Disorders - Suicide or self-harm behaviours
Rossouw, T. I., Fonagy, P.
Objective: We examined whether mentalization-based treatment for adolescents (MBT-A) is more effective than treatment as usual (TAU) for adolescents who self-harm. Method: A total of 80 adolescents (85 female) consecutively presenting to mental health services with self-harm and comorbid depression were randomly allocated to either MBT-A or TAU. Adolescents were assessed for self-harm, risk-taking and mood at baseline and at 3-monthly intervals until 12 months. Their attachment style, mentalization ability and borderline personality disorder (BPD) features were also assessed at baseline and at the end of the 12-month treatment. Results: MBT-A was more effective than TAU in reducing self-harm and depression. This superiority was explained by improved mentalization and reduced attachment avoidance and reflected improvement in emergent BPD symptoms and traits. Conclusions: MBT-A may be an effective intervention to reduce self-harm in adolescents. Clinical trial registration information: - The emergence of personality disorder traits in adolescents who deliberately self harm and the potential for using a mentalisation based treatment approach as an early intervention for such individuals: a randomised controlled trial; http://www.controlled-trials.com; ISRCTN95266816. (copyright) 2012 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 51(12) : 1304-1313.e3
- Year: 2012
- 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
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)
Ougrin, D., Zundel, T., Kyriakopoulos, M., Banarsee, R., Stahl, D., Taylor, E.
Self-harm is one of the best predictors of death by suicide, but few studies directly compare adolescents with suicidal versus nonsuicidal self-harm. Seventy adolescents presenting with self-harm (71% young women, ages 12-18 years) who participated in a randomized controlled trial were divided into suicidal and nonsuicidal self-harm categories using the Columbia Classification Algorithm of Suicide Assessment. Adolescents with suicidal self-harm were more likely than those with nonsuicidal self-harm to be young women, 22/23 (96%) versus 34/47 (72%), odds ratio (OR) = 8.33, 95% confidence interval (CI) [1.03, 50.0]; had a later age of onset of self-harm, 15.4 years vs. 13.8 years, mean difference = 1.6, 95% CI [.8, 2.43]; and used self-poisoning more often, 18/23 (78%) versus 11/47 (23%), OR = 3.43, 95% CI [2.00, 5.89]. Only those with nonsuicidal self-harm had an improvement on Children's Global Assessment Scale score following a brief therapeutic intervention, mean difference = 8.20, 95% CI [.97, 15.42]. However, there was no interaction between treatment and suicidality. There are important differences between adolescents presenting with suicidal and nonsuicidal self-harm. Suicidal self-harm in adolescence may be associated with a less favorable response to therapeutic assessment. (copyright) 2011 American Psychological Association.
Psychological Assessment, 24(1) : 11-20
- 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)
, Other Psychological Interventions
Kutcher, S., Wei, Y.
PURPOSE OF REVIEW: Addressing youth mental health in secondary schools has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental health promotion, prevention, early identification and intervention/treatment. RECENT FINDINGS: In contrast to the abundance of school-based mental health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration. SUMMARY: Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental health promotion, prevention and intervention. (copyright) 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Current Opinion in Psychiatry, 25(4) : 311-316
- Year: 2012
- Problem: Depressive Disorders, 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)
, Other Psychological Interventions, Other service delivery and improvement interventions
Kidger, J., Araya, R., Donovan, J., Gunnell, D.
BACKGROUND AND OBJECTIVES: The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the school environment in cohort studies. METHODS: Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers. RESULTS: Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological shortcomings were common. CONCLUSIONS: There is limited evidence that the school environment has a major influence on adolescent mental health, although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring schoollevel factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing effective and feasible interventions compared with complex whole-school programs. Copyright (copyright) 2012 by the American Academy of Pediatrics.
Pediatrics, 129(5) : 925-949
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Cox, Georgina R., Robinson, Jo, Williamson, Michelle, Lockley, Anne, Cheung, Yee Tak Derek, Pirkis, Jane
Background: Suicide clusters have commonly been documented in adolescents and young people.; Aims: The current review conducts a literature search in order to identify and evaluate postvention strategies that have been employed in response to suicide clusters in young people.; Methods: Online databases, gray literature, and Google were searched for relevant articles relating to postvention interventions following a suicide cluster in young people.; Results: Few studies have formally documented response strategies to a suicide cluster in young people, and at present only one has been longitudinally evaluated. However, a number of strategies show promise, including: developing a community response plan; educational/psychological debriefings; providing both individual and group counseling to affected peers; screening high risk individuals; responsible media reporting of suicide clusters; and promotion of health recovery within the community to prevent further suicides.; Conclusions: There is a gap in formal evidence-based guidelines detailing appropriate postvention response strategies to suicide clusters in young people. The low-frequency nature of suicide clusters means that long-term systematic evaluation of response strategies is problematic. However, some broader suicide prevention strategies could help to inform future suicide cluster postvention responses.;
Crisis, 33(4) : 208-214
- Year: 2012
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
Andion, O., Ferrer, M., Matali, J., Gancedo, B., Calvo, N., Barral, C., Valero, S., Di Genova, A., Diener, M. J., Torrubia, R., Casas, M.
Dialectical behavior therapy (DBT) is an effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to confirm the results. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Psychotherapy, 49(2) : 241-250
- Year: 2012
- Problem: Non-suicidal self-harm behaviours
, 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: Psychological Interventions (any)
, Dialectical behavioural therapy (DBT)
Asarnow, Joan Rosenbaum, Baraff, Larry J., Berk, Michele, Grob, Charles S., Devich-Navarro, Mona, Suddath, Robert, Piacentini, John C., Rotheram-Borus, Mary Jane, Cohen, Daniel, Tang, Lingqi
Objective: Methods: Results: Conclusions: Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared.In a randomized controlled trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge.Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes.Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments.
Psychiatric Services, 62(11) : 1303-1309
- Year: 2011
- 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)
, Technology, interventions delivered using technology (e.g. online, SMS)
Chen, E. Y. H., Tang, J. Y., Hui, C. L., Chiu, C. P., Lam, M. M., Law, C. W., Yew, C. W., Wong, G. H., Chung, D. W., Tso, S., Chan, K. P., Yip, K. C., Hung, S. F., Honer, W. G.
Aim: Although phase-specific early intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early intervention in first-episode psychosis. Method: In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal behaviour and service utilization from clinical records. Results: Patients in the early intervention group had longer full-time employment or study (P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P=0.001), fewer suicides (P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72). Conclusions: The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate of relapse. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 5(4) : 315-323
- Year: 2011
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Cusimano, Michael D., Sameem, Mojib
Objective: Data Sources: Review Methods: Results: Conclusion: To assess the effectiveness of middle and high school-based suicide prevention curricula.The following were searched: Ovid MEDLINE(R) in-process and other non-indexed citations and Ovid MEDLINE(R), Ovid Healthstar, CINAHL, PsycINFO, all EBM reviews-Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED, and the ISI Web of Science, until October 2009; government web pages for statistics and other demographic data in countries where they were available; citation lists of relevant articles.Randomised controlled studies, interrupted time series analyses with a concurrent comparison group, studies with follow-up examinations (post-test questionnaires and monitoring suicide rates), and middle to high school-based curriculum studies, including both male and female participants, were included.36 potentially relevant studies were identified, eight of which met the inclusion criteria. Overall, statistically significant improvements were noted in knowledge, attitude, and help-seeking behaviour. A decrease in self reported ideation was reported in two studies. None reported on suicide rates.Although evidence exists that school-based programmes to prevent suicide among adolescents improve knowledge, attitudes, and help-seeking behaviours, no evidence yet exists that these prevention programmes reduce suicide rates. Further well designed, controlled research is required before such programmes are instituted broadly to populations at risk.
Injury Prevention, 17(1) : 43-49
- Year: 2011
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
Corcoran, Jacqueline, Dattalo, Patrick, Crowley, Meghan, Brown, Emily, Grindle, Lauren
Suicide is a leading cause of death for young people and rates of serious suicidal thoughts are even higher. Due to these high rates and potential harm to youth, effective interventions are necessary. The purpose of this systematic review was to determine the impact of interventions designed for suicidal adolescents. Both quasi-experimental and experimental designs in the published and unpublished literature were included, and a total of 17 studies were located. According to meta-analysis, intervention group participants were slightly less likely to have suicidal and self-harm events than control group participants. However, when studies assessed outcome at a later period than immediately after intervention, experimental group participants were slightly more likely to have suicidal and self-harm events than control group participants. For studies that measured suicidal ideation at posttest, intervention group participants were slightly less likely to report suicidal ideation than control group participants, both at posttest and at follow-up. These contradictory findings are explored and discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Children & Youth Services Review, 33(11) : 2112-2118
- Year: 2011
- 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)