Disorders - Suicide or self-harm behaviours
Wharff, E. A., Ginnis, K. B., Ross, A. M., White, E. M., White, M. T., Forbes, P. W.
OBJECTIVE: In current practice, treatment as usual (TAU) for suicidal adolescents includes evaluation, with little or no intervention provided in the emergency department (ED), and disposition, usually to an inpatient psychiatry unit. The family-based crisis intervention (FBCI) is an emergency psychiatry intervention designed to sufficiently stabilize suicidal adolescents within a single ED visit so that they may return home safely with their families. The objective of this article is to report efficacy outcomes related to FBCI for suicidal adolescents and their families.
METHODS: A total of 142 suicidal adolescents (age, 13-18 years) and their families presenting for psychiatric evaluation to a large pediatric ED were randomized to receive FBCI or TAU. Patients and caregivers completed self-report measures of suicidality, family empowerment, and satisfaction with care provided at pretest, posttest, and 3 follow-up time points over a 1-month period.
RESULTS: Patients randomized to FBCI were significantly more likely to be discharged home with outpatient follow-up care compared with their TAU counterparts (P < 0.001). Families randomized to the FBCI condition reported significantly higher levels of family empowerment and client satisfaction with care at posttest compared with their TAU counterparts. Gains were maintained over the follow-up period. No completed suicides were reported during the study period in either condition.
CONCLUSIONS: Family-based crisis intervention is a model of care for suicidal adolescents that may be a viable alternative to traditional ED care that involves inpatient psychiatric hospitalization.
Pediatric Emergency Care, 35(3) : 170-175
- 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)
, Other Psychological Interventions
Wolitzky-Taylor, K., LeBeau, R.T., Perez, M., Gong-Guy, E., Fong, T.
OBJECTIVE: To examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses.
METHODS: College suicide prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed.
RESULTS: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide prevention programs for at-risk students.
CONCLUSION: Prevention programs are beneficial for training those likely to come in contact with people endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal students as well.
Journal of American College Health, : 1-11
- 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)
, Dialectical behavioural therapy (DBT)
Siu, A. M. H.
This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide and self-harm as well as promoting help seeking behavior among young people. Copyright © 2018 Society for Adolescent Health and Medicine
Journal of Adolescent Health, 64(6 Supplement) : S59-S64
- Year: 2019
- 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)
, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement interventions
Rengasamy, M., Sparks, G.
OBJECTIVE: Brief telephone follow-up for a patient with suicidal tendencies after he or she has been discharged from an emergency room or hospital has been shown to decrease subsequent suicide attempts. However, despite the high rate of suicidal behavior in adolescents, this intervention has not been examined in this population. As part of a quality improvement intervention, postdischarge telephone contacts were used to attempt to reduce suicidal behavior and inpatient rehospitalizations among adolescents.
METHODS: Adolescents who were hospitalized for suicidal ideation or attempt (N=142) were randomly assigned to one of two telephone interventions delivered over a 90-day period: either a single call intervention (SCI) or a multiple calls intervention (MCI). The intervention consisted of assessment of suicidality, review of safety plan, and discussion of medication and weapon safety, with up to six telephone contacts in the MCI and up to one contact in the SCI. Primary outcome measures included suicidal behavior and inpatient rehospitalizations; secondary outcome measures included adolescents' confidence in their safety plan.
RESULTS: Adolescents receiving the MCI had a significantly lower rate of suicidal behavior (6%) compared with adolescents receiving SCI (17%; odds ratio [OR]=0.28, p=0.037); results persisted while the analysis controlled for relevant covariates (OR=0.25, p=0.032). Similarly, adolescents receiving the MCI reported significantly greater confidence in their safety plan at 90 days (95%vs. 74%; p=0.001), which, in turn, was associated with a lower rate of suicidal behavior (OR=0.95, p=0.019).
CONCLUSIONS: A telephone-based intervention for providing recurrent follow-up soon after discharge is feasible in the adolescent population and may be effective in reducing postdischarge suicidal behavior.
Psychiatric Services, 70(7) : 545-552
- 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, Other service delivery and improvement interventions
Brown, L. A., Belli, G., Suzuki, N., Capaldi, S., Foa, E. B.
OBJECTIVE: Adolescents with posttraumatic stress disorder (PTSD) are at higher risk for suicide compared to adolescents without PTSD. This study aimed to explore whether PTSD treatment reduces suicidal ideation in adolescents and whether the degree of reduction in PTSD was associated with reduction in suicidal ideation.
METHODS: Adolescent females with PTSD from a sexual assault (55% Black, 15.3 years, SD = 1.5) were randomized to either prolonged exposure therapy for adolescents (PE-A, n= 31) or client-centered therapy (CCT, n = 30). They reported on suicidal ideation, depression and PTSD at pre- and post-treatment, every therapy session, and follow-up, and about 40% endorsed suicidal ideation at baseline.
RESULTS: There was a significant reduction in a single-item measure of suicidal ideation during treatment across all participants. The Time in Treatment x Condition interaction was significant (p < .05, d = 0.52), indicating a significantly steeper reduction in suicidal ideation in PE-A compared to in CCT. The degree of reduction in PTSD (ps < .05, d = 0.26-0.54) and depression symptoms (ps < .05, d = 0.54-0.81) in treatment and follow-up was associated with the speed of suicidal ideation reduction in treatment and follow-up.
CONCLUSIONS: Adolescents randomized to PE-A had significantly faster reductions in suicidal ideation compared to those randomized to CCT. Greater reduction in PTSD and depression symptoms were associated with faster reduction in suicidal ideation. Clinically, this study demonstrates that adolescents who have suicidal ideation without current intent may benefit from PE-A.
Journal of Clinical Child & Adolescent Psychology, : 1-9
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
Diamond, G. S., Kobak, R. R., Krauthamer-Ewing, E. S., Levy, S. A., Herres, J. L., Russon, J. M., Gallop, R. J.
Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents' suicide ideation and depressive symptoms. Method(s): A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Result(s): There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, >=50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion(s): Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419. Copyright © 2018 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry, 58(7) : 721-731
- Year: 2019
- Problem: Depressive Disorders, 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: Psychological Interventions (any)
, Family therapy, Supportive therapy
Sayal, K., Roe, J., Ball, H., Atha, C., Kaylor-Hughes, C., Guo, B., Townsend, E., Morriss, R.
Background: Self-harm and depression are strong risk factors for repeat self-harm and suicide. We aimed to investigate the feasibility of a randomised controlled trial (RCT) of remotely delivered problem-solving cognitive behaviour therapy (PSCBT) plus treatment as usual (TAU) versus TAU in young people with repeat self-harm and depression. Method(s): Single-blind multi-centre RCT with an internal pilot, pre-set stop-go criteria and qualitative semi-structured interviews. Eligible participants (aged 16-30 years) were recruited from 9 adult or child and adolescent self-harm and crisis services; had >= 2 lifetime self-harm episodes, one in the preceding 96 h; and Beck Depression Inventory-II (BDI-II) score >= 17. Participants were randomised (1:1) to either TAU or TAU and 10-12 sessions of PSCBT delivered by mobile phone or video-calling. Result(s): Twenty-two participants were recruited (11 in each arm), 10 (46%) completed follow-up at 6 months, 9 (82%) started the PSCBT and 4 (36%) completed it. The study did not meet three of its four stop-go criteria, reflecting considerable barriers to recruitment and retention. Participants had severe depression symptoms: with mean BDI-II 38.9 in the PSCBT and 37.2 in TAU groups, respectively. Three (14%) unblindings occurred for immediate safety concerns. Barriers to recruitment and retention included lack of agency for participants, severity of depression, recency of crisis with burden for participants and clinicians who diagnosed depression according to pervasiveness. Conclusion(s): RCTs of PSCBT for young people with depression and self-harm are not feasible using recruitment through mental health services that conduct assessments following self-harm presentations. Clinician assessment following self-harm presentation mainly identifies those with severe rather than mild-moderate depression. Copyright © 2019 The Author(s).
BMC Psychiatry, 19 (1) (no pagination)(2005) :
- 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)
, Cognitive & behavioural therapies (CBT)
, Problem solving therapy (PST)
, Technology, interventions delivered using technology (e.g. online, SMS)
Dardas, L. A.
Purpose: The purpose of this study was to explore whether adolescent-perceived family functioning moderates the depression treatment effects on suicidal ideations. Method(s): This is a nonpreregistered exploratory secondary analysis of the TADS RCT, which included four treatment groups: fluoxetine, CBT, their combination, and placebo. A random coefficients regression model with posteriori CONTRAST statements was conducted to examine the effects of depression treatment on adolescents' suicidal ideations over time (N = 439). Baron and Kenny's (1986) and Kraemer et al.'s (2002) approach was followed to explore family functioning as a potential moderator of the treatment effects on suicidal ideations over time. Result(s): Adolescents in the four treatment groups did not differ significantly in their suicidal ideations at initial status; however, those in the combination group had faster reduction in suicidality. Family functioning moderated the relationship between depression treatment and adolescents' suicidal ideations. In particular, the results revealed that for adolescents who reported positive family functioning (n = 249), treatment had a significant impact on their suicidal ideations over time. However, for adolescents who reported negative family functioning (n = 190), type of treatment did not have a differential effect on improvement in severity of suicidal ideation over time. Conclusion(s): Findings provided evidence that the process by which depression treatment impacts adolescents' suicidality is contingent upon their family environment. Family-centered approaches to adolescent depression treatment are recommended. Copyright © 2019 Association for Child and Adolescent Mental Health
Child and Adolescent Mental Health., :
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Glenn, C. R., Esposito, E. C., Porter, A. C., Robinson, D. J.
The current review provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2: Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT. Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop brief efficacious interventions that may be scalable to reach large numbers of youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Clinical Child and Adolescent Psychology, 48(3) : 357-392
- Year: 2019
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other service delivery and improvement interventions
Griffiths, H., Duffy, F., Duffy, L., Brown, S., Hockaday, H., Eliasson, E., Graham, J., Smith, J., Thomson, A., Schwannauer, M.
Background: Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT's effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304-1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents. Method(s): The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables. Result(s): Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm. Conclusion(s): It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population. Trial registration: NCT02771691; Trial Registration Date: 25/04/2016. Copyright © 2019 The Author(s).
BMC Psychiatry, 19 (1) (no pagination)(167) :
- 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)
, Mentalization-based therapy
Xavier, A., Otero, P., Blanco, V., Vazquez, F. L.
OBJECTIVE: The aim of this study was to evaluate the efficacy of a problem-solving intervention for the prevention of suicidal risk in Brazilian adolescents with elevated suicidal potential and depressive symptoms.
METHODS: A randomized controlled trial was conducted involving 100 participants (mean age 17.2 years, 60% women, 46% mixed race), allocated to the problem-solving intervention (n = 50) or the usual care control group (n = 50). Blinded interviewers conducted assessments at pretreatment, posttreatment, 1, 3, and 6 months of follow-up. The main outcome was suicidal orientation; secondary outcomes were suicidal risk, suicidal plans and attempts, depressive symptoms, and problem-solving skills.
RESULTS: At posttreatment and up to 6-month follow-up, there was lower suicidal orientation and suicidal risk in the problem-solving group compared to the control group. There were lower suicidal plans and attempts (0.0% participants vs 2.2% with a suicide plan and 2.2% with both suicide plan and attempt); risk difference was 0.04 (95% CI: 0.01-0.09) and the number needed to treat was 25 (95% CI: 11-70). Significant effects of the intervention on depressive symptoms were found at posttreatment and maintained for 6 months. The change in global and functional problem-solving skills mediated the reduction in suicide orientation.
CONCLUSIONS: Thus, suicidal risk can be successfully prevented in adolescents.
Suicide & Life Threatening Behavior, : 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)
, Problem solving therapy (PST)
Lu, R., Zhou, Y., Wu, Q., Peng, X., Dong, J., Zhu, Z., Xu, W.
Background: The population of left-behind children is growing rapidly in China in recent years. Without parents' company, left-behind children may develop severe emotional problems, which can trigger extreme behaviours such as self-harm and suicide. Previous literature suggests that mindfulness-based intervention could effectively alleviate a variety of sufferings such as anxiety and suicide ideation. The current study sought to examine the effectiveness of mindfulness-based intervention on suicide ideation among left-behind children in China. Methods: This study investigated the effects of an 8-week mindfulness training programme on suicide ideation of left-behind children in China. Forty-nine left-behind children completed a pretest and posttest on mindfulness level, social anxiety, self-esteem, and suicide ideation, with 21 in the mindfulness training group and 28 in the waitlist control group. Results: Adjusting for pretest differences analyses of covariance found that, compared with waitlist control group, the mindfulness training group showed a significant improvement in mindfulness level and decreases in social anxiety and suicide ideation after the 8-week mindfulness training. Conclusion: The findings from this study support that the use of mindfulness-based intervention can effectively reduce the suicide ideation and social anxiety of left-behind children in China. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Child: Care, Health and Development, 45(3) : 371-379
- Year: 2019
- Problem: Social phobia (social anxiety disorder)
, 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)
, Mindfulness based therapy