Disorders - Suicide or self-harm behaviours
Pistone, I., Beckman, U., Eriksson, E., Lagerlof, H., Sager, M.
BACKGROUND: Suicide is a major public health problem. Educational interventions for preventing suicidal behaviour are widely used, although little is known regarding the collective effectiveness of these interventions. AIM: We evaluated the existing evidence for the effectiveness of education interventions in the prevention of suicidal behaviour. METHOD(S): In this systematic review and meta-analysis, we searched multiple databases using terms related to suicide prevention. The articles were reviewed by two independent reviewers, and the quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data from individual studies were combined in meta-analyses. RESULT(S): We identified 41 studies evaluating two different types of interventions: school-based education interventions and gatekeeper training. Education interventions showed significant gains in terms of knowledge and attitudes, though the effects seem to vary depending on subjects' personal characteristics. School-based education interventions significantly reduced suicidal ideation and suicide attempts in youths. Gatekeeper training showed no significant effect on suicide attempts or gatekeeper skills, though the quality of evidence for the estimate, according to GRADE criteria, was rated as very low. CONCLUSION(S): The results of this study indicate that school-based education interventions are effective in preventing suicidal ideation and suicide attempts. In clinical practice, as well as in research, the development and implementation of educational interventions should focus on participants' individual characteristics.
The International journal of social psychiatry, : 20764019852655
- Year: 2019
- Problem: 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)
, Psychoeducation, Other service delivery and improvement interventions
Witt, K., Boland, A., Lamblin, M., McGorry, P. D., Veness, B., Cipriani, A., Hawton, K., Harvey, S., Christensen, H., Robinson, J.
QUESTION: A growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts.
STUDY SELECTION AND ANALYSIS: The authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017.
FINDINGS: Data from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress.
CONCLUSIONS: Relatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.
Evidence-Based Mental Health, 22(2) : 84-90
- Year: 2019
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
Briggs, S., Netuveli, G., Gould, N., Gkaravella, A., Gluckman, N. S., Kangogyere, P., Farr, R., Goldblatt, M. J., Lindner, R.
BACKGROUND: Preventing suicide and self-harm is a global health priority. Although there is a growing evidence base for the effectiveness of psychoanalytic and psychodynamic psychotherapies for a range of disorders, to date there has been no systematic review of its effectiveness in reducing suicidal and self-harming behaviours.AimsTo systematically review randomised controlled trials of psychoanalytic and psychodynamic psychotherapies for suicidal attempts and self-harm.
METHOD: We searched PubMed, PsycINFO, Psycharticles, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials for randomise controlled trials of psychoanalytic and psychodynamic psychotherapies for reducing suicide attempts and self-harm.
RESULTS: Twelve trials (17 articles) were included in the meta-analyses. Psychoanalytic and psychodynamic therapies were effective in reducing the number of patients attempting suicide (pooled odds ratio, 0.469; 95% CI 0.274-0.804). We found some evidence for significantly reduced repetition of self-harm at 6-month but not 12-month follow-up. Significant treatment effects were also found for improvements in psychosocial functioning and reduction in number of hospital admissions.
CONCLUSIONS: Psychoanalytic and psychodynamic psychotherapies are indicated to be effective in reducing suicidal behaviour and to have short-term effectiveness in reducing self-harm. They can also be beneficial in improving psychosocial well-being. However, the small number of trials and moderate quality of the evidence means further high-quality trials are needed to confirm our findings and to identity which specific components of the psychotherapies are effective.Declaration of interestNone.
British Journal of Psychiatry, 214(6) : 320-328
- 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)
, Psychodynamic/Psychoanalysis
Comtois, K. A., Kerbrat, A. H., Decou, C. R., Atkins, D. C., Majeres, J. J., Baker, J. C., Ries, R. K.
Importance: Accessible and cost-effective interventions for suicidality are needed to address high rates of suicidal behavior among military service members. Caring Contacts are brief periodic messages that express unconditional care and concern and have been previously shown to prevent suicide deaths, attempts, ideation, and hospitalizations. Objective(s): To test the effectiveness of augmenting standard military health care with Caring Contacts delivered via text message to reduce suicidal thoughts and behaviors over 12 months. Design, Setting, and Participant(s): This randomized clinical trial was conducted at 3 military installations in the southern and western United States. Soldiers and Marines identified as being at risk of suicide were recruited between April 2013 and September 2016. The final follow-up was in September 2017. Intervention(s): Both groups received standard care, and the Caring Contacts group also received consisted of 11 text messages delivered on day 1, at week 1, at months 1, 2, 3, 4, 6, 8, 10, and 12, and on participants' birthdays. Main Outcomes and Measures: Primary outcomes were current suicidal ideation and suicide risk incidents (hospitalization or medical evacuation). Secondary outcomes were worst-point suicidal ideation, emergency department visits, and suicide attempts. Suicidal ideation was measured by the Scale for Suicide Ideation, suicide risk incidents, and emergency department visits by the Treatment History Interview; attempted suicide was measured by the Suicide Attempt Self-Injury Count. Result(s): Among 658 randomized participants (329 randomizely assigned to each group), data were analyzed for 657 individuals (mean [SD] age, 25.2 [6.1] years; 539 men [82.0%]). All participants reported suicidal ideation at baseline, and 291 (44.3%) had previously attempted suicide. Of the 657 participants, 461 (70.2%) were assessed at 12 months. Primary outcomes were nonsignificant. There was no significant effect on likelihood or severity of current suicidal ideation or likelihood of a suicide risk incident; there was also no effect on emergency department visits. However, participants who received Caring Contacts (172 of 216 participants [79.6%]) had lower odds than those receiving standard care alone (179 of 204 participants [87.7%]) of experiencing any suicidal ideation between baseline and follow-up (odds ratio, 0.56 [95% CI, 0.33-0.95]; P =.03) and fewer had attempted suicide since baseline (21 of 233 [9.0%] in the group receiving Caring Contacts vs 34 of 228 [14.9%] in the standard-care group; odds ratio, 0.52 [95% CI, 0.29-0.92]; P =.03). Conclusions and Relevance: This trial provides inconsistent results on the effectiveness of caring text messages between primary and secondary outcomes, but this inexpensive and scalable intervention offers promise for preventing suicide attempts and ideation in military personnel. Additional research is needed. Trial Registration: ClinicalTrials.gov identifier: NCT01829620. Copyright © 2019 American Medical Association. All rights reserved.
JAMA Psychiatry, 76(5) : 474-483
- 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, Technology, interventions delivered using technology (e.g. online, SMS)
Kelly, E. V., Newton, N. C., Stapinski, L. A., Conrod, P. J., Barrett, E. L., Champion, K. E., Teesson, M.
OBJECTIVE: To examine the secondary effects of a personality-targeted intervention on bullying and harms among adolescent victims and bullies.
METHOD: Outcomes were examined for victims and bullies in the Climate and Preventure study, Australia. Participants completed self-report measures at baseline and four follow-up assessments (6, 12, 24, 36 months). Thirteen intervention schools (n=1087) received Preventure, a brief personality-targeted CBT intervention for adolescents with 'high-risk' personality types (hopelessness, anxiety sensitivity, impulsivity, sensation seeking). Thirteen control schools (n=1103) received health education as usual. Bullying was examined for 'high-risk' victims (n=143 in Preventure schools vs n=153 in control schools), and bullies (n=63 in Preventure schools vs n=67 in control schools) in the total sample. Harms were examined for 'high-risk' victims (n=110 in Preventure schools vs n=87 in control schools) and bullies (n=50 in Preventure schools vs n=30 in control schools) in independent schools.
RESULTS: There was no significant intervention effect for bullying victimization or perpetration in the total sample. In the sub-sample, mixed models showed greater reductions in victimization (b = -0.208, 95% CI -0.4104to -0.002, p<.05), suicidal ideation (b = -0.130, 95% CI -0.225 to -0.034, p<.01) and emotional symptoms (b = -0.263, 95% CI -0.466 to -0.061, p<.05) among 'high-risk' victims in Preventure vs control schools. Conduct problems (b = -0.292, 95% CI -0.554 to -0.030, p<.05) showed greater reductions among 'high-risk' bullies in Preventure vs control schools, and suicidal ideation showed greater reductions among 'high-risk' female bullies in Preventure vs control schools (b=-0.820, 95% CI -1.198 to -0.442, p<.001).
CONCLUSION: The findings support targeting personality in bullying prevention.
CLINICAL TRIAL REGISTRATION INFORMATION: The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use And Related Harms in Australian Adolescents; http://www.anzctr.org.au/; ACTRN12612000026820.
Journal of the American Academy of Child & Adolescent Psychiatry, : 30
- Year: 2019
- Problem: 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)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy
Czyz, E., King, C., Biermann, B.
This pilot randomized controlled trial examined the feasibility and acceptability of a motivational interview (MI)-enhanced safety planning intervention (MI-SafeCope) for teens hospitalized due to suicide risk and explored proximal outcomes (possible mechanisms of change). Participants were 36 hospitalized adolescents (ages 13-17; 78.8% female) with last-week suicidal ideation and/or past-month suicide attempts. Adolescents were randomized to MI-SafeCope, a three-component intervention (individual and family sessions, postdischarge call), or to treatment as usual. Primary outcomes were feasibility and acceptability. We also explored differences in proximal outcomes assessed at 2 weeks, 1 month, and 3 months (family connectedness, motivation for safety plan use, parental motivation to encourage safety plan use), as well as daily for 4 weeks (self-efficacy, coping behavior, safety plan use). Participation and retention rates and intervention satisfaction ratings indicate feasibility and acceptability. Mixed-effects models of daily assessments indicated, for the MI-SafeCope group, significantly higher self-efficacy to refrain from suicidal action (B = 1.15, p = .030), greater reliance on self to cope with suicidal ideation (B = 1.56, p = .042), and higher likelihood of safety plan use to manage suicidal thoughts (B = 0.25, p = .004). Parents in the MI-SafeCope group reported higher motivation to encourage safety plan use (B = 1.04, p = .031). Safety planning incorporating MI is feasible and acceptable with hospitalized teens. Preliminary findings suggest that MI strategies may be promising in maintaining adherence to safety plans, increasing self-efficacy and coping, and in fostering parents' motivation to encourage safety plan use. Our study also highlights the benefit of daily-level assessment of individuals' response to suicide-specific interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Clinical Child and Adolescent Psychology, 48(2) : 250-262
- 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)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Other service delivery and improvement interventions
Mehlum, L., Ramleth, R. K., Tormoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., Miller, A. L., Larsson, B., Sund, A. M., Groholt, B.
BACKGROUND: Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects.
METHODS: Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial.
TRIAL REGISTRATION NUMBER: NCT01593202 (www.ClinicalTrials.gov).
RESULTS: At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A.
CONCLUSIONS: There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.
Journal of Child Psychology & Psychiatry & Allied Disciplines, : 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)
, Dialectical behavioural therapy (DBT)
Wilksch, S. M., O'Shea, A., Wade, T. D.
Objective: Eating disorders are known to have high comorbidity, and the current report outlines the impact of an online eating disorder risk reduction program on brief, self-report measures of depressive symptoms, alcohol and other drug use, and suicidality. Method(s): An online pragmatic, randomized-controlled trial was conducted with N = 316 young-women (M age = 20.80 years) across Australia and New Zealand. Media Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received positive body image tips. Prevention effects (asymptomatic at baseline) and treatment effects (symptomatic at baseline) were investigated. Result(s): MS-T participants were 94% and 91% less likely than controls to develop Moderate or higher depressive symptoms at 6-month (MS-T = 3.3%; controls = 35.4%) and 12-month follow-up (MS-T = 3.4%; controls = 29.4%), respectively. MS-T participants did not commence using recreational drugs at any assessment point, compared to 18.2% of controls at a least one assessment point. Regarding treatment effects, MS-T participants were 84% more likely to no longer be using recreational drugs at 12-month follow-up (MS-T = 60%; controls = 21.1%). Mutitvariate logistic regressions revealed group, depressive symptoms and alcohol use to be significant predictors of elevated suicide risk, where being an MS-T participant, without depressive symptoms and not drinking alcohol, significantly lowered likelihood of developing elevated suicide risk. Disordered eating at post-program mediated the relationship between group and depressive symptoms across post-program to 12-mnoth follow-up. Discussion(s): MS-T shows promise as a program with important mental health benefits in addition to previous reports of lowered eating disorder diagnosis, risk and impairment. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 52(2) : 132-141
- 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)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
King, C. A., Arango, A., Kramer, A., Busby, D., Czyz, E., Foster, C. E., Gillespie, B. W.
Importance: The prevalence of suicide among adolescents is rising, yet little is known about effective interventions. To date, no intervention for suicidal adolescents has been shown to reduce mortality. Objective(s): To determine whether the Youth-Nominated Support Team Intervention for Suicidal Adolescents-Version II (YST) is associated with reduced mortality 11 to 14 years after psychiatric hospitalization for suicide risk. Design, Setting, and Participant(s): This post hoc secondary analysis of a randomized clinical trial used National Death Index (NDI) data from adolescent psychiatric inpatients from 2 US psychiatric hospitals enrolled in the clinical trial from November 10, 2002, to October 26, 2005. Eligible participants were aged 13 to 17 years and presented with suicidal ideation (frequent or with suicidal plan), a suicide attempt, or both within the past 4 weeks. Participants were randomized to receive treatment as usual (TAU) or YST plus TAU (YST). Evaluators and staff who matched identifying data to NDI records were masked to group. The length of NDI follow-up ranged from 11.2 to 14.1 years. Analyses were conducted between February 12, 2018, and September 18, 2018. Intervention(s): The YST is a psychoeducational, social support intervention. Adolescents nominated "caring adults" (mean, 3.4 per adolescent from family, school, and community) to serve as support persons for them after hospitalization. These adults attended a psychoeducational session to learn about the youth's problem list and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioral choices. The adults received weekly supportive telephone calls from YST staff for 3 months. Main Outcomes and Measures: Survival 11 to 14 years after index hospitalization, measured by NDI data for deaths (suicide, drug overdose, and other causes of premature death), from January 1, 2002, through December 31, 2016. Result(s): National Death Index records were reviewed for all 448 YST study participants (319 [71.2%] identified as female; mean [SD] age, 15.6 [1.3] years; 375 [83.7%] of white race/ethnicity). There were 13 deaths in the TAU group and 2 deaths in the YST group (hazard ratio, 6.62; 95% CI, 1.49-29.35; P <.01). No patients were withdrawn from YST owing to adverse effects. Conclusions and Relevance: The findings suggest that the YST intervention for suicidal adolescents is associated with reduced mortality. Because this was a secondary analysis, results warrant replication with examination of mechanisms. Trial Registration: ClinicalTrials.gov identifier: NCT00071617. Copyright © 2019 American Medical Association. All rights reserved.
JAMA Psychiatry, 76(5) : 492-498
- 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)
, Psychoeducation, Other Psychological Interventions, Other service delivery and improvement interventions
Gillespie, C., Joyce, M., Flynn, D., Corcoran, P.
Background: Dialectical behaviour therapy for adolescents (DBT-A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural dysregulation. Previous studies have reported on varying lengths of treatment, however, and optimal treatment duration has not yet been identified. While the treatment developers initially proposed a 16-week programme, they have more recently recommended an extension to 24 weeks. This study compares outcomes for adolescents and parent/guardians who participated in 16- and 24-week DBT-A programmes in a community setting. Method(s): Eighty-four adolescents and 100 parent/guardians participated in 16-week DBT-A, while 68 adolescents and 67 parent/guardians participated in the 24-week programme. Outcome measures for adolescents included the presence and frequency of self-harm, suicidal ideation and depression; and for parents were burden, grief and parental stress. Outcomes were assessed at pre- and postintervention. Linear mixed-effects models were used to estimate the treatment duration effect (24-week vs. 16-week) utilising all available data at pre- and postintervention. Result(s): Data analyses showed a reduction in the presence and frequency of self-harm at postintervention for adolescents in both programmes. Both adolescent and parent participants in the 16- and 24-week programmes also showed changes indicating significant improvement on all self-report outcome measures (p <.05). A treatment duration effect was identified with adolescents in the 24-week programme reporting greater gains on measures of suicidal ideation and depression (p <.05). However, drop-out rates were higher for the 24-week programme. Conclusion(s): The findings of the current study indicate that 24-week DBT-A may have additional benefits in comparison to 16-week DBT-A in terms of further reductions in suicidal ideation and depression. Given the nature of this study, it was not possible to explore a potential time effect, however, so these results should be interpreted with caution. Further research will assist in determining an optimal programme duration of DBT-A. 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)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Dialectical behavioural therapy (DBT)
, Other service delivery and improvement interventions
Kennard, B. D., Goldstein, T., Foxwell, A. A., McMakin, D. L., Wolfe, K., Biernesser, C., Moorehead, A., Douaihy, A., Zullo, L., Wentroble, E., Owen, V., Zelazny, J., Iyengar, S., Porta, G., Brent, D.
Objective: The authors report on a pilot study of an inpatient intervention for suicidal adolescents, As Safe as Possible (ASAP), supported by a smartphone app (BRITE) to reduce suicide attempts following hospital discharge. Method(s): Across two sites, 66 adolescents hospitalized for suicidal ideation (N=26) or a recent suicide attempt (N=40) were randomly assigned to the ASAP intervention program plus treatment as usual or to treatment as usual alone. ASAP, which focuses on emotion regulation and safety planning, is a 3-hour intervention delivered on the inpatient unit. The BRITE app prompted participants to rate their level of emotional distress on a daily basis and provided personalized strategies for emotion regulation and safety planning. A blind, independent evaluator assessed suicide attempts following hospital discharge and suicidal ideation at 4, 12, and 24 weeks after discharge. Result(s): The ASAP intervention did not have a statistically significant effect on suicide attempt, although findings were in the hypothesized direction for occurrence of an attempt (16% compared with 31%; x2=1.86, df=1, g=20.36) and time to an attempt (hazard ratio=0.49, 95% CI=0.16, 1.47). Past history of a suicide attempt was a significant moderator of treatment outcome, with a stronger, albeit nonsignificant, effect of the ASAP intervention among participants with a history of suicide attempt (hazard ratio=0.23, 95% CI=0.05, 1.09). There were no treatment effects on suicidal ideation. The majority of participants (70%) used the BRITE app (median usage, 19 times). Participants reported high satisfaction with both the intervention and the app. Conclusion(s): The ASAP intervention program shows promise in reducing the incidence of postdischarge suicide attempts among adolescents hospitalized for suicidality and merits further study. Copyright © 2018 American Psychiatric Association. All rights reserved.
American Journal of Psychiatry, 175(9) : 864-872
- Year: 2018
- 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, Technology, interventions delivered using technology (e.g. online, SMS)
Rengasamy, M., Phelps-Tschang, J., Simpson, M., Tew, J. D., Sparks, G.
Objectives: Few studies have examined the efficacy of telephone-based interventions in reducing suicide attempt rates in adolescents after discharge from the inpatient psychiatric setting. The time immediately after discharge is a well-known high-risk period for suicide attempts. This abstract describes a quality improvement intervention using postdischarge telephone contacts with patients and families to assess the effect on suicide attempts. Method(s): As part of a quality improvement initiative at a major metropolitan hospital, we randomly assigned 142 adolescents (ages 12a"18 years) who were admitted to inpatient psychiatric units for suicidal ideation or suicide attempt to either a recurrent telephone intervention over a 3-month period or a single phone call at 3 months after discharge. The recurrent intervention consisted of up to 6 phone contacts to adolescents and their parents, whereas the single intervention consisted of up to one telephone intervention. The intervention of 10a"15 minutes consisted of inquiring about any suicide attempts, a safety plan review that includes medication/weapon safety, and offering assistance with treatment follow-up evaluation. When possible, both the child and at least one parent were engaged during the contact. Suicide attempts were assessed using the medical record and adolescent/family report and were defined as interrupted, aborted, or actual attempts. Result(s): Adolescents in the recurrent intervention arm had significantly fewer suicide attempts (5.6%) compared with adolescents in the mild intervention arm (17.1%) over a 3-month period [I++2(1, N = 142) = 4.77, p < 0.05]. In the recurrent intervention arm, 84.7% of parents and 72.2% of adolescents had at least one phone contact. An average of 3.8 phone contacts to parents and 3.1 phone contacts were made to adolescents who received at least one phone contact in the recurrent intervention arm. There were no differences in baseline suicide attempts, prior inpatient hospitalizations, diagnoses, age, gender, or inpatient rehospitalizations between the 2 intervention arms. Conclusion(s): This telephone-based intervention was feasible, and recurrent intervention outreach may be more effective than a single contact in reducing suicide attempts for adolescents in the postdischarge period. TREAT Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S265
- Year: 2018
- 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, Other service delivery and improvement interventions