Disorders - Suicide or self-harm behaviours
Schilling, E. A., Lawless, M., Buchanan, L., Aseltine, R. H., Jr.
Although the Signs of Suicide (SOS) suicide prevention program has been implemented at both the middle and high school levels, its efficacy has been demonstrated previously only among high school students. The current study evaluated SOS implemented in high military impact middle schools. Compared to controls, SOS participants demonstrated improved knowledge about suicide and suicide prevention, and participants with pretest ideation reported fewer suicidal behaviors at posttest than controls with pretest ideation. These results provide preliminary evidence for SOS's efficacy as a suicide prevention program for middle school students.; © 2014 The American Association of Suicidology.
Suicide & Life-Threatening Behavior, 44(6) : 653-667
- Year: 2014
- 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, Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions, Other service delivery and improvement interventions
Shek, D. T. L., Ma, C. M. S.
Adopting a static group comparison design, this study examined the effectiveness of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programs) using social survey data. In a longitudinal study, 3328 students were recruited from 28 secondary schools for the wave 1 data, with 16 participating schools (P group) and 12 nonparticipating schools (NP group). The data were collected roughly 4 months after the inception of Project P.A.T.H.S., and the data collection time for the two groups was similar. Results showed that the two groups did not differ in their school characteristics, with the exception of student age, length of stay in Hong Kong and family functioning. Analyses of covariance were conducted with the removal of the effects of age, length of stay in Hong Kong and family functioning. Compared with students in the nonparticipating schools, students participating in the Project P.A.T.H.S. had better positive youth development and displayed less adolescent risk behavior. Acknowledging the limitations of a static group comparison as a pre-experimental design, the present study provides supplementary evidence on the effectiveness of the Project P.A.T.H.S. in Hong Kong.
International Journal on Disability & Human Development, 13(4) : 489-496
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Townsend, E.
Self-harm is a common problem among young people with many presenting to clinical services via general hospitals, but many more do not come to the attention of clinical services at all. Self-harm is strongly associated with completed suicide so it is extremely important that patients are assessed and treated for this problem effectively. Despite the scale of the problem in young people, there is a very limited evidence base on what interventions may help them to recover from self-harm. The evidence is discussed here and some recommendations are made about how to engage clinically with young people who self-harm from assessment to therapeutic intervention.
Evidence-Based Mental Health, 17(4) : 97-99
- Year: 2014
- 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)
Robinson, J., Cox, G., Hetrick, S.
Background: Suicide-related behaviours are common among young people. At least 100,000 adolescents complete suicide every year, and worldwide, suicide ranks in the top five causes of mortality among 15 - 19 year olds. Suicide attempt and suicidal ideation are more common, with just under 10% of adolescents reporting lifetime rates of attempted suicide, and almost 30% reporting a lifetime prevalence of suicidal ideation. A number of countries have developed national suicide prevention strategies with youth as one of the groups to be targeted, yet despite this, and despite the extent of this problem, little is known about the effectiveness of interventions to reduce risk, in both general and clinical populations. Thus the aims of this paper are to briefly describe the rates and risk factors associated with suicide-related behaviour in young people and the to examine in more detail the evidence for a range of interventions designed to reduce risk that could inform both clinical practice and government policy. Methods: Three systematic reviews, and one narrative review, were conducted in order to examine the range, and effectiveness, of interventions designed to reduce suicide risk among young people, in clinical, schoolbased and online settings. For each of the reviews conducted suicide-related behaviour had to be a primary outcome of interest. Results: Suicide prevention in clinical settings: Fifteen published trails were included. Of them two targeted young people with mood disorders, one targeted young people with borderline personality disorder and one study targeted young people with a psychotic disorder. Interventions included (but are not restricted to): medication, a family-based intervention, dialectical behavioural therapy, problem-solving therapy, cognitive behavioural therapy and group therapy. No differences were found between treatment and control groups except in one study that found a difference in rates of suicidal ideation between individual cognitive behavioural therapy and treatment as usual. Suicide prevention in school settings: Forty-three studies were included here, of which 15 reported on universal education or awareness programs, 23 reported on selective interventions (e.g. gatekeeper training and screening programs), 3 reported on targeted interventions, and 2 examined a postvention response in schools. Of these studies the most promising appeared to be gatekeeper training and screening programs, although more research is necessary. Suicide prevention in online settings: These reviews found that, despite the number, and potential effectiveness of, online programs for young people with depression and/or anxiety disorders, there are currently no published studies reporting on the effects of online therapy for suicidal youth. Similarly a number of studies have been found that discuss the relationship between suicide and social media, however despite the popularity and the potential reach of social media, no actual interventions studies were identified. Discussion: Overall it is concluded that whilst we know much about the epidemiology of suicide among youth, there is a dearth of well-conducted studies that provide adequate evidence regarding what works in youth suicide prevention. This has implications both clinically and at a policy level. A greater emphasis on intervention studies - including novel interventions would lead to better practice in terms of detecting and supporting suicidal young people, and could also contribute to a better informed, and more evidence-based, policy agenda around the world.
Schizophrenia Research, 153 : S10-S11
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
Harrod, Curtis. S., Goss, Cynthia. W., Stallones, Lorann., DiGuiseppi, Carolyn.
Background: Suicide is a leading cause of death among post-secondary students worldwide. Suicidal thoughts and planning are common among post-secondary students. Previous reviews have examined the effectiveness of interventions for symptomatic individuals; however, many students at high risk of suicide are undiagnosed and untreated.; Objectives: We evaluated the effect on suicide and suicide-related outcomes of primary suicide prevention interventions that targeted students within the post-secondary setting.; Search Methods: We searched the following sources up to June 2011: Specialised Registers of two Cochrane Groups, Cochrane Central Register of Controlled Trials, and nine other databases, trial registers, conference proceedings, and websites of national and international organizations. We screened reference lists and contacted authors of included studies to identify additional studies. We updated the search in November 2013; we will include these results in the review's next update.; Selection Criteria: We included studies that tested an intervention for the primary prevention of suicide using a randomized controlled trial (RCT), controlled before-and-after (CBA), controlled interrupted time series (CITS), or interrupted time series (ITS) study design. Interventions targeted students within the post-secondary setting (i.e. college, university, academy, vocational, or any other post-secondary educational institution) without known mental illness, previous suicide attempt or self-harm, or suicidal ideation. Outcomes included suicides, suicide attempts, suicidal ideation, changes in suicide-related knowledge, attitudes and behavior, and availability of means of suicide.; Data Collection and Analysis: We used standardized electronic forms for data extraction, risk of bias and quality of evidence determination, and analysis. We estimated standardised mean differences (SMD) with 95% confidence intervals (CIs). We analysed studies by intervention type and study design. We summarized RCT effect sizes using random-effects models meta-analyses; and analysed statistical heterogeneity using the Chi(2) test and I(2) statistic. We described narratively the results from studies that used other study designs.; Main Results: Eight studies met inclusion criteria. They were heterogeneous in terms of participants, study designs, and interventions. Five of eight studies had high risk of bias. In 3 RCTs (312 participants), classroom-based didactic and experiential programs increased short-term knowledge of suicide (SMD = 1.51, 95% CI 0.57 to 2.45; moderate quality evidence) and knowledge of suicide prevention (SMD = 0.72, 95% CI 0.36 to 1.07; moderate quality evidence). The effect on suicide prevention self-efficacy in one RCT (152 participants) was uncertain (SMD = 0.20, 95% CI -0.13 to 0.54; low quality evidence). One CBA analysed the effects of an institutional policy that restricted student access to laboratory cyanide and mandated professional assessment for suicidal students. The incidence of student suicide decreased significantly at one university with the policy relative to 11 control universities, 2.00 vs. 8.68 per 100,000 (Z = 5.90; P < 0.05). Four CBAs explored effects of training 'gatekeepers' to recognize and respond to warning signs of emotional crises and suicide risk in students they encountered. The magnitude of effect sizes varied between studies. Gatekeeper training enhanced short-term suicide knowledge in students, peer advisors residing in student accommodation, and faculty and staff, and suicide prevention self-efficacy among peer advisors. There was no evidence of an effect on participants' suicide-related attitudes or behaviors. One CBA found no evidence of effects of gatekeeper training of peer advisors on suicide-related knowledge, self-efficacy, or gatekeeper behaviors measured four to six months after intervention.; Authors' Conclusions: We found insufficient evidence to support widespread implementation of any programs or policies for primary suicide prevention in post-secondary educational settings. As all evaluated interventions combined primary and secondary prevention components, we were unable to determine the independent effects of primary preventive interventions. Classroom instruction and gatekeeper training increased short-term suicide-related knowledge. We found no studies that tested the effects of classroom instruction on suicidal behavior or long-term outcomes. Limited evidence suggested minimal longer-term effects of gatekeeper training on suicide-related knowledge, while no evidence was found evaluating its effect on suicidal behavior. A policy-based suicide intervention reduced student suicide, but findings have not been replicated. Our findings are limited by the overall low quality of the evidence and the lack of studies from middle- and low-income countries. Rigorously designed studies should test the effects of preventive interventions on important health outcomes, including suicidal ideation and behavior, in varying post-secondary settings.;
Cochrane Database of Systematic Reviews, 10 : CD009439
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
Husain, Nusrat., Afsar, Salahuddin., Ara, Jamal., Fayyaz, Hina., Rahman, R. U., Tomenson, Barbara., Hamirani, Munir., Chaudhry, Nasim., Fatima, Batool., Husain, Meher., Naeem, Farooq., Chaudhry, Imran. B.
Background: Self-harm is a major risk factor for completed suicide.; Aims: To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU).; Method: The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation.; Results: A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU.; Conclusions: The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.; Royal College of Psychiatrists.
British Journal of Psychiatry, 204(6) : 462-470
- Year: 2014
- 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)
Ghaziuddin, N., Merchant, C., Dopp, R., King, C.
Objective: Describe suicidal ideation and suicide related/other emergencies (SRE), among depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization. Methods: One hundred twenty adolescents, who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication groups: SSRI antidepressant only (n = 71); SSRI plus mood stabilizer (n = 17); SSRI plus antipsychotic (n = 20); and SSRI plus antipsychotic and mood stabilizer (n = 12). Standardized instruments were used. Results: Mean age = 15.5 (plus or minus) 1.3, Caucasian = 80.8%, female = 74.2%, mean CDRS-R = 61.7 (plus or minus) 12.1, suicide attempt during month prior to hospitalization = 58.6%. During the 3-month post-hospitalization period: (1) there were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were associated with greater reduction in suicidal ideation at 3-months. Conclusion: Declines in suicidal ideation, depression severity, and suicide attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify medication adherence is a study limitation.
Asian Journal of Psychiatry, 11 : 13-19
- Year: 2014
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Anticonvulsants/mood stabilisers (excl. lithium)
Jegannathan, B., Dahlblom, K., Kullgren, G.
Background: Most of the school-based interventions to prevent suicide are from high income countries and there is a need for evidence based interventions in resource-poor settings. The aim of this study is to evaluate the outcome of a school based intervention to reduce risk factors for suicide among young people in Cambodia by promoting life skills. Method: Six classes were randomly selected from two schools each, one designated as experimental and the other as control school, respectively. In experimental school 168 young people (M = 92, F = 76) received 6 sessions of life skills education and in the control school 131 students (M = 53, F = 78) received three general sessions on health. We looked at the pre-post differences on Life-Skills Development Scale Adolescent Form (LSDS-AF)- and Youth Self-Report (YSR) questionnaire to measure the effect size (ES) from the intervention after 6 months. We analyzed the data by stratifying for gender and for those who reported more severe suicidal expressions at baseline (high-risk group). Results: The girls showed improvement in Human Relationship (ES = 0.57), Health Maintenance (ES = 0.20) and the Total Life Skills Dimensions (ES = 0.24), whereas boys with high-risk behavior improved on Human Relationship (ES = 0.48), Purpose in Life (ES = 0.26) and Total Life Skills Dimensions (ES = 0.22). Effect size for YSR-syndrome scores among all individuals showed no improvement for either gender. Among high-risk individuals boys had a small to moderate effect size from intervention on Withdrawn/Depressed (ES = 0.40), Attention problems (ES = 0.46), Rule breaking behavior (ES = 0.36), Aggressive behavior (ES = 0.48) and Externalizing syndrome (ES = 0.64). Conclusion: Promoting life skills in schools may enhance the overall mental health of young people, indirectly influencing suicide, particularly among boys with high-risk behavior in Cambodia. (copyright) 2014 Elsevier B.V.
Asian Journal of Psychiatry, 9 : 78-84
- Year: 2014
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Skills training
Perry, Y., Petrie, K., Buckley, H., Cavanagh, L., Clarke, D., Winslade, M., Hadzi-Pavlovic, D., Manicavasagar, V., Christensen, H.
Evidence suggests that poor mental health literacy is a key barrier to help-seeking for mental health difficulties in adolescence. Educational programs have shown positive effects on literacy, however, the evidence base remains limited and available studies have many methodological limitations. Using cluster Randomised Control Trial (RCT) methodology, the current study examines the impact of 'HeadStrong', a school-based educational intervention, on mental health literacy, stigma, help-seeking, psychological distress and suicidal ideation. A total of 380 students in 22 classes (clusters) from 10 non-governmentsecondary schools was randomised to receive either HeadStrong or Personal Development, Health and Physical Education (PDHPE) classes. Participants were assessed pre- and post-intervention, and at 6-month follow-up. Literacy improved and stigma reduced in both groups at post-intervention and follow-up, relative to baseline. However, these effects were significantly greater in the HeadStrong condition. The study demonstrates the potential of HeadStrong to improve mental health literacy and reduce stigma. (copyright) 2014 The Foundation for Professionals in Services for Adolescents.
Journal of Adolescence, 37(7) : 1143-1151
- Year: 2014
- Problem: Anxiety Disorders (any), Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Kerr, D. C. R., Degarmo, D. S., Leve, L. D., Chamberlain, P.
Objective: Multidimensional Treatment Foster Care (MTFC) has been found to reduce delinquency among girls in juvenile justice through 2-year follow-up. Given that such girls are at elevated risk for suicide and depression into adulthood, we tested MTFC effects on long-term trajectories of suicidal ideation and depressive symptoms. Method: Girls (N = 166; mean [SD] age = 15.3 [1.2] years; 68% White) with a recent criminal referral who were mandated to out-of-home care were enrolled in 2 sequential cohorts. Girls were randomized to receive MTFC (n = 81) or group care (GC) treatment as usual (TAU; n = 85); the second MTFC cohort also received modules targeting substance use and risky sexual behavior. Depressive symptoms and suicidal ideation were assessed repeatedly through early adulthood (mean [SD] follow-up = 8.8 [2.9] years). Suicide attempt history was assessed in early adulthood. Results: Girls assigned to MTFC showed significantly greater decreases in depressive symptoms across the long-term follow-up than GC girls ((pi)= .86, p <.05). Decreases in suicidal ideation rates were slightly stronger in MTFC than in GC as indicated by a marginal main effect (odds ratio [OR] =.92, p <.10) and a significant interaction that favored MTFC in the second cohort relative to the first (OR =.88, p <.01). There were no significant MTFC effects on suicide attempt. Conclusions: MTFC decreased depressive symptoms and suicidal thinking beyond the decreases attributable to time and TAU. Thus, MTFC has further impact on girlsa' lives than originally anticipated. (copyright) 2014 APA.
Journal of Consulting & Clinical Psychology, 82(4) : 684-693
- Year: 2014
- Problem: 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: Service Delivery & Improvement, Other service delivery and improvement interventions
Mousavi, S. G., Zohreh, R., Maracy, M. R., Ebrahimi, A., Sharbafchi, M. R.
Background: prevention of suicide is one of priority world health. Suicide is one of the preventable causes of death. The aim of this study is evaluation of telephone follow up on suicide reattempt.; Materials and Methods: This randomized controlled clinical trial is a prospective study which has been done in Noor Hospital of Isfahan-Iran, at 2010. 139 patients who have suicide attempt history divided in one of two groups, randomly, 70 patients in" treatment as usual (TAU)" and 69 patients in "brief interventional control (BIC). Seven telephone contact with BIC group patients have been done "during six months" and two questionnaires have been filled in each session. The data has been analyzed by descriptive and Chi-square test, under SPSS.; Results: No significant differences of suicide reattempt has been found between two groups (P = 0.18), but significant reduction in frequency of suicidal thoughts (P = 0.007) and increase in hope at life (P = 0.001) was shown in intervention group.; Conclusion: Telephones follow up in patients with suicide history decrease suicidal thought frequency" and increase hope in life, significantly.;
Advanced Biomedical Research, 3 : 198-198
- Year: 2014
- 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
Mehlum, L., Tormoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., Larsson, B. S., Stanley, B. H., Miller, A. L., Sund, A. M., Groholt, B.
Objective: We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. Method: This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Results: Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. Conclusion: DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129. © 2014 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, :
- Year: 2014
- 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)