Baldacara, L.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517.

Revista brasileira de psiquiatria, (pagination) :

Harrington, R., Kerfoot, M., Dyer, E., McNiven, F., Gill, J., Harrington, V., Woodham, A., Byford, S.

Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves

Objective: To establish whether an intervention given by child psychiatric social workers to the families of children and adolescents who had attempted suicide by taking an overdose reduced the patients' suicidal feelings and improved family functioning. Method: One hundred sixty-two patients, aged 16 or younger, who had deliberately poisoned themselves were randomly allocated to routine care (n = 77) or routine care plus the intervention (n = 85). The intervention consisted of an assessment session and four home visits by the social workers to conduct family problem-solving sessions. The control group received no visits. Both groups were assessed at the time of recruitment and 2 and 6 months later. The primary outcome measures were the Suicidal ideation Questionnaire, the Hopelessness Scale, and the Family Assessment Device. Results: There were no significant differences in the primary outcomes between the intervention and control groups at either of the outcome assessments. Parents in the intervention group were more satisfied with treatment (mean difference 1.4 [95% confidence interval 0.8 to 2.1]). A subgroup without major depression had much less suicidal ideation at both outcome assessments (analysis of covariance p < .01) compared with controls. Conclusions: The home-based family intervention resulted in reduced suicidal ideation only for patients without major depression.

Journal of the American Academy of Child & Adolescent Psychiatry., 37(5) : 512-518

Ploeg, J., Ciliska, D., Dobbins, M., Hayward, S., Thomas, H., Underwood, J.

A systematic overview of adolescent suicide prevention programs

The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11 relevant studies. The findings, of this overview indicate that there is currently insufficient evidence to support curriculum-based suicide prevention programs. The evidence suggests that there may be both beneficial and harmful effects of the programs on students. In most studies, knowledge related to suicide improved as a result of the programs. However, studies found both beneficial and harmful effects on attitudes related to suicide. One study found in increase in hopelessness and maladaptive coping for males following the intervention. The literature suggests that more broadly based comprehensive school health programs should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour. [References: 33]

Canadian Journal of Public Health, Revue Canadienne de Sante Publique. 87(5) : 319- 24

Rudd, M. D., Rajab, M. H., Orman, D. T., Joiner, T., Stulman, D. A., Dixon, W.

Effectiveness of an outpatient intervention targeting suicidal young adults: Preliminary results

This study evaluated the effectiveness of a time-limited, outpatient intervention targeting suicidal young adults. Participants (N = 264) were randomly assigned to either the experimental treatment or the control condition (i.e., treatment as usual). In addition to intake assessments, participants completed follow-ups at 1, 6, 12, 18, and 24 months. Both treatment and control participants evidenced significant improvement across all outcome measures throughout the follow-up period. Reductions were reported in suicidal ideation and behavior, associated symptomatology, and experienced stress, along with marked improvement in self-appraised problem- solving ability. Results also indicated that the experimental treatment was more effective than treatment as usual at retaining the highest risk participants. Available data demonstrate the efficacy of a time-limited, outpatient intervention for suicidal young adults. Implications of current findings for intervention with and treatment of this population are discussed.

Journal of Consulting & Clinical Psychology., 64(1) : 179-190

Cotgrove, A., Zirinsky, L., Black, D., Weston, D.

Secondary prevention of attempted suicide in adolescence

Patients discharged from hospital following a suicide attempt were randomly allocated to either: (1) a treatment group receiving standard management plus a token allowing re-admission to hospital on demand; or (2) a control group receiving standard management only. The rates of further suicide attempts and the use of the token in the year following the initial attempt were monitored. Of the 47 adolescents who were allocated tokens, only three (6%) made further suicide attempts in the following year, and five (11%) made use of their tokens to gain admission into hospital. In the control group of 58 adolescents, seven (12%) made further suicide attempts. Although the differences between the groups did not reach the level of statistical significance, the results do suggest lower rates of repeat suicide attempts in the group which received the token, even if it was not used. A clinical assessment of the seriousness of the risk at the time of the first suicide attempt was predictive for later attempts (p=0.01).

Journal of Adolescence., 18(5) : 569- 577

Eggert, L. L., Thompson, E. A., Herting, J. R., Nicholas, L. J.

Reducing suicide potential among high-risk youth: Tests of a school-based prevention program. [erratum appears in Suicide Life Threat Behav 1999 Spring;29(1):96]

This study tested the efficacy of a school-based prevention program for reducing suicide potential among high-risk youth. A sample of 105 youth at suicide risk participated in a three-group, repeated-measures, intervention study. Participants in (1) an assessment plus 1-semester experimental program, (2) an assessment plus 2-semester experimental program, and (3) an assessment-only group were compared, using data from preintervention, 5- month, and 10-month follow-up assessments. All groups showed decreased suicide risk behaviors, depression, hopelessness, stress, and anger; all groups also reported increased self-esteem and network social support. Increased personal control was observed only in the experimental groups, and not in the assessment-only control group. The potential efficacy of the experimental school-based prevention program was demonstrated. The necessary and sufficient strategies for suicide prevention, however, need further study as the assessment-only group, who received limited prevention elements, showed improvements similar to those of the experimental groups.

Suicide & Life-Threatening Behavior, 25(2) : 276- 96

LaFromboise, T., Howard-Pitney, B.

The Zuni life skills development curriculum: Description and evaluation of a suicide prevention program

Journal of Counseling Psychology, 42(4) : 479

McLeavey, B. C., Daly, R. J., Ludgate, J. W., Murray, C. M.

Interpersonal problem- solving skills training in the treatment of self- poisoning patients

The present study evaluated the effectiveness of interpersonal problem- solving skills training (IPSST) for the treatment of self-poisoning patients. Thirty-nine self-poisoning patients were assigned randomly either to IPSST or to a control treatment condition (a brief problem-oriented approach). Both conditions were equally effective in reducing the number of presenting problems and in reducing hopelessness levels. However, the IPSST condition was significantly more effective than the control condition as determined by other outcome measures (measures of interpersonal cognitive problem solving, self-rated personal problem-solving ability, perceived ability to cope with ongoing problems, and self-perception). Follow-up studies showed maintenance of IPSST treatment gains at 6 months and a greater reduction of repetition of self-poisoning in the IPSST group at 1 year posttreatment.

Suicide & Life-Threatening Behavior., 24(4) : 382- 394

Klingman, A, Hochdorf, Z

Coping with distress and self harm: The impact of a primary prevention program among adolescents

The effectiveness of a school-based primary prevention psychological program is assessed in the present study. The program was designed to (a) improve students' distress-coping, (b) prepare them as \"gatekeepers\" with regard to self-destructive behavior of peers and (c) assess the program's face validity and social validity. The program was primarily based on cognitive-behavioral modification principles, procedures and techniques. Two hundred and thirty-seven students, drawn from six homeroom grade eight classes were randomly assigned to experimental and control (no intervention) conditions. The program consisted of seven units passed during twelve weekly one-hour sessions. Overall, the program had a positive effect on attitudes, emotions, knowledge and awareness of distress coping skills. In addition, it had some degree of face validity and social validity from the students' vantage point. These results lend support to the feasibility of a cognitive-behavioral, school-based prevention program for students' distress-coping enhancement.

Journal of Adolescence, 16(2) : 121-40

Orbach, I., Bar-Joseph, H.

The impact of a suicide prevention program for adolescents on suicidal tendencies, hopelessness, ego identity, and coping

Three-hundred ninety-three adolescents from six schools participated in a study aimed at examining the effectiveness of an experiential suicide prevention program with regard to suicidal tendencies, hopelessness, ego identity, and coping ability. The subjects were randomly divided into experimental (n = 215) and control (n = 178) groups. The experimental groups took part in seven weekly 2-hour meetings. The program was based on the notion that a gradual, controlled confrontation and exploration of inner experiences and life difficulties related to suicidal behavior accompanied by an emphasis on coping strategies can immunize against self-destructive feelings. In this pretest-posttest design, the students completed questionnaires of suicidal tendencies, hopelessness, ego identity, and coping ability before and after the program. The statistical analyses showed that the experimental groups were superior to the controls, with at least some of the dependent measures pointing out the effectiveness of the program.

Suicide & Life-Threatening Behavior, 23(2) : 120-129

Hazell, P., Lewin, T.

An evaluation of postvention following adolescent suicide

This study sought to evaluate postvention provided to two schools following student suicides. A risk index for suicidal behavior among exposed adolescents was devised. The index clearly differentiated high (n = 272) and low (n = 534) scorers on a range of outcome variables. While two-thirds of students attending postvention counselling had two or more putative risk factors for suicidal behavior, a further 231 uncounselled students had similar risk scores. Counselled students (n = 63) did not differ from matched controls (n = 63) at 8-month follow-up on a range of outcome variables. Measures to improve future postvention are discussed.

Suicide & Life-Threatening Behavior., 23(2) : 101-109

Vieland V, Whittle B, Garland A, Hicks R, Shaffer D

The impact of curriculum-based suicide prevention programs for teenagers: An 18-month follow-up

In a long-term follow-up of a study designed to assess the impact of school-based suicide prevention curricula on high school students, a group of 174 students from two high schools who were exposed to a prevention program were compared with a group of 207 control students from two additional high schools who were not exposed to the curriculum. A questionnaire, designed to measure the effects of the prevention program on actual help-seeking behaviors and suicide morbidity during the follow-up period, was administered 18 months after delivery of the program. The study failed to find convincing evidence of any program effect.

Journal of the American Academy of Child & Adolescent Psychiatry, 30(5) : 811- 5