Disorders - suicide or self-harm behaviours
Briggs, S., Netuveli, G., Gould, N., Gkaravella, A., Gluckman, N. S., Kangogyere, P., Farr, R., Goldblatt, M. J., Lindner, R.
BACKGROUND: Preventing suicide and self-harm is a global health priority. Although
there is a growing evidence base for the effectiveness of psychoanalytic and psychodynamic psychotherapies for a range of disorders, to date there
has been no systematic review of its effectiveness in reducing suicidal and self-harming behaviours.AimsTo systematically review randomised
controlled trials of psychoanalytic and psychodynamic psychotherapies for suicidal attempts and self-harm.\rMETHOD: We searched PubMed, PsycINFO,
Psycharticles, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials for randomise controlled trials of psychoanalytic and
psychodynamic psychotherapies for reducing suicide attempts and self-harm.\rRESULTS: Twelve trials (17 articles) were included in the meta-analyses.
Psychoanalytic and psychodynamic therapies were effective in reducing the number of patients attempting suicide (pooled odds ratio, 0.469; 95% CI
0.274-0.804). We found some evidence for significantly reduced repetition of self-harm at 6-month but not 12-month follow-up. Significant treatment
effects were also found for improvements in psychosocial functioning and reduction in number of hospital admissions.\rCONCLUSIONS: Psychoanalytic and
psychodynamic psychotherapies are indicated to be effective in reducing suicidal behaviour and to have short-term effectiveness in reducing self-
harm. They can also be beneficial in improving psychosocial well-being. However, the small number of trials and moderate quality of the evidence
means further high-quality trials are needed to confirm our findings and to identity which specific components of the psychotherapies are
effective.Declaration of interestNone.
British Journal of Psychiatry, 214(6) : 320-
328
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
Comtois, K. A., Kerbrat, A. H., Decou, C. R., Atkins, D. C., Majeres, J. J., Baker, J. C., Ries, R. K.
Importance: Accessible and cost-effective interventions for suicidality are needed to address high rates of
suicidal behavior among military service members. Caring Contacts are brief periodic messages that express unconditional care and concern and have
been previously shown to prevent suicide deaths, attempts, ideation, and hospitalizations. Objective(s): To test the effectiveness of augmenting
standard military health care with Caring Contacts delivered via text message to reduce suicidal thoughts and behaviors over 12 months. Design,
Setting, and Participant(s): This randomized clinical trial was conducted at 3 military installations in the southern and western United States.
Soldiers and Marines identified as being at risk of suicide were recruited between April 2013 and September 2016. The final follow-up was in
September 2017. Intervention(s): Both groups received standard care, and the Caring Contacts group also received consisted of 11 text messages
delivered on day 1, at week 1, at months 1, 2, 3, 4, 6, 8, 10, and 12, and on participants' birthdays. Main Outcomes and Measures: Primary outcomes
were current suicidal ideation and suicide risk incidents (hospitalization or medical evacuation). Secondary outcomes were worst-point suicidal
ideation, emergency department visits, and suicide attempts. Suicidal ideation was measured by the Scale for Suicide Ideation, suicide risk
incidents, and emergency department visits by the Treatment History Interview; attempted suicide was measured by the Suicide Attempt Self-Injury
Count. Result(s): Among 658 randomized participants (329 randomizely assigned to each group), data were analyzed for 657 individuals (mean [SD] age,
25.2 [6.1] years; 539 men [82.0%]). All participants reported suicidal ideation at baseline, and 291 (44.3%) had previously attempted suicide. Of the
657 participants, 461 (70.2%) were assessed at 12 months. Primary outcomes were nonsignificant. There was no significant effect on likelihood or
severity of current suicidal ideation or likelihood of a suicide risk incident; there was also no effect on emergency department visits. However,
participants who received Caring Contacts (172 of 216 participants [79.6%]) had lower odds than those receiving standard care alone (179 of 204
participants [87.7%]) of experiencing any suicidal ideation between baseline and follow-up (odds ratio, 0.56 [95% CI, 0.33-0.95]; P =.03) and fewer
had attempted suicide since baseline (21 of 233 [9.0%] in the group receiving Caring Contacts vs 34 of 228 [14.9%] in the standard-care group; odds
ratio, 0.52 [95% CI, 0.29-0.92]; P =.03). Conclusions and Relevance: This trial provides inconsistent results on the effectiveness of caring text
messages between primary and secondary outcomes, but this inexpensive and scalable intervention offers promise for preventing suicide attempts and
ideation in military personnel. Additional research is needed. Trial Registration: ClinicalTrials.gov identifier: NCT01829620. Copyright © 2019
American Medical Association. All rights reserved.
JAMA Psychiatry, 76(5) : 474-
483
- 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, Technology, interventions delivered using technology (e.g. online, SMS)
Kelly, E. V., Newton, N. C., Stapinski, L. A., Conrod, P. J., Barrett, E. L., Champion, K. E., Teesson, M.
OBJECTIVE: To examine
the secondary effects of a personality-targeted intervention on bullying and harms among adolescent victims and bullies.\rMETHOD: Outcomes were
examined for victims and bullies in the Climate and Preventure study, Australia. Participants completed self-report measures at baseline and four
follow-up assessments (6, 12, 24, 36 months). Thirteen intervention schools (n=1087) received Preventure, a brief personality-targeted CBT
intervention for adolescents with 'high-risk' personality types (hopelessness, anxiety sensitivity, impulsivity, sensation seeking). Thirteen
control schools (n=1103) received health education as usual. Bullying was examined for 'high-risk' victims (n=143 in Preventure schools vs n=153 in
control schools), and bullies (n=63 in Preventure schools vs n=67 in control schools) in the total sample. Harms were examined for 'high-risk'
victims (n=110 in Preventure schools vs n=87 in control schools) and bullies (n=50 in Preventure schools vs n=30 in control schools) in independent
schools.\rRESULTS: There was no significant intervention effect for bullying victimization or perpetration in the total sample. In the sub-sample,
mixed models showed greater reductions in victimization (b = -0.208, 95% CI -0.4104to -0.002, p<.05), suicidal ideation (b = -0.130, 95% CI -0.225 to
-0.034, p<.01) and emotional symptoms (b = -0.263, 95% CI -0.466 to -0.061, p<.05) among 'high-risk' victims in Preventure vs control schools.
Conduct problems (b = -0.292, 95% CI -0.554 to -0.030, p<.05) showed greater reductions among 'high-risk' bullies in Preventure vs control schools,
and suicidal ideation showed greater reductions among 'high-risk' female bullies in Preventure vs control schools (b=-0.820, 95% CI -1.198 to -
0.442, p<.001).\rCONCLUSION: The findings support targeting personality in bullying prevention.\rCLINICAL TRIAL REGISTRATION INFORMATION: The CAP
Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use And Related Harms in Australian Adolescents;
http://www.anzctr.org.au/; ACTRN12612000026820.
Journal of the American Academy of Child & Adolescent
Psychiatry, : 30
- Year: 2019
- Problem: 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), Cognitive & behavioural therapies (CBT), Motivational interviewing, includes Motivational Enhancing Therapy
Czyz, E., King, C., Biermann, B.
This pilot randomized controlled trial examined the
feasibility and acceptability of a motivational interview (MI)-enhanced safety planning intervention (MI-SafeCope) for teens hospitalized due to
suicide risk and explored proximal outcomes (possible mechanisms of change). Participants were 36 hospitalized adolescents (ages 13-17; 78.8% female)
with last-week suicidal ideation and/or past-month suicide attempts. Adolescents were randomized to MI-SafeCope, a three-component intervention
(individual and family sessions, postdischarge call), or to treatment as usual. Primary outcomes were feasibility and acceptability. We also explored
differences in proximal outcomes assessed at 2 weeks, 1 month, and 3 months (family connectedness, motivation for safety plan use, parental
motivation to encourage safety plan use), as well as daily for 4 weeks (self-efficacy, coping behavior, safety plan use). Participation and retention
rates and intervention satisfaction ratings indicate feasibility and acceptability. Mixed-effects models of daily assessments indicated, for the MI-
SafeCope group, significantly higher self-efficacy to refrain from suicidal action (B = 1.15, p = .030), greater reliance on self to cope with
suicidal ideation (B = 1.56, p = .042), and higher likelihood of safety plan use to manage suicidal thoughts (B = 0.25, p = .004). Parents in the
MI-SafeCope group reported higher motivation to encourage safety plan use (B = 1.04, p = .031). Safety planning incorporating MI is feasible and
acceptable with hospitalized teens. Preliminary findings suggest that MI strategies may be promising in maintaining adherence to safety plans,
increasing self-efficacy and coping, and in fostering parents' motivation to encourage safety plan use. Our study also highlights the benefit of
daily-level assessment of individuals' response to suicide-specific interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Clinical Child and Adolescent
Psychology, 48(2) : 250-262
- 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), Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Other service delivery and improvement
interventions
Mehlum, L., Ramleth, R. K., Tormoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., Miller, A. L., Larsson, B., Sund, A. M., Groholt, B.
BACKGROUND: Knowledge is lacking on the long-term outcomes of
treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate
are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A)
compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects.\rMETHODS:
Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized
trial.\rTRIAL REGISTRATION NUMBER: NCT01593202 (www.ClinicalTrials.gov).\rRESULTS: At the 3-year follow-up DBT-A remained superior to EUC in reducing
the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there
were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect
of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial
treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced
outcomes in patients who had received DBT-A.\rCONCLUSIONS: There were on average no between-group differences at the 3-year follow-up in clinical
outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction
in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable
treatment alternative for adolescents with repetitive self-harming behavior.
Journal of Child Psychology & Psychiatry & Allied
Disciplines, : 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), Dialectical behavioural therapy
(DBT)
Gillespie, C., Joyce, M., Flynn,
D., Corcoran, P.
Background: Dialectical
behaviour therapy for adolescents (DBT-A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural
dysregulation. Previous studies have reported on varying lengths of treatment, however, and optimal treatment duration has not yet been identified.
While the treatment developers initially proposed a 16-week programme, they have more recently recommended an extension to 24 weeks. This study
compares outcomes for adolescents and parent/guardians who participated in 16- and 24-week DBT-A programmes in a community setting. Method(s):
Eighty-four adolescents and 100 parent/guardians participated in 16-week DBT-A, while 68 adolescents and 67 parent/guardians participated in the 24-
week programme. Outcome measures for adolescents included the presence and frequency of self-harm, suicidal ideation and depression; and for parents
were burden, grief and parental stress. Outcomes were assessed at pre- and postintervention. Linear mixed-effects models were used to estimate the
treatment duration effect (24-week vs. 16-week) utilising all available data at pre- and postintervention. Result(s): Data analyses showed a
reduction in the presence and frequency of self-harm at postintervention for adolescents in both programmes. Both adolescent and parent participants
in the 16- and 24-week programmes also showed changes indicating significant improvement on all self-report outcome measures (p <.05). A treatment
duration effect was identified with adolescents in the 24-week programme reporting greater gains on measures of suicidal ideation and depression (p
<.05). However, drop-out rates were higher for the 24-week programme. Conclusion(s): The findings of the current study indicate that 24-week DBT-A
may have additional benefits in comparison to 16-week DBT-A in terms of further reductions in suicidal ideation and depression. Given the nature of
this study, it was not possible to explore a potential time effect, however, so these results should be interpreted with caution. Further research
will assist in determining an optimal programme duration of DBT-A. 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)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Dialectical behavioural therapy
(DBT), Other service delivery and improvement
interventions
Gillespie, C., Joyce, M., Flynn, D., Corcoran,
P.
Background: Dialectical
behaviour therapy for adolescents (DBT-A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural
dysregulation. Previous studies have reported on varying lengths of treatment, however, and optimal treatment duration has not yet been identified.
While the treatment developers initially proposed a 16-week programme, they have more recently recommended an extension to 24 weeks. This study
compares outcomes for adolescents and parent/guardians who participated in 16- and 24-week DBT-A programmes in a community setting. Method(s):
Eighty-four adolescents and 100 parent/guardians participated in 16-week DBT-A, while 68 adolescents and 67 parent/guardians participated in the 24-
week programme. Outcome measures for adolescents included the presence and frequency of self-harm, suicidal ideation and depression; and for parents
were burden, grief and parental stress. Outcomes were assessed at pre- and postintervention. Linear mixed-effects models were used to estimate the
treatment duration effect (24-week vs. 16-week) utilising all available data at pre- and postintervention. Result(s): Data analyses showed a
reduction in the presence and frequency of self-harm at postintervention for adolescents in both programmes. Both adolescent and parent participants
in the 16- and 24-week programmes also showed changes indicating significant improvement on all self-report outcome measures (p <.05). A treatment
duration effect was identified with adolescents in the 24-week programme reporting greater gains on measures of suicidal ideation and depression (p
<.05). However, drop-out rates were higher for the 24-week programme. Conclusion(s): The findings of the current study indicate that 24-week DBT-A
may have additional benefits in comparison to 16-week DBT-A in terms of further reductions in suicidal ideation and depression. Given the nature of
this study, it was not possible to explore a potential time effect, however, so these results should be interpreted with caution. Further research
will assist in determining an optimal programme duration of DBT-A. 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)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Dialectical behavioural therapy
(DBT), Other service delivery and improvement
interventions
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. A., Arango, A., Kramer, A., Busby, D., Czyz,
E., Foster, C. E., Gillespie, B. W.
Importance: The prevalence of suicide among
adolescents is rising, yet little is known about effective interventions. To date, no intervention for suicidal adolescents has been shown to reduce
mortality. Objective(s): To determine whether the Youth-Nominated Support Team Intervention for Suicidal Adolescents-Version II (YST) is associated
with reduced mortality 11 to 14 years after psychiatric hospitalization for suicide risk. Design, Setting, and Participant(s): This post hoc
secondary analysis of a randomized clinical trial used National Death Index (NDI) data from adolescent psychiatric inpatients from 2 US psychiatric
hospitals enrolled in the clinical trial from November 10, 2002, to October 26, 2005. Eligible participants were aged 13 to 17 years and presented
with suicidal ideation (frequent or with suicidal plan), a suicide attempt, or both within the past 4 weeks. Participants were randomized to receive
treatment as usual (TAU) or YST plus TAU (YST). Evaluators and staff who matched identifying data to NDI records were masked to group. The length of
NDI follow-up ranged from 11.2 to 14.1 years. Analyses were conducted between February 12, 2018, and September 18, 2018. Intervention(s): The YST is
a psychoeducational, social support intervention. Adolescents nominated \"caring adults\" (mean, 3.4 per adolescent from family, school, and
community) to serve as support persons for them after hospitalization. These adults attended a psychoeducational session to learn about the youth's
problem list and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and
positive behavioral choices. The adults received weekly supportive telephone calls from YST staff for 3 months. Main Outcomes and Measures: Survival
11 to 14 years after index hospitalization, measured by NDI data for deaths (suicide, drug overdose, and other causes of premature death), from
January 1, 2002, through December 31, 2016. Result(s): National Death Index records were reviewed for all 448 YST study participants (319 [71.2%]
identified as female; mean [SD] age, 15.6 [1.3] years; 375 [83.7%] of white race/ethnicity). There were 13 deaths in the TAU group and 2 deaths in
the YST group (hazard ratio, 6.62; 95% CI, 1.49-29.35; P <.01). No patients were withdrawn from YST owing to adverse effects. Conclusions and
Relevance: The findings suggest that the YST intervention for suicidal adolescents is associated with reduced mortality. Because this was a secondary
analysis, results warrant replication with examination of mechanisms. Trial Registration: ClinicalTrials.gov identifier: NCT00071617. Copyright ©
2019 American Medical Association. All rights reserved.
JAMA Psychiatry, 76(5) : 492-
498
- 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), Psychoeducation, Other Psychological Interventions, Other service delivery and improvement
interventions
Kennard, B. D., Goldstein, T., Foxwell, A.
A., McMakin, D. L., Wolfe, K., Biernesser, C., Moorehead, A., Douaihy, A., Zullo, L., Wentroble, E., Owen,
V., Zelazny, J., Iyengar, S., Porta, G., Brent, D.
Objective: The authors report on a pilot study of an inpatient intervention for suicidal adolescents, As Safe as Possible (ASAP), supported
by a smartphone app (BRITE) to reduce suicide attempts following hospital discharge. Method(s): Across two sites, 66 adolescents hospitalized for
suicidal ideation (N=26) or a recent suicide attempt (N=40) were randomly assigned to the ASAP intervention program plus treatment as usual or to
treatment as usual alone. ASAP, which focuses on emotion regulation and safety planning, is a 3-hour intervention delivered on the inpatient unit.
The BRITE app prompted participants to rate their level of emotional distress on a daily basis and provided personalized strategies for emotion
regulation and safety planning. A blind, independent evaluator assessed suicide attempts following hospital discharge and suicidal ideation at 4, 12,
and 24 weeks after discharge. Result(s): The ASAP intervention did not have a statistically significant effect on suicide attempt, although findings
were in the hypothesized direction for occurrence of an attempt (16% compared with 31%; x2=1.86, df=1, g=20.36) and time to an attempt
(hazard ratio=0.49, 95% CI=0.16, 1.47). Past history of a suicide attempt was a significant moderator of treatment outcome, with a stronger, albeit
nonsignificant, effect of the ASAP intervention among participants with a history of suicide attempt (hazard ratio=0.23, 95% CI=0.05, 1.09). There
were no treatment effects on suicidal ideation. The majority of participants (70%) used the BRITE app (median usage, 19 times). Participants reported
high satisfaction with both the intervention and the app. Conclusion(s): The ASAP intervention program shows promise in reducing the incidence of
postdischarge suicide attempts among adolescents hospitalized for suicidality and merits further study. Copyright © 2018 American Psychiatric
Association. All rights reserved.
American Journal of
Psychiatry, 175(9) : 864-872
- Year: 2018
- 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, Technology, interventions delivered using technology (e.g. online, SMS)
Rengasamy, M., Phelps-Tschang, J., Simpson, M., Tew, J. D., Sparks, G.
Objectives: Few studies have examined the efficacy of telephone-based interventions in reducing suicide attempt rates in adolescents
after discharge from the inpatient psychiatric setting. The time immediately after discharge is a well-known high-risk period for suicide attempts.
This abstract describes a quality improvement intervention using postdischarge telephone contacts with patients and families to assess the effect on
suicide attempts. Method(s): As part of a quality improvement initiative at a major metropolitan hospital, we randomly assigned 142 adolescents (ages
12a\"18 years) who were admitted to inpatient psychiatric units for suicidal ideation or suicide attempt to either a recurrent telephone intervention
over a 3-month period or a single phone call at 3 months after discharge. The recurrent intervention consisted of up to 6 phone contacts to
adolescents and their parents, whereas the single intervention consisted of up to one telephone intervention. The intervention of 10a\"15 minutes
consisted of inquiring about any suicide attempts, a safety plan review that includes medication/weapon safety, and offering assistance with
treatment follow-up evaluation. When possible, both the child and at least one parent were engaged during the contact. Suicide attempts were assessed
using the medical record and adolescent/family report and were defined as interrupted, aborted, or actual attempts. Result(s): Adolescents in the
recurrent intervention arm had significantly fewer suicide attempts (5.6%) compared with adolescents in the mild intervention arm (17.1%) over a 3-
month period [I++2(1, N = 142) = 4.77, p < 0.05]. In the recurrent intervention arm, 84.7% of parents and 72.2% of adolescents had at
least one phone contact. An average of 3.8 phone contacts to parents and 3.1 phone contacts were made to adolescents who received at least one phone
contact in the recurrent intervention arm. There were no differences in baseline suicide attempts, prior inpatient hospitalizations, diagnoses, age,
gender, or inpatient rehospitalizations between the 2 intervention arms. Conclusion(s): This telephone-based intervention was feasible, and recurrent
intervention outreach may be more effective than a single contact in reducing suicide attempts for adolescents in the postdischarge period. TREAT
Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10
Supplement) : S265
- Year: 2018
- 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, Other service delivery and improvement
interventions
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