Disorders - Suicide or self-harm behaviours
Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., Monti, P.
Objective: This study tested a cognitive-behavioral treatment protocol for adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial. Method: Forty adolescents (M age = 15 years; 68 female, 89 White) and their families recruited from an inpatient psychiatric hospital were randomly assigned to an integrated outpatient cognitive-behavioral intervention for co-occurring AOD and suicidality (I-CBT) or enhanced treatment as usual (E-TAU). Primary measures include the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Suicide Ideation Questionnaire, Columbia Impairment Scale, Timeline Followback, Rutgers Alcohol Problem Index, and Rutgers Marijuana Problem Index. Assessments were completed at pretreatment as well as 3, 6, 12, and 18 months postenrollment. Results: In intent-to-treat analyses, I-CBT was associated with significantly fewer heavy drinking days and days of marijuana use relative to E-TAU but not with fewer drinking days. Those randomized to I-CBT in comparison to E-TAU also reported significantly less global impairment as well as fewer suicide attempts, inpatient psychiatric hospitalizations, emergency department visits, and arrests. Adolescents across groups showed equivalent reductions in suicidal ideation. Conclusions: I-CBT for adolescents with co-occurring AOD and suicidality is associated with significant improvement in both substance use and suicidal behavior, as well as markedly decreased use of additional health services including inpatient psychiatric hospitalizations and emergency department visits. Further testing of integrated protocols for adolescent AOD and suicidality with larger and more diverse samples is warranted. (copyright) 2011 American Psychological Association.
Journal of Consulting & Clinical Psychology, 79(6) : 728-739
- Year: 2011
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Ertl, Verena, Pfeiffer, Anett, Schauer, Anett, Elbert, Thomas, Neuner, Frank
Context: The psychological rehabilitation of former child soldiers and their successful reintegration into postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers. Objective: To assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals. Design, Setting, and Participants: Randomized controlled trial recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization. Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention. Intervention: Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities. Main Outcome Measures: Change in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation, feelings of guilt, and perceived stigmatization. Results: PTSD symptom severity (range, 0-148) was significantly more improved in the narrative exposure therapy group than in the academic catch-up (mean change difference, ‚àí14.06 [95% confidence interval, ‚àí27.19 to ‚àí0.92]) and waiting-list (mean change difference, ‚àí13.04 [95% confidence interval, ‚àí26.79 to 0.72]) groups. Contrast analyses of the time √ó treatment interaction of the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F[sub]1,234.1[/sub] = 5.21, P = .02) and wait-listing (F[sub]1,228.3[/sub] = 5.28, P = .02). Narrative exposure therapy produced a larger within-treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81). Conclusion: Among former Ugandan child soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing resulted in greater reduction of PTSD symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
JAMA, 306(5) : 503-512
- Year: 2011
- Problem: Post Traumatic Stress Disorder, 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)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Supportive therapy, Other Psychological Interventions, Narrative exposure therapy (NET)
Balaji, M., Andrews, T., Andrew, G., Patel, V.
Purpose To evaluate the acceptability, feasibility, and effectiveness of a population-based intervention to promote health of youth (age: 1624 years) in Goa. Methods Two pairs of urban and rural communities were selected; one of each was randomly assigned to receive a multi-component intervention and the other wait-listed. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer education, and health information materials. Effectiveness was assessed through beforeafter population surveys at baseline and at 18 months. Outcomes were measured using a structured interview schedule with all eligible youth. Logistic regression compared each pair, adjusted for baseline differences, on prevalence of outcomes in the domains of reproductive and sexual health (RSH), violence, mental health, substance use, and help seeking for health concerns. Results In both intervention communities, prevalence of violence perpetrated and probable depression was significantly lower and knowledge and attitudes about RSH significantly higher (p < .05). The rural sample also reported fewer menstrual complaints and higher levels of help-seeking for RSH complaints by women, and knowledge and attitudes about emotional health and substance use; and, the urban sample reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and RSH complaints. Although information materials were acceptable and feasible in both communities, community peer education was feasible only in the rural community. The institution-based interventions were generally acceptable and feasible. Conclusions Multicomponent interventions comprising information materials, educational-institution interventions and, in rural contexts, community peer interventions are acceptable and feasible and likely to be effective for youth health promotion. (copyright) 2011 Society for Adolescent Health and Medicine.
Journal of Adolescent Health, 48(5) : 453-460
- Year: 2011
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Perera Ramani, E. A., Kathriarachchi, S. T.
Background: Suicidal behaviour among youth is a major public health concern in Sri Lanka. Prevention of youth suicides using effective, feasible and culturally acceptable methods is invaluable in this regard, however research in this area is grossly lacking. Objective: This study aimed at determining the effectiveness of problem solving counselling as a therapeutic intervention in prevention of youth suicidal behaviour in Sri Lanka. Setting and design: This control trial study was based on hospital admissions with suicidal attempts in a sub-urban hospital in Sri Lanka. The study was carried out at Base Hospital Homagama. Materials and Methods: A sample of 124 was recruited using convenience sampling method and divided into two groups, experimental and control. Control group was offered routine care and experimental group received four sessions of problem solving counselling over one month. Outcome of both groups was measured, six months after the initial screening, using the visual analogue scale. Results: Individualized outcome measures on problem solving counselling showed that problem solving ability among the subjects in the experimental group had improved after four counselling sessions and suicidal behaviour has been reduced. The results are statistically significant. Conclusion: This Study confirms that problem solving counselling is an effective therapeutic tool in management of youth suicidal behaviour in hospital setting in a developing country.
Indian Journal of Psychiatry, 53(1) : 30-35
- Year: 2011
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Problem solving therapy (PST)
Ougrin, Dennis, Zundel, Tobias, Ng, Audrey, Banarsee, Reetoo, Bottle, Alex, Taylor, Eric
Objective: Design: Setting: Participants: Interventions: Main Outcome Measures: Results: Conclusions: Trial Registration: To determine whether Therapeutic Assessment (TA) versus assessment as usual (AAU) improves engagement with follow-up in adolescents presenting with self-harm.Randomised controlled trial with 3 months naturalistic follow-up.Child and adolescent mental health services in two London National Health Service Trusts.26 clinicians randomised into TA and AAU groups recruited 70 newly referred adolescents with self-harm.TA, a manualised procedure including a basic psychosocial assessment and a 30 min therapeutic intervention; AAU, standard psychosocial assessment.Attendance at the first follow-up session; number of the follow-up sessions attended and changes in Strengths and Difficulties Questionnaire and Children's Global Assessment Scale scores. All measures were adjusted for clustering, social class, changes of therapist and previous contact with services.Using the data on all participants (n=70), those in the TA group were significantly more likely to attend the first follow-up appointment: 29 (83%) versus 17 (49%), OR 5.12, 95% CI (1.49 to 17.55) and more likely to attend four or more treatment sessions: 14 (40%) versus 4 (11%), OR 5.19, 95% CI (2.22 to 12.10). Three months after the initial assessment there were no statistically significant differences between the groups on Strengths and Difficulties Questionnaire scores: 15.6 versus 16.0, mean difference -0.37, 95% CI (-3.28 to 2.53) or Children's Global Assessment Scale scores: 64.6 versus 60.1, mean difference 4.49, 95% CI (-0.98 to 9.96).TA was associated with statistically significant improvement in engagement. TA could be usefully applied at the point of initial assessment for adolescents with self-harm.ISRCTN 81605131 http://www.controlled-trials.com/ISRCTN81605131/.
Archives of Disease in Childhood, 96(2) : 148-153
- 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: Psychological Interventions (any)
, Other Psychological Interventions
Ougrin, Dennis, Latif, Saqib
Background: Aims: Methods: Results: Conclusions: Despite recent advances in the understanding and treatment of self-harm, poor engagement with therapy remains a serious problem.To investigate whether offering specific psychological treatment (SPT) leads to better engagement than offering treatment as usual (TAU) in adolescents who have self-harmed.Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed for randomized controlled trials comparing SPT versus TAU in adolescents presenting with self-harm.Seven studies met inclusion criteria, and six were entered into the meta-analysis. There was no statistically significant difference between the number of subjects not completing four or more sessions of an SPT (27.7%, 70/253) than TAU (43.3%, 106/245), RR = 0.71 (95% CI: 0.49-1.05).Engaging adolescents with psychological treatment is necessary although not sufficient to achieve treatment goals. Further research is needed to develop tools for maximizing engagement.
Crisis, 32(2) : 74-80
- 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)
Kim, G. H., Kim, K., Park, H.
Depression is increasing among Korean college students. Moreover, it is common for depressed individuals to consider attempting suicide. The purpose of this study therefore was to develop and examine the effectiveness of an int ived a depression-reducing program in eight 1-hr weekly sessions. Measures of suicidal ideation and depression were administered. The program has effects on suicidal ideation and depression among female college students. The findings suggest that the study program may be useful in reducing suicidal ideation and depression among female college students. (copyright) The Author(s) 2011.
Western Journal of Nursing Research, 33(4) : 560-576
- Year: 2011
- 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)
, Other Psychological Interventions
Green, J. M., Wood, A. J., Kerfoot, M. J., Trainor, G., Roberts, C., Rothwell, J., Woodham, A., Ayodeji, E., Barrett, B., Byford, S., Harrington, R.
Objective: To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people. Design: Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress. Participants: Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting: Eight child and adolescent mental health services in the northwest UK. Interventions: Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres. Main outcome measures: Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded. Results: 183 adolescents were allocated to each arm (total n = 366). Loss to follow-up was low (‹4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P = 0.95) at 6 months and 0.88 (0.59 to 1.33, P = 0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to 1.20, P = 0.29) at 6 months and 0.94 (0.63 to 1.40, P = 0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21 781) than for routine care (£15 372) but the difference was not significant (95% CI −1416 to 10782, P = 0.132). Conclusions: The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
British Medical Journal, 342(7802) : 1-12
- 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: Psychological Interventions (any)
, Other Psychological Interventions
Vijayakumar, Lakshmi, Umamaheswari, C., Shujaath Ali, Zubaida Sultana, Devaraj, P., Kesavan, K.
Aim: Materials and Methods: Results: Conclusions: To determine whether brief intervention and contact (BIC) is effective in reducing subsequent suicidal behavior among suicide attempters.Suicide attempters (n=680) admitted in a general hospital in Chennai were randomly allocated to treatment as usual and BIC whose components include brief intervention at the time of discharge and contact for 18 months.Completed suicide was significantly lower in the BIC group, OR 35.4 (CI 18.4 - 78.2) as also attempted suicide, OR 17.3 (CI 10.8 - 29.7).This low-cost intervention which can be readily implemented may be an important suicide prevention strategy in healthcare settings in India.
Indian Journal of Psychiatry, 53(3) : 244-248
- 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)
, Psychoeducation, Other service delivery and improvement interventions
Robinson, J., Hetrick, S. E., Martin, C.
Objective: Risk of suicide attempt, suicidal ideation and deliberate self-harm is high among young people, yet limited evidence exists regarding effective interventions, particularly from randomized controlled trials. The aim of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials testing interventions for adolescents and young adults who have presented to a clinical setting with any of these behaviours. Methods: The Cochrane Central Register of Controlled Trials, Medline, EMBASE and PsycINFO were searched for articles published from 1980 to June 2010. The following keywords formed the basis of the search strategy: 'self-injurious behaviour', 'attempted suicide', 'suicide', 'suicidal behaviour', 'self-inflicted wounds', 'self-mutilation', 'self-harm'. We also hand searched conference abstracts from two major suicide prevention conferences and the reference lists of all retrieved articles and previous reviews. Results: There were 15 trials included in the review, with six ongoing trials also identified. In general, the reporting of the conduct of trials was poor, making it difficult to assess the risk of bias. The reporting of outcome data was inconsistent. No differences were found between treatment and control groups except in one study that found a difference between individual cognitive behavioural therapy and treatment as usual. Conclusion: The evidence regarding effective interventions for adolescents and young adults with suicide attempt, deliberate self-harm or suicidal ideation is extremely limited. Many more methodologically rigorous trials are required. However, in the meantime CBT shows some promise, but further investigation is required in order to determine its ability to reduce suicide risk among young people presenting to clinical services. (copyright) 2011 The Royal Australian and New Zealand College of Psychiatrists.
Australian & New Zealand Journal of Psychiatry, 45(1) : 3-26
- Year: 2011
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
Bertolote, Jose M., Fleischmann, Alexandra, De Leo, Diego, Phillips, Michael R., Botega, Neury J., Vijayakumar, Lakshmi, De Silva, Damani, Schlebusch, Lourens, Nguyen, Van Tuong, Sisask, Merike, Bolhari, Jafar, Wasserman, Danuta
Background: Aims: Methods: Results: Conclusions: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings.To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS).Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure - has been reported in a previous paper.Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites.This study from five low- and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.
Crisis, 31(4) : 194-201
- Year: 2010
- 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)
, Psychoeducation
Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., Levy, S.,
Objective: To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. Method: This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms. Results: Using intent to treat, patients in ABFT demonstrated significantly greater rates of change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size (ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6-99.6) than patients in EUC (51.7%; 95% CI = 32.4-54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI = 52.6-87.4; EUC 34.6%; 95% CI = 15.6-54.2; odds ratio = 4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus 2.9). Conclusions: ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study). Clinical Trial Registry Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097. (copyright) 2010.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(2) : 122-131
- Year: 2010
- 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)
, Family therapy