Disorders - Suicide or self-harm with comorbid mental disorder
Weinstein, S. M., Cruz,
R. A., Isaia, A. R., Peters, A. T., West, A. E.
Despite high rates of suicide ideation (SI) and behavior in youth with pediatric bipolar
disorder (PBD), little work has examined how psychosocial interventions impact suicidality among this high-risk group. The current study examined SI
outcomes in a randomized clinical trial comparing Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT) for PBD versus psychotherapy
treatment-as-usual (TAU). Although not designed for suicide prevention, CFF-CBT addresses child and family factors related to suicide risk and thus
was hypothesized to generalize to the treatment of suicidality.
Suicide & Life-Threatening Behavior, 48(6) : 797-
811
- 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: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy
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)
Zou,
Y., Li, H., Shi, C., Lin, Y., Zhou, H., Zhang, J.
The present study aimed to explore the effects of psychological pain theory-based cognitive therapy (PPTBCT) on suicide among
depressed patients, compared with a control group who received usual psychological care (UPC). The sample consisted of 32 depressed patients and 32
healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory, Three-Dimensional
Psychological Pain Scale (TDPPS), and Problem Solving Inventory(PSI), and Automatic Thoughts Questionnaire (ATQ). All measures differed significantly
between depressed patients and healthy controls. Then clinical participants were assigned randomly to the PPTBCT (n=19) and control (n=13) groups.
During the 8-week intervention, scores related to depression, suicidal ideation, psychological pain, and automatic thoughts were decreased in both
groups at the post-intervention and 4-week follow-up time points, compared with pre-intervention scores. BSI scores remained low at follow up and did
not differ significantly from post-intervention scores in the PPTBCT group, but were significantly higher at follow up than at post-intervention in
the control group. PPTBCT may effectively reduce suicide risk in patients with major depressive disorder, although the effects of its application
need to be confirmed.
Psychiatry Research, 249 : 23-
29
- Year: 2017
- 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), Cognitive & behavioural therapies (CBT)
Calear, A. L., Christensen, H., Freeman, A., Fenton, K., Busby-Grant, J., van-Spijker, B., Donker, T.
Youth suicide is a significant public
health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing
and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12-25 years. PsycInfo, PubMed and Cochrane databases
were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for
youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials
fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a
significant effect on suicidal ideation (Cohen's d = 0.16-3.01), suicide attempts (phi = 0.04-0.38) or deliberate self-harm (phi = 0.29-0.33; d =
0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a
diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this
population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach.
(PsycINFO Database Record (c) 2016 APA, all rights reserved)
European Child & Adolescent Psychiatry, 25(5) : 467-
482
- Year: 2016
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Zalsman, G., Hawton, K., Wasserman, D., van-Heeringen, K. Arensman,
E., Sarchiapone, M., Carli, V., Hoschl, C., Barzilay, R., Balazs, J., Purebl, G., Kahn, J.
P., Saiz, P. A., Lipsicas, C. B., Bobes, J., Cozman, D., Hegerl, U., Zohar, J.
BACKGROUND: Many countries are developing suicide
prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide
prevention interventions since 2005.\rMETHODS: We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for
studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies,
screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest,
namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk
individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles
and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-
analysis, we present a narrative analysis.\rFINDINGS: We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised
controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in
prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots
for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds
ratio [OR] 0.45, 95% CI 0.24-0.85; p=0.014) and suicidal ideation (0.5, 0.27-0.92; p=0.025). The anti-suicidal effects of clozapine and lithium have
been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are
important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general
public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and
internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions.\rINTERPRETATION: In the quest
for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the
individual level and the population level should be assessed with robust research designs.\rFUNDING: The Expert Platform on Mental Health, Focus on
Depression, and the European College of Neuropsychopharmacology.\rCopyright © 2016 Elsevier Ltd. All rights reserved.
, 3(7) : 646-59
- Year: 2016
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), Universal prevention
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions
Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H., Brent, D. A., Birmaher, B.
Objective: The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial
treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP). Methods: We recruited participants 12-18 years of age with a primary
BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned
using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-
affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach
consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed
outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly
over 1 year. Results: Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly
reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents
receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more
likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among
adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents
receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation.
Conclusions: DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents
with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to
establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.
Journal of Child & Adolescent Psychopharmacology, 25(2) : 140-
149
- Year: 2015
- 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), Dialectical behavioural therapy
(DBT)
Salpekar, J. A., Joshi, P. T., Axelson, D. A., Reinblatt, S. P., Yenokyan, G., Sanyal, A., Walkup, J. T., Vitiello,
B., Luby, J. L., Wagner, K. D., Nusrat, N., Riddle, M. A.
Objective: To assess the efficacy of mood-stabilizing medications for depression and
suicidality in pediatric bipolar disorder. Method: The Treatment of Early Age Mania (TEAM) study is a multicenter, prospective, randomized, masked
comparison of divalproex sodium (VAL), lithium carbonate (LI), and risperidone (RISP) in an 8-week parallel clinical trial. A total of 279 children
and adolescents with DSM-IV diagnoses of bipolar I disorder, mixed or manic, aged 6 to 15 years were enrolled. The primary outcome measure was
improvement on the Clinical Global Impression scale for depression (CGI-BP-I-D). Secondary outcome measures included the Children's Depression
Rating Scale (CDRS-R) and suicidality status. Statistics included longitudinal analysis of outcomes using generalized linear mixed models with random
intercept both for the complete data set and by using last observation carried forward. Results: CGI-BP-I-D ratings were better in the RISP group
(60.7%) as compared to the LI (42.2%; p = .03) or VAL (35.0%; p = .003) groups from baseline to the end of the study. CDRS scores in all treatment
groups improved equally by study end. In week 1, scores were lower with RISP compared to VAL (mean = 4.72, 95% CI = 2.67, 6.78), and compared to LI
(mean = 3.63, 95% CI = 1.51, 5.74), although group differences were not present by the end of the study. Suicidality was infrequent, and there was no
overall effect of treatment on suicidality ratings. Conclusion: Depressive symptoms, present in the acutely manic or mixed phase of pediatric bipolar
disorder, improved with all 3 medications, though RISP appeared to yield more rapid improvement than LI or VAL and was superior using a global
categorical outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 54(12) : 999-
1007
- Year: 2015
- 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: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium), Lithium
Spirito, A., Wolff, J. C., Seaboyer, L. M., Hunt, J., Esposito-Smythers, C., Nugent, N., Zlotnick, C., Miller, I.
OBJECTIVE: The purpose of this study was to conduct a treatment development study to examine the feasibility,
acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral
therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]).\rMETHODS: A randomized, controlled, repeated measures design was used to test the hypothesis
that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24
adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th
ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE.\rRESULTS: The concurrent
protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat
lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment
protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an
adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however,
at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and
remained low at follow-up in both groups.\rCONCLUSIONS: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents.
The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is
necessary to better understand which adolescents would benefit most from concurrent treatment with a parent.
Journal of Child &
Adolescent Psychopharmacology, 25(2) : 131-9
- Year: 2015
- 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), Cognitive & behavioural therapies (CBT)
Spirito, A., Wolff, J. C., Seaboyer, L. M., Hunt, J., Esposito-Smythers, C., Nugent, N., Zlotnick, C., Miller, I.
Objective: The purpose of this study was to conduct a
treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their
depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). Methods: A randomized, controlled,
repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with
Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association,
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSMIV
criteria for current or past MDE. Results: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents.
Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required
to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the
end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This
difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in
both groups during active and maintenance treatment, and remained low at follow-up in both groups. Conclusions: The PA-CBT protocol is feasible to
conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power
to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment
with a parent. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of Child &
Adolescent Psychopharmacology, 25(2) : 131-139
- Year: 2015
- 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: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Brewer, W.
J., Lambert, T. J., Witt, K., Dileo, J., Duff, C., Crlenjak, C., McGorry, P. D., Murphy, B. P.
Background: The first episode of psychosis is a crucial period when early intervention can alter the
trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early
Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive
outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal
recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment
as usual. Methods: Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk
management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a
naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were
compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case
management referral and discharge. Findings: Referrals were predominately unemployed males with low levels of functioning and educational attainment.
They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and
forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings,
admissions, bed days, and crisis contacts. Interpretation: Characterisation of intensive case management patients validated the clinical research
focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream
within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to
determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs
should reduce the distress associated with pathways to care for patients, their families, and the community. Funding: National Health & Medical
Research Council and the Colonial Foundation.
Lancet Psychiatry, 2(1) : 29-37
- Year: 2015
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Case management
Ghaziuddin, N., Merchant, C., Dopp, R., King, C.
Objective: Describe suicidal ideation and suicide related/other emergencies (SRE), among
depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization. Methods: One hundred twenty adolescents,
who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent
medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication
groups: SSRI antidepressant only (n = 71); SSRI plus mood stabilizer (n = 17); SSRI plus antipsychotic (n = 20); and SSRI plus antipsychotic and mood
stabilizer (n = 12). Standardized instruments were used. Results: Mean age = 15.5 (plus or minus) 1.3, Caucasian = 80.8%, female = 74.2%, mean CDRS-R
= 61.7 (plus or minus) 12.1, suicide attempt during month prior to hospitalization = 58.6%. During the 3-month post-hospitalization period: (1) there
were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity
was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were
associated with greater reduction in suicidal ideation at 3-months. Conclusion: Declines in suicidal ideation, depression severity, and suicide
attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in
combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify
medication adherence is a study limitation.
Asian Journal of Psychiatry, 11 : 13-
19
- Year: 2014
- 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: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium)