the confidence interval, mortality was reduced by 50%. Results warrant replication with examination of mechanisms; however, they
suggest that YST, a psychoeducational, supportive intervention involving caring adults, favorably altered the trajectories of adolescents
contemplating suicide. S, RCT, ADOL Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10
Supplement) : S260
- Year: 2018
- 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), Psychoeducation, Other Psychological Interventions
Gabbay, V., Freed, R. D., Alonso, C. M., Senger, S., Stadterman, J., Davison, B. A., Klein, R. G.
Objective: Reports are mixed on the efficacy of omega-3 fatty acids (O3FA) for the treatment of major depressive disorder (MDD), with
only limited data in adolescents. The present trial aimed to investigate systematically the efficacy of O3FA as a monotherapy, compared to a placebo,
in adolescents with MDD. Secondarily, we explored O3FA effects on anhedonia, irritability, and suicidality-all key features of adolescent MDD.
Method(s): Fifty-one psychotropic medication-free adolescents with DSM-IV-TR diagnoses of MDD (aged 12-19 years; 57% female) were randomized to
receive O3FA or a placebo for 10 weeks. Data were collected between January 2006 and June 2013. O3FA and a placebo were administered on a fixed-
flexible dose titration schedule based on clinical response and side effects. The initial dose of 1.2 g/d was increased 0.6 g/d every 2 weeks, up to
a maximum of 3.6 g/d. Clinician-rated and self-rated depression severity, along with treatment response, served as primary outcome measures.
Additionally, we examined O3FA effects on depression-related symptoms, including anhedonia, irritability, and suicidality. Treatment differences were
analyzed via intent-to-treat analyses. Result(s): O3FA were not superior to a placebo on any clinical feature, including depression severity and
levels of anhedonia, irritability, or suicidality. Additionally, response rates were comparable between treatment groups. Within-treatment analyses
indicated that both treatments were associated with significant improvement in depression severity on self- (O3FA: t= -4.38, P< .001; placebo: t= -
3.52, P= .002) and clinician (O3FA: t= -6.47, P< .001; placebo: t= -8.10, P< .001) ratings. Conclusion(s): In adolescents with MDD, O3FA do not
appear to be superior to placebo. © Copyright 2018 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 79 (4) (no
pagination)(17m11596) :
- Year: 2018
- 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: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Hogberg, G., Hallstrom, T.
Suicide
attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention
by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused
cognitive behavioural therapy (MR-CBT) (n = 15) was compared with treatment as usual (TAU) (n = 12) in a group of depressed adolescents in a clinical
setting. MR-CBT focuses on mood regulation by means of counter conditioning with memory reconsolidation being the proposed mechanism of change.
Subjects practice keeping emotionally positive memories to diminish the emotional impact of negative memories. Symptoms of depression were tested
with a short version of the Mood and Feelings Questionnaire (SMFQ), and wellbeing with the World Health Organization 5 Wellbeing Index (WHO-5).
Suicidal events were rated according to the clinical interview Columbia Suicide Severity Rating Scale (C-SSRS). Suicidal events at the end of
treatment were significantly reduced in the MR-CBT group, but not in the TAU group. Depression and wellbeing improved significantly in both treatment
groups. While far from conclusive, the results are encouraging enough to suggest that further studies should be undertaken to examine whether
psychotherapy focusing on mood regulation for young individuals at risk might enhance secondary prevention of suicide. Copyright © 2018 by the
authors. Licensee MDPI, Basel, Switzerland.
International Journal of
Environmental Research and Public Health, 15 (5) (no pagination)(921) :
- Year: 2018
- 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), Cognitive & behavioural therapies (CBT)
Lin, T. J., Ko, H. C., Wu, J.
Y., Oei, T. P., Lane, H. Y., Chen, C. H.
In this study the
effectiveness of the condensed Dialectical Behavior Therapy Skills Training Group (DBTSTG) was compared to the Cognitive Therapy Group (CTG) in
reducing depression and suicide reattempt and modifying emotion regulation strategies among those with borderline personality disorder (BPD). A total
of 82 depressed BPD college students with a suicidal history within the past 6-months were randomly allocated to DBTSTG or CTG. Both groups had
similar reductions in suicide reattempts and depression after the intervention and 6-month follow-ups. However, the CTG showed improvements in
cognitive errors, but the DBTSTG revealed increases in acceptance and decreases in suppression scores. Both groups were effective in decreasing
depression and suicide reattempt in BPD college students, probably through increasing adaptive antecedent-focused or response-focused strategies of
emotion regulation, respectively.
Archives of Suicide Research, : 1-18
- Year: 2018
- Problem: 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), Dialectical behavioural therapy
(DBT), Skills training