Disorders - suicide or self-harm behaviours
Balaguru, V., Sharma, J., Waheed, W.
Background: Schools appear an obvious place to deliver suicide prevention interventions for children and adolescents. The
complexity of suicide interventions lead to a paucity of good quality evidence. An alternate approach of information gathering is needed to identify
and collate evidence from existing interventions. Scope: We completed a realist review of school-based suicide interventions. This is a novel method
of understanding complex interventions that uses an iterative approach. In this review, we attempt to clarify and lay out what type of suicide
intervention programme might be useful in schools, based on the local needs and context. Conclusion: It is possible to develop and implement an
evidence-based suicide intervention in schools by understanding the different processes that can contribute to success or failure of these
interventions in a real-world setting. (copyright) 2012 Association for Child and Adolescent Mental Health.
Child & Adolescent Mental Health, 18(3) : 131-139
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Muriungi, S.
K., Ndetei, D. M.
Objective. To determine the effectiveness of psycho-education on symptom severity in depression, hopelessness, suicidality,
anxiety and risk of substance abuse among para-medical students at Kenya Medical Training College (KMTC). Methodology. A clinical trial drew
experimental (N=1 181) and control (N=1 926) groups from different KMTC campuses. Self-administered questionnaires were used to collect data: the
researcher-designed social demographic questionnaire was used at baseline only, while Beck's Depression Inventory, Beck's Hopelessness Scale,
Beck's Suicide Ideation Scale, Beck's Anxiety Inventory and World Health Organization alcohol, smoking and substance involvement screening test
(ASSIST) (for drug abuse) were used for baseline, mid-point and end-point assessments at 3-month intervals. The experimental group received a total
of 16 hours of structured psycho-education. All study participants gave informed consent. Results. Overall, there was no significant reduction in
symptom severity between the experimental and control groups at 3 months (p>0.05) but there was a significant difference at 6 months (p<0.05).
Conclusion. Psycho-education was effective in reducing the severity of symptoms of depression, hopelessness, suicidality, anxiety and risk of
substance abuse at 6 months.
South African Journal of Psychiatry, 19(2) : 41-
50
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Ono, Y., Sakai, A., Otsuka, K., Uda, H., Oyama, H., Ishizuka, N., Awata, S., Ishida, Y., Iwasa, H., Kamei, Y., Motohashi, Y., Nakamura, J., Nishi, N., Watanabe, N., Yotsumoto, T., Nakagawa, A., Suzuki, Y., Tajima,
M., Tanaka, E., Sakai, H., Yonemoto, N.
Background: Multilevel and multimodal
interventions have been suggested for suicide prevention. However, few studies have reported the outcomes of such interventions for suicidal
behaviours. Methods: We examined the effectiveness of a community-based multimodal intervention for suicide prevention in rural areas with high
suicide rates, compared with a parallel prevention-as-usual control group, covering a total of 631,133 persons. The effectiveness was also examined
in highly populated areas near metropolitan cities (1,319,972 persons). The intervention started in July 2006, and continued for 3.5 years. The
primary outcome was the incidence of composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency
ward for critical care. We compared the rate ratios (RRs) of the outcomes adjusted by sex, age group, region, period and interaction terms. Analyses
were performed on an intention-to-treat basis and stratified by sex and age groups. Findings: In the rural areas, the overall median adherence of the
intervention was significantly higher. The RR of the composite outcome in the intervention group decreased 7% compared with that of the control
group. Subgroup analyses demonstrated heterogeneous effects among subpopulations: the RR of the composite outcome in the intervention group was
significantly lower in males (RR = 0.77, 95% CI 0.59 - 0.998, p = 0.0485) and the RR of suicide attempts was significantly lower in males (RR = 0.39,
95% CI 0.22 - 0.68, p = 0.001) and the elderly (RR = 0.35, 95% CI 0.17 - 0.71, p = 0.004). The intervention had no effect on the RR of the composite
outcome in the highly populated areas. Interpretation: Our findings suggest that this community-based multimodal intervention for suicide prevention
could be implemented in rural areas, but not in highly populated areas. The effectiveness of the intervention was shown for males and for the elderly
in rural areas. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
PLoS
ONE, 8(10) :
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Klimes-Dougan, B., Klingbeil, D. A., Meller, S. J.
Background: While the ultimate goal of adolescent suicide-prevention efforts is
to decrease the incidence of death by suicide, a critical intermediary goal is directing youths toward effective sources of assistance.; Aim: To
comprehensively review the universal prevention literature and examine the effects of universal prevention programs on student's attitudes and
behaviors related to help-seeking.; Method: We systematically reviewed studies that assessed help-seeking outcomes including prevention efforts
utilizing (1) psychoeducational curricula, (2) gatekeeper training, and (3) public service messaging directed at youths. Of the studies reviewed, 17
studies evaluated the help-seeking outcomes. These studies were identified through a range of sources (e.g., searching online databases, examining
references of published articles on suicide prevention).; Results: The results of this review suggest that suicide-prevention programming has a
limited impact on help-seeking behavior. Although there was some evidence that suicide-prevention programs had a positive impact on students' help-
seeking attitudes and behaviors, there was also evidence of no effects or iatrogenic effects. Sex and risk status were moderators of program effects
on students help-seeking.; Conclusions: Caution is warranted when considering which suicidal prevention interventions best optimize the intended
goals. The impact on adolescents' help-seeking behavior is a key concern for educators and mental-health professionals.;
Crisis, 34(2) : 82-97
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any)
O'Leary-Barrett, M., Topper, L., Al-
Khudhairy, N., Pihl, R.
O., Castellanos-Ryan, N., Mackie, C. J., Conrod, P. J.
Objective To assess the 2-year impact of teacher-delivered, brief, personality-targeted interventions on internalizing and
externalizing symptoms in an adolescent U.K. sample. Method This cluster-randomized trial was run in 19 London schools (N = 1,024 adolescents).
Trained school-based professionals delivered two 90-minute, CBT-based group interventions targeting 1 of 4 personality-risk profiles: anxiety
sensitivity, hopelessness, impulsivity, or sensation seeking. Self-report depression, anxiety, and conduct disorder symptoms were assessed at 6-month
intervals. Results Interventions were associated with significantly reduced depressive, anxiety, and conduct symptoms (p <.05) over 2 years in the
full sample, reduced odds of severe depressive symptoms (odds ratio [OR] = 0.74, CI = 0.58-0.96), and conduct problems (OR = 0.79, CI = 0.65-0.96),
and a nonsignificant reduction in severe anxiety symptoms (OR = 0.79, CI = 0.59-1.05). Evaluating a priori personality-specific hypotheses revealed
strong evidence for impulsivity-specific effects on severe conduct problems, modest evidence of anxiety sensitivity-specific effects on severe
anxiety, and no evidence for hopelessness-specific effects on severe depressive symptoms. Conclusions Brief, personality-targeted interventions
delivered by educational professionals can have a clinically significant impact on mental health outcomes in high-risk youth over 2 years, as well as
personality-specific intervention effects in youth most at risk for a particular problem, particularly for youth with high levels of impulsivity.
Clinical trial registration information - Adventure: The Efficacy of Personality-Targeted Interventions for Substance Misuse and Other Risky
Behaviors as Delivered by Educational Professionals; http://clinicaltrials.gov; NCT00776685.
Journal of the
American Academy of Child & Adolescent Psychiatry, 52(9) : 911-920
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, 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), Other Psychological Interventions
Ougrin, D., Boege, I., Stahl, D., Banarsee, R., Taylor, E.
Background: An earlier randomised controlled trial demonstrated improved treatment engagement in adolescents who
received Therapeutic Assessment (TA) versus Assessment As Usual (AAU), following an emergency presentation with self-harm.; Objectives: To determine
2-year outcomes for the same adolescents focusing on frequency of Accident and Emergency (A&E) self-harm presentations and treatment engagement.;
Method: Patients in the TA groups (n=35) and the AAU group (n=34) were followed up 2 years after the initial assessment. Their primary and secondary
care electronic records were analysed.; Results: There was no significant difference in the frequency of self-harm resulting in A&E presentations
between the two groups (OR 0.69, 95% CI 0.23 to 2.13, p=0.53). Treatment engagement remained higher in the TA group than the AAU group.; Conclusions:
TA is not associated with a lower frequency of A&E self-harm presentations. The effect of TA on engagement is maintained 2 years after the initial
assessment. Interventions to reduce self-harm in adolescents are needed.; Trial Registration: ISRCTN 81605131, http://www.controlled-
trials.com/ISRCTN81605131/;
Archives of Disease in Childhood, 98(10) : 772-776
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Pineda, J., Dadds, M. R.
Objective:
Family processes are a risk factor for suicide but few studies target this domain. We evaluated the effectiveness of a family intervention, the
Resourceful Adolescent Parent Program (RAP-P) in reducing adolescent suicidal behavior and associated psychiatric symptoms. Method: A preliminary
randomized controlled trial compared RAP-P plus Routine Care (RC) to RC only, in an outpatient psychiatric clinic for N = 48 suicidal adolescents and
their parents. Key outcome measures of adolescent suicidality, psychiatric disability, and family functioning were completed at pre-treatment, 3-
month, and 6-month follow-up. Results: RAP-P was associated with high recruitment and retention, greater improvement in family functioning, and
greater reductions in adolescents' suicidal behavior and psychiatric disability, compared to RC alone. Benefits were maintained at follow-up with a
strong overall effect size. Changes in adolescent's suicidality were largely mediated by changes in family functioning. Conclusion: The study
provides preliminary evidence for the use of family-focused treatments for adolescent suicidal behavior in outpatient settings. Clinical trial
registration information - Family intervention for adolescents with suicidal behaviour: A randomized controlled trial and mediation analysis;
http://anzctr.org/; ACTRN12613000668707. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Journal of the American Academy of Child & Adolescent Psychiatry, 52(8) : 851-
862
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
du-Roscoat, E., Beck, F.
Aim: This review focuses on
interventions to prevent suicide. It excludes psychotherapy evaluations and pharmaceutical clinical trials. The aim of this article is to provide
useful input to the reflection on and the development of actions for professionals who may be concerned by suicide prevention.; Method: This research
is based on 41 published evaluation studies presenting results on at least one of the three following outcomes: completed suicides, suicide attempts,
and suicidal ideations. These studies have been classified into seven categories of preventive action.; Results: According to data from the
literature selected for our analysis, the three most efficient categories of intervention seem to be the limitation of access to lethal means, the
preservation of contact with the patients hospitalized for a suicide attempt after hospitalization, and the implementation of emergency call centers.
The four other categories of intervention examined in this study - the training of general practitioners, the reorganization of care, programs in
schools, and information campaigns - have not yet shown sufficient proof of their efficacy. Nevertheless, these interventions, under certain
conditions, can also contribute significantly to the prevention of suicide.; Conclusion: The majority of effective interventions minister to people
already suffering from psychological disorders, but health promotion initiatives prior to situations of psychological disorders also deserve to be
considered, in particular the implementation of services for the isolated elderly.; Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Revue D'épidémiologie Et De Santé
Publique, 61(4) : 363-374
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
Hughes, J. L., Asarnow, J. R.
Suicide is the third leading cause of death in adolescents, and often, youths with suicidal behavior or ideation present to
the emergency department (ED) for care. Many suicidal youths do not receive mental health care after discharge from the ED, and interventions are
needed to enhance linkage to outpatient intervention. This article describes the Family Intervention for Suicide Prevention (FISP). Designed for use
in emergency settings, the FISP is a family-based cognitive behavior therapy session designed to increase motivation for follow-up treatment,
support, coping, and safety, augmented by care linkage telephone contacts after discharge. In a randomized trial of the intervention, the FISP was
shown to significantly increase the likelihood of youths receiving outpatient treatment, including psychotherapy and combined medication and
psychotherapy. The FISP is a brief, focused, efficacious treatment that can be delivered in the ED to improve the probability of follow-up treatment
for suicidal youths. (copyright) 2013 Elsevier Inc.
Clinical
Pediatric Emergency Medicine, 14(1) : 28-34
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Katz, C., Bolton, S-L., Katz, L. Y., Isaak, C., Tilston-Jones, T., Sareen, J.
Objective: Suicide is one of the leading causes of death among
youth today. Schools are a cost-effective way to reach youth, yet there is no conclusive evidence regarding the most effective prevention strategy.
We conducted a systematic review of the empirical literature on school-based suicide prevention programs.; Method: Studies were identified through
MEDLINE and Scopus searches, using keywords such as \"suicide, education, prevention and program evaluation.\" Additional studies were identified
with a manual search of relevant reference lists. Individual studies were rated for level of evidence, and the programs were given a grade of
recommendation. Five reviewers rated all studies independently and disagreements were resolved through discussion.; Results: Sixteen programs were
identified. Few programs have been evaluated for their effectiveness in reducing suicide attempts. Most studies evaluated the programs' abilities to
improve students' and school staffs' knowledge and attitudes toward suicide. Signs of Suicide and the Good Behavior Game were the only programs
found to reduce suicide attempts. Several other programs were found to reduce suicidal ideation, improve general life skills, and change gatekeeper
behaviors.; Conclusions: There are few evidence-based, school-based suicide prevention programs, a combination of which may be effective. It would be
useful to evaluate the effectiveness of general mental health promotion programs on the outcome of suicide. The grades assigned in this review are
reflective of the available literature, demonstrating a lack of randomized controlled trials. Further evaluation of programs examining suicidal
behavior outcomes in randomized controlled trials is warranted.; © 2013 Wiley Periodicals, Inc.
Depression & Anxiety, 30(10) : 1030-
1045
- Year: 2013
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Gleeson, J. F. M., Chanen, A., Cotton, S. M., Pearce, T., Newman, B., McCutcheon, L.
Aim: First-episode psychosis and borderline
personality disorder are severe mental disorders that have their onset in youth. Their co-occurrence is clinically well recognized, is associated
with significant risks and is complex to treat. Yet, there is no published specific intervention for this problem. This study reports a pilot
randomized controlled trial comparing combined specialist first-episode treatment plus specialist early intervention for borderline personality,
entitled Helping Young People Early, with specialist first-episode treatment alone. We aimed to evaluate the safety and feasibility of adding early
intervention for borderline personality. Methods: The study investigated the safety of specialist first-episode treatment plus specialist early
intervention for borderline personality in relation to deterioration in psychosis, aggression, self-harm and suicidality, and feasibility in relation
to the completion of therapy phases. Sixteen patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision
(DSM-IV-TR) criteria for first-episode psychosis and borderline personality (four or more DSM-IV criteria) were randomized either to specialist
first-episode treatment alone or specialist first-episode treatment plus specialist early intervention for borderline personality and were followed
up at the end of treatment and 6months later. Results: The results showed that it was feasible to recruit and assess a high risk and complex group of
patients who were agreeable to study participation. Specialist first-episode treatment plus specialist early intervention for borderline personality
was an acceptable and safe treatment. Conclusion: A larger-scale randomized controlled trial of early intervention for borderline personality for
young first-episode psychosis patients with co-occurring full or subsyndromal borderline personality is warranted. (copyright) 2011 Blackwell
Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 6(1) : 21-
29
- Year: 2012
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive analytic therapy (CAT), Case management
Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., Iverson, K. M.
Objective: College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with
complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an
optimized control condition and analyzed baseline global functioning as a moderator. Method: The intent-to-treat (ITT) sample included 63 college
students between the ages of 18 and 25 years who were suicidal at baseline, reported at least 1 lifetime nonsuicidal self-injurious (NSSI) act or
suicide attempt, and met 3 or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or
an optimized treatment-as-usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments.
Both treatments lasted 7-12 months and included both individual and group components. Assessments were conducted at pretreatment, 3 months, 6 months,
9 months, 12 months, and 18 months (follow-up). Results: Mixed effects analyses (ITT sample) revealed that DBT, compared with the control condition,
showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and
psychotropic medication use and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up.
No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who
were lower functioning at pretreatment. Conclusions: DBT is an effective treatment for suicidal, multiproblem college students. Future research
should examine the implementation of DBT in CCCs in a stepped care approach. (copyright) 2012 American Psychological Association.
Journal of Consulting &
Clinical Psychology, 80(6) : 982-994
- Year: 2012
- Problem: Non-suicidal self-harm behaviours, 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)