Disorders - Suicide or self-harm behaviours
King, C., Arango, A., Kramer, A., Busby, D., Czyz, E., Foster, C. E., Gillespie, B.
Objectives: The prevalence of suicide among adolescents is rising, yet little is known about effective interventions. No previous intervention for suicidal adolescents has been shown to reduce mortality. This study was designed to determine whether the Youth-Nominated Support Team Intervention for Suicidal Adolescentsa"Version II (YST) was associated with reduced mortality 10a"12 years after psychiatric hospitalization for suicide risk. Method(s): We conducted a 10a"12-year follow-up evaluation, using National Death Index (NDI) data for all participants (N = 448) in the YST randomized clinical trial (ClinicalTrials.gov: NCT00071617) comparing treatment as usual (TAU) to YST plus TAU (YST). Participants were inpatients with mental illness, ages 13a"17 years, who were admitted with suicidal ideation (frequent or with suicidal plan) or a suicide attempt within the past 4 weeks. Enrollment took place from 2002 to 2005 at 2 mental health hospitals (2002a"2005). In YST, adolescents nominate aoecaring adultsa (mean 3.4 support persons per adolescent from family, school, community settings) to serve as support persons after hospitalization. With parental permission, these adults attend a psychoeducation session to learn about the youthaTMs problem list and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioral choices. They receive weekly, supportive telephone calls from YST professional staff for 3 months. The primary study outcome was survival, measured by NDI data, for deaths through 2014. Result(s): NDI records were reviewed for all 448 YST Study participants [72% female; mean age (SD) = 15.6 years (1.3); 83% Caucasian]. There were 11 deaths in the TAU group and 1 death in the YST group (hazard ratio: 11.2, p < 0.01 [95% CI = 1.5a"87.0]). No patients were withdrawn from YST because of adverse effects. Conclusion(s): This is the first intervention for suicidal adolescents to show evidence of reduced mortality. Even at the lowest end of the confidence interval, mortality was reduced by 50%. Results warrant replication with examination of mechanisms; however, they suggest that YST, a psychoeducational, supportive intervention involving caring adults, favorably altered the trajectories of adolescents contemplating suicide. S, RCT, ADOL Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S260
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Santamarina-Perez, P., Mendez, I., Picado, M., Eiroa, F. J., Font, E., Moreno, E., Martinez, E., Linan, A. M., Cordovilla, C., Romero, S.
Objectives: Impaired cognitive function is a feature of suicidal behavior. It also might be considered a risk factor in adolescents with high vulnerability to commit suicide. Previous studies have suggested that some aspects of cognitive function improve after psychological treatment. However, to our knowledge, there are no studies that have evaluated the influence of psychological treatment on cognitive functioning in adolescents with suicidal behavior. The aim of this study was to examine changes on neuropsychological functioning in adolescents with suicidal behavior following a psychological treatment with DBT and supportive therapy (ST) compared with healthy control subjects. Method(s): A total of 35 adolescents with self-harming behavior and 17 healthy control subjects between 12 and 18 years of age completed neuropsychological testing at baseline and after 16 weeks. The neuropsychological battery consisted of the following: 1) Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV); 2) Spain-Complutense Verbal Learning Test; 3) Rey Complex Figure Test; 4) Trail Making Test; 5) Stroop Effect Test; 6) Controlled Oral Word Association Test (COWAT); and 7) Tower of London test. Patients were randomized after baseline assessment into 2 psychological groups: DBT and ST. Result(s): t tests were used for baseline comparisons between suicidal adolescents and control groups, and between repeated measure analyses of variance for the difference in change between the suicidal adolescents and control groups from baseline and follow-up, for all neuropsychological scores. Significant neuropsychological impairment was evident at baseline in suicidal participants compared with healthy control subjects. After 16 weeks of psychotherapy, neuropsychological scores showed significant improvement regardless of the type of therapy. We found effect sizes between 0.10 and 0.18 in intelligence index (verbal comprehension, perceptual reasoning, and processing speed), in verbal memory (delayed recall and recognition), and in executive functioning (Tower of London-total time). Conclusion(s): These results suggest that both DBT and ST might improve some cognitive functions associated with adolescents with suicidal behavior. Additional studies with larger sample groups are needed to confirm these results. COG, S, TREAT Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S221
- 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: Psychological Interventions (any)
, Dialectical behavioural therapy (DBT)
, Supportive therapy
King, C. A., Gipson, P. Y., Arango, A., Foster, C. E., Clark, M., Ghaziuddin, N., Stone, D.
This study examined the effectiveness of LET's CONNECT (LC), a community mentorship program for youths who report peer social problems, which is based on a positive youth development framework. Participants were 218 youths (66.5% girls), aged 12 to 15 years, who were recruited from an urban medical emergency department and screened positive for bullying victimization, bullying perpetration, and/or low social connectedness. Youths were randomized to LC (n = 106) or the control condition (n = 112). Six-month outcomes were assessed with self-report measures of youth social connectedness, community connectedness, thwarted belongingness, depression, self-esteem, and suicidal ideation. LC was associated with a significant increase in only one of these outcomes, social connectedness (effect size = 0.4). It was associated consistently with trend-level positive changes for thwarted belongingness (decreased), depression (decreased), community connectedness, and self-esteem (effect sizes = 0.2). There was no effect on suicidal ideation (effect size = 0.0), and although not a primary outcome, eight youths in the LC condition and seven youths in the control condition engaged in suicidal behavior between baseline and follow-up. Although LC effect sizes are consistent with those from previous studies of community mentorship, there were multiple challenges to LC implementation that affected dosage and intervention fidelity, and that may account for the lack of stronger positive effects. Copyright © 2018 Wiley Periodicals, Inc.
Journal of Community Psychology, 46(7) : 885-902
- Year: 2018
- 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, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Brent, D. A., Kennard, B. D.
Objectives: This presentation will describe and evaluate the impact of a brief inpatient intervention, As Safe As Possible (ASAP), supported by an emotion-regulation and safety-planning smartphone application (app) called BRITE on postdischarge suicide attempts. Method(s): A total of 66 suicidal adolescent inpatients were randomized to either ASAP/BRITE + treatment as usual (TAU) versus TAU alone. ASAP was a 2.7-hour inpatient intervention that emphasized safety planning, emotion regulation, and distress tolerance. The app was personalized to each participant to provide reminders for reasons for living, distraction, and interventions for distress tolerance and emotion regulation, as well as providing access to a safety plan with emergency contact numbers. Result(s): Within 6 months, 16% of those assigned to ASAP/BRITE had made suicide attempts versus 31% of those in TAU. Perceived social support increased in the ASAP/BRITE arm, and the more participants used the app, the greater their increase in reasons for living (rho = 0.37, p = 0.08). Three participants made suicide attempts while still in the hospital. Excluding these individuals and adjusting for the baseline variable associated with the time to suicide attempt, participants assigned to ASAP/BRITE had a significantly lower hazard ratio (HR) for suicide attempt [HR = 0.22 (95% CI 0.05-0.99)]. ASAP/BRITE showed a stronger effect in those with a history of a suicide attempts (N = 53) [test for moderation, HR = 0.07 (95% CI 0.01-0.79), p = 0.03]. Conclusion(s): In this pilot study, ASAP/BRITE shows promise as a brief inpatient intervention to decrease postdischarge suicide attempts. SIB, S, PRE Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S33
- 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)
Iyengar, U., Snowden, N., Asarnow, J. R., Moran, P., Tranah, T., Ougrin, D.
Background: Suicide attempts (SA) and other types of self-harm (SH) are strong predictors of death by suicide in adolescents, emphasizing the need to investigate therapeutic interventions in reduction of these and other symptoms. We conducted an updated systematic review of randomized controlled trials (RCTs) from our previous study reporting therapeutic interventions that were effective in reducing SH including SA, while additionally exploring reduction of suicidal ideation (SI) and depressive symptoms (DS). Method: A systematic literature search was conducted across OVID Medline, psycINFO, PubMed, EMBASE, and Cochrane Library from the first available article to October 22nd, 2017, with a primary focus on RCTs evaluating therapeutic interventions in the reduction of self-harm. Search terms included self-injurious behavior; self-mutilation; suicide, attempted; suicide; drug overdose. Results: Our search identified 1,348 articles, of which 743 eligible for review, yielding a total of 21 studies which met predetermined inclusion criteria. Eighteen unique therapeutic interventions were identified among all studies, stratified by individual-driven, socially driven, and mixed interventions, of which 5 studies found a significant effect for primary outcomes of self-harm and suicide attempts (31.3%), and 5 studies found a significant effect for secondary outcomes of suicidal ideation and depressive symptoms (29.4%) for therapeutic intervention vs. treatment as usual. Collapsing across different variations of Cognitive Behavior Therapy (CBT), and classifying Dialectical Behavior Therapy for Adolescents (DBT-A) as a type of CBT, CBT is the only intervention with replicated positive impact on reducing self-harm in adolescents. Conclusion: While the majority of studies were not able to determine efficacy of therapeutic interventions for both primary and secondary outcomes, our systematic review suggests that individual self-driven and socially-driven processes appeared to show the greatest promise for reducing suicide attempts, with benefits of combined self-driven and systems-driven approaches for reducing overall self-harm. Further RCTs of all intervention categories are needed to address the clinical and etiological heterogeneity of suicidal behavior in adolescents, specifically suicidal ideation and depressive symptoms.
Frontiers in psychiatry Frontiers Research Foundation, 9 : 583
- Year: 2018
- 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)
McManama-O'Brien, K. H., Sellers, C. M., Battalen, A. W., Ryan, C. A., Maneta, E. K., Aguinaldo, L. D., White, E., Spirito, A.
Alcohol use, both short-term intoxication and longer-term use, is a notable risk factor for suicide. Despite the strong relationship between alcohol use and suicidal thoughts and behaviors, providers typically treat these two problems independently. In particular, acute psychiatric care hospitalizations for adolescents are typically brief, and many only cursorily address alcohol use. Integrating a brief motivational enhancement intervention for alcohol use into an inpatient psychiatric hospitalization treatment protocol has the potential to enhance motivation to stop or reduce drinking if adolescents can more fully understand how it increases risk for suicidal behavior. This study tested the feasibility, acceptability, and preliminary effects of the Alcohol and Suicide Intervention for Suicidal Teens (ASIST), a brief motivational enhancement intervention targeting alcohol use and suicidal thoughts and behaviors for suicidal adolescents receiving inpatient psychiatric treatment. Results from a randomized pilot trial of ASIST (N = 50) revealed that the intervention was both feasible and acceptable, with 92% of those in the ASIST condition reporting that the intervention helped them to understand how their alcohol use is related to their suicidal thoughts and behaviors. Study findings suggest a larger randomized controlled trial may be warranted to test the effectiveness of ASIST with psychiatrically hospitalized adolescents. Copyright © 2018
Journal of Substance Abuse Treatment, 94 : 105-112
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Personalised feedback, normative feedback
Gabbay, V., Freed, R. D., Alonso, C. M., Senger, S., Stadterman, J., Davison, B. A., Klein, R. G.
Objective: Reports are mixed on the efficacy of omega-3 fatty acids (O3FA) for the treatment of major depressive disorder (MDD), with only limited data in adolescents. The present trial aimed to investigate systematically the efficacy of O3FA as a monotherapy, compared to a placebo, in adolescents with MDD. Secondarily, we explored O3FA effects on anhedonia, irritability, and suicidality-all key features of adolescent MDD. Method(s): Fifty-one psychotropic medication-free adolescents with DSM-IV-TR diagnoses of MDD (aged 12-19 years; 57% female) were randomized to receive O3FA or a placebo for 10 weeks. Data were collected between January 2006 and June 2013. O3FA and a placebo were administered on a fixed-flexible dose titration schedule based on clinical response and side effects. The initial dose of 1.2 g/d was increased 0.6 g/d every 2 weeks, up to a maximum of 3.6 g/d. Clinician-rated and self-rated depression severity, along with treatment response, served as primary outcome measures. Additionally, we examined O3FA effects on depression-related symptoms, including anhedonia, irritability, and suicidality. Treatment differences were analyzed via intent-to-treat analyses. Result(s): O3FA were not superior to a placebo on any clinical feature, including depression severity and levels of anhedonia, irritability, or suicidality. Additionally, response rates were comparable between treatment groups. Within-treatment analyses indicated that both treatments were associated with significant improvement in depression severity on self- (O3FA: t= -4.38, P< .001; placebo: t= -3.52, P= .002) and clinician (O3FA: t= -6.47, P< .001; placebo: t= -8.10, P< .001) ratings. Conclusion(s): In adolescents with MDD, O3FA do not appear to be superior to placebo. © Copyright 2018 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 79 (4) (no pagination)(17m11596) :
- Year: 2018
- Problem: Depressive Disorders, 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: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Hooley, J. M., Fox, K. R., Wang, S. B., Kwashie, A. N. D.
Background: Nonsuicidal self-injury (NSSI), which involves self-damaging behavior (e.g., cutting) causes tissue damage and places people at elevated risk for future suicidal behaviors. Yet few specific treatments for NSSI currently exist. Extreme self-criticism is implicated in the development and maintenance of NSSI. We conducted a randomized controlled trial to evaluate Autobiographical Self-Enhancement Training (ASET), a novel, cognitive intervention for NSSI focused on reducing self-criticism and enhancing positive self-worth. We also examined whether Expressive Writing (EW) was a helpful treatment for NSSI. Method(s): Participants (N = 144) who had engaged in NSSI at least twice in the past month were recruited online and then randomly assigned via Qualtrics to receive the ASET intervention (N = 49), the EW intervention (N = 49), or Daily Journaling [JNL; N = 46]), an active comparison condition. Treatments were designed as month-long daily diaries. Participants in ASET wrote about something that made them feel good about themselves that day, participants in EW described something that had been on their mind that day, and participants in JNL reported on the events of the day in a factually descriptive manner without emotional content. Result(s): Intent-to-treat analyses revealed that, regardless of treatment group, participants showed significant reductions in self-criticism, NSSI episodes, depression, and suicide ideation from baseline to the end of active treatment. Relative to the JNL group, the ASET group reported significantly less self-criticism at post-treatment; this was not maintained at follow-up. There was also a trend toward ASET being associated with less suicide ideation at the end of treatment compared to EW. This difference was significant at the 3-month follow-up. Unexpectedly, the JNL group reported significantly less suicide ideation than the EW group at post-treatment; this was maintained at 3-month follow-up. No significant treatment effects were detected for suicide plans, suicidal behaviors, desire to discontinue NSSI, or likelihood of future NSSI. Conclusion(s): Self-criticism is an important treatment target in NSSI, but changing self-criticism in people with an established history of NSSI presents challenges. Nonetheless, all approaches provided benefits. This study also established the feasibility of inexpensive and easily disseminated treatments for NSSI. Copyright © 2018 The Author(s).
BMC Psychiatry, 18 (1) (no pagination)(264) :
- Year: 2018
- 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)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Creative expression: music, dance, drama, art
, Technology, interventions delivered using technology (e.g. online, SMS)
Robinson, J., Bailey, E., Witt, K., Stefanac, N., Milner, A., Currier, D., Pirkis, J., Condron, P., Hetrick, S.
Background: Young people require specific attention when it comes to suicide prevention, however efforts need to be based on robust evidence.
Methods: We conducted a systematic review and meta-analysis of all studies examining the impact of interventions that were specifically designed to reduce suicide-related behavior in young people.
Findings: Ninety-nine studies were identified, of which 52 were conducted in clinical settings, 31 in educational or workplace settings, and 15 in community settings. Around half were randomized controlled trials. Large scale interventions delivered in both clinical and educational settings appear to reduce self-harm and suicidal ideation post-intervention, and to a lesser extent at follow-up. In community settings, multi-faceted, place-based approaches seem to have an impact. Study quality was limited.
Interpretation: Overall whilst the number and range of studies is encouraging, gaps exist. Few studies were conducted in low-middle income countries or with demographic populations known to be at increased risk. Similarly, there was a lack of studies conducted in primary care, universities and workplaces. However, we identified that specific youth suicide-prevention interventions can reduce self-harm and suicidal ideation; these types of intervention need testing in high-quality studies.
EClinicalMedicine, 4-5 : 52-91
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
Joe, S., Scott, M. L., Banks, A.
We reviewed the controlled studies that report outcome findings for Black adolescent males 24 years of age and younger at risk of suicide. Our review identified 48 articles published from 2000 to 2015, 33 that met our initial criteria for full-text articles review, resulting in 6 that met all inclusion criteria. We sought to understand what works for Black males experiencing suicide ideation or engaging in suicidal behaviors (e.g., attempts). We identified crossover effects for multisystemic therapy for reducing the risk for suicide ideation and attempts. Attachment-based family therapy was salient for use as a component of clinical practice for Black males being treated for suicide ideation. While remaining randomized control trials did involve Black youth, dis-aggregated data based on ethnicity and gender were not reported. Overall, the located studies are too few to provide unequivocal guidance for practice.
Research on Social Work Practice, 28(3) : 340-345
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Family therapy, Multisystemic therapy, Other Psychological Interventions
Frey, L. M., Hunt, Q. A.
The purpose of this article is to review the scientific evidence on the effects of family based interventions for suicidal ideation and behavior. We conducted an extensive search of electronic databases using a comprehensive search strategy. This search resulted in 16 studies that tested 13 interventions for treating suicidal ideation and behavior using family based interventions. Of the interventions identified, three yielded an overall improvement in suicidal ideation and behavior while an additional three interventions produced partial improvement in mental health symptoms. These studies targeted suicidal ideation and behavior in youth or adolescents while no studies examined family interventions for adults with suicidal ideation and behavior. The limitations of these studies and the need for additional research are examined. Copyright © 2017 American Association for Marriage and Family Therapy.
Journal of marital and family therapy, 44(1) : 107-124
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy, Other Psychological Interventions
Williams, C. L., Witte, T. K.
We evaluated the effects of exposure to a suicide news article on a variety of outcome variables and whether adhering to one specific media guideline (i.e., including psychoeducational information and preventative resources) buffered any of the negative effects of exposure.
Suicide & Life-Threatening Behavior, 48(3) : 253-270
- Year: 2018
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions