Disorders - Suicide or self-harm behaviours
Tan, J. X., Fajardo, M. L. R.
Background: Antisocial behaviour and conduct disorders are the most common behavioural and mental health problems in children and young people globally. An efficacious intervention is needed to manage these antisocial behaviours that have costly consequences. Multisystemic Therapy (MST), an intensive home-based intervention for youths with psychosocial and behavioural problems, is recommended under National Institute for Health and Clinical Excellence guidelines for conduct disorder. However, reviews on the efficacy of MST are mixed.
Aim: To review randomised controlled trials (RCTs) reporting efficacy of MST among youths presenting with antisocial behaviour and emotional disorder respectively.
Method: A systematic map term to subject heading search was conducted in PsycINFO, Embase, and Ovid Medline databases for articles up to November 2015. RCTs comparing MST vs.treatment as usual (TAU) in youths presenting with antisocial behaviour and emotional disorder were included.
Results: 12 RCTs (n = 1425) reported efficacy of MST vs. TAU in youths presenting with antisocial behaviour and emotional disorder. Clinically significant treatment effects of MST showed a reduction of antisocial behaviour which includes delinquency. MST, vs. psychiatric hospitalisation, was associated with a reduction of suicidal attempts in youths presenting with psychiatric emergencies. 4 studies showed that MST was less costly than TAU in the short term, with further analysis required for long-term cost-effectiveness.
Conclusion: MST is an efficacious intervention for severe antisocial behaviours in reduction of delinquency and should be included in clinical practices. MST was shown to have a positive effect on emotional disorder but further research is needed to evaluate the efficacy of MST with emotional disorder. Further analysis is required to assess the services utilized for long-term cost effectiveness.
London Journal of Primary Care, 9(6) : 95-103
- Year: 2017
- 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)
, Multisystemic therapy
Midgley, N., OKeeffe, S., French, L., Kennedy, E.
While the evidence base for psychodynamic therapy with adults is now quite substantial, there is still a lack of research evaluating the effectiveness of psychodynamic therapies with children and young people. Those studies that have been carried out are also not widely known in the field. To help address the second point, in 2011, we carried out a review of the evidence base for psychodynamic psychotherapy for children and adolescents, which identified 35 studies which together provided some preliminary evidence for this treatment for a range of childhood disorders. The present study is an updated review, focusing on research published between March 2011 and November 2016. During this period, 23 additional studies were published, of which 5 were reports on randomised controlled trials, 3 were quasi-experimental controlled studies and 15 were observational studies. Although most studies covered children with mixed diagnoses, there were a number of studies examining specific diagnostic groups, including children with depression, anxiety and disruptive disorders. whilst the quality of studies was mixed, some were well-designed and reported, and overall indicated promising findings. Nevertheless, further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy across a range of different disorders, and to ensure that services can provide a range of evidence-based treatments for children and young people. Copyright © 2017 Association of Child Psychotherapists.
Journal of Child Psychotherapy, 43(3) : 307-329
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders, 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
Roberts, C. M., Kane, R. T., Rooney, R. M., Pintabona, Y., Baughman, N., Hassan, S., Cross, D., Zubrick, S. R., Silburn, S. R.
The efficacy of an enhanced version of the Aussie Optimism Program (AOP) was investigated in a cluster randomized controlled trial. Grade 6 students aged 10-11 years of age (N = 2288) from 63 government primary schools in Perth, Western Australia, participated in the pre, post, and follow-up study. Schools were randomly assigned to one of three conditions: Aussie Optimism with teacher training, Aussie Optimism with teacher training plus coaching, or a usual care condition that received the regular Western Australian Health Education Curriculum. Students in the Aussie Optimism conditions received 20, 1-h lessons relating to social and interpersonal skills and optimistic thinking skills over the last 2 years of primary school. Parents in the active conditions received a parent information booklet each year, plus a self-directed program in Grade 7. Students and parents completed the Extended Strengths and Difficulties Questionnaire. Students who scored in the clinical range on the Emotional Symptoms Scale were given The Diagnostic Interview for Children and Adolescents IV, to assess suicidal ideation and behavior, and depressive and anxiety disorders.
Frontiers in Psychology, 8 : 1392
- Year: 2017
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Santamarina, P., Blanco, I. M., Picado, M., Font, E., Moreno, E., Martinez, E., Linan, A. M., Romero, S.
Objectives: Self-harm in adolescents is a major clinical problem and is strongly associated with suicide. DBT was originally developed for adults with suicidal behavior to improve skills and regulate intense emotions. Evidence has shown that DBT is associated with a substantial reduction in self-harm in that population. Currently, DBT has been adapted for youth with suicidal behavior, and there is little evidence in support of its efficacy. However, to date, none of these RCTs has compared DBT with another group therapy. We examined whether DBT is more effective than a combined individual and group supportive therapy (ST) to reduce self-harm in adolescents. Methods: Thirty-five participants (ages 12-18 years) with recent and repetitive self-harming behavior were selected from a psychiatry outpatient clinic. Patients were randomly assigned to receive either treatment: DBT (n = 18) or ST (n = 17). Both treatments included 16 weekly group sessions with adolescents and families separately, and biweekly individual sessions. Group DBT was carried out following the manualized intervention protocol developed by Rathus and Miller. The ST was not manualized and consisted of an eclectic psychotherapy approach, which included psychoeducational and supportive therapy. Assessments of self-harming behavior (number of self-reported selfharm episodes), suicidal ideation (Suicidal Ideation Questionnaire), and Clinical Global Impression (CGI) for suicide were made at baseline and at the end of the trial period. Analyses were conducted using ANCOVA adjusted for baseline measures. Results: The groups did not differ from one another at baseline with respect to sociodemographic and clinical variables. DBT was superior to ST in reducing self-harm and CGI. Analyses indicated large effect sizes for self-harm [0.89 (95% CI 0.7-1.71); P = 0.034] and CGI [0.75 (95% CI 0-1.49); P = 0.049] among adolescents receiving DBT. Although there were no between-group differences in suicidal ideation, we found that it improved after receiving both treatments. Conclusions: This is the first RCT to demonstrate the efficacy of DBT treatment for adolescents with suicidal behavior by comparing it to another group treatment. These findings suggest that DBT is a promising treatment for suicidal behavior in this population.
Journal of the American Academy of Child and Adolescent Psychiatry, 56 (10) : S226-S227
- Year: 2017
- 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
Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De-La-Mata, N., Christensen, H.
OBJECTIVES: Rates of youth suicide in Australian Indigenous communities are 4 times the national youth average and demand innovative interventions. Historical and persistent disadvantage is coupled with multiple barriers to help seeking. Mobile phone applications offer the opportunity to deliver therapeutic interventions directly to individuals in remote communities. The pilot study aimed to evaluate the effectiveness of a self-help mobile app (ibobbly) targeting suicidal ideation, depression, psychological distress and impulsivity among Indigenous youth in remote Australia.
SETTING: Remote and very remote communities in the Kimberley region of North Western Australia.
PARTICIPANTS: Indigenous Australians aged 18-35 years.
INTERVENTIONS: 61 participants were recruited and randomised to receive either an app (ibobbly) which delivered acceptance-based therapy over 6 weeks or were waitlisted for 6 weeks and then received the app for the following 6 weeks.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the Depressive Symptom Inventory-Suicidality Subscale (DSI-SS) to identify the frequency and intensity of suicidal ideation in the previous weeks. Secondary outcomes were the Patient Health Questionnaire 9 (PHQ-9), The Kessler Psychological Distress Scale (K10) and the Barratt Impulsivity Scale (BIS-11).
RESULTS: Although preintervention and postintervention changes on the (DSI-SS) were significant in the ibobbly arm (t=2.40; df=58.1; p=0.0195), these differences were not significant compared with the waitlist arm (t=1.05; df=57.8; p=0.2962). However, participants in the ibobbly group showed substantial and statistically significant reductions in PHQ-9 and K10 scores compared with waitlist. No differences were observed in impulsivity. Waitlist participants improved after 6 weeks of app use.
CONCLUSIONS: Apps for suicide prevention reduce distress and depression but do not show significant reductions on suicide ideation or impulsivity. A feasible and acceptable means of lowering symptoms for mental health disorders in remote communities is via appropriately designed self-help apps.
Trial registration number: actrn12613000104752.
BMJ Open, 7(1) : e013518
- Year: 2017
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- 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)
Won, S. J., Choi, Y. S.
This study was attempted in order to offer basic data, which are useful for understanding and guiding middle school students' behavior in the school field, to teachers and counselors by closely examining which influence the application of aromatherapy intervention targeting middle school students has upon academic stress, academic self-efficacy, suicidal ideation, and salivary cortisol. As this is a study in the randomized control group pre-post test design that applied with making aroma essential oil in the form of aroma stick so that continuous management can be easy, it proved the effective intervention method available for being used in alleviating academic stress and enhancing academic self-efficacy in middle school students by objectively verifying an effect of aroma essential oil. Also, a useful method was suggested that even the middle school students as the stressful youths can easily use with having an interest in own health promotion. The intervention of aromatherapy using aroma essential oil has significance in corresponding to a flow of stress and health management in modern times of pointing to a natural healing method focusing on a concept of wellbeing, and in offering a scientific basic of a complementary and alternative therapy. Copyright © 2017, Scientific Publishers of India. All rights reserved.
Biomedical Research (India), 28(16) : 7005-7011
- Year: 2017
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Other complementary & alternative interventions
Zou, Y., Li, H., Shi, C., Lin, Y., Zhou, H., Zhang, J.
The present study aimed to explore the effects of psychological pain theory-based cognitive therapy (PPTBCT) on suicide among depressed patients, compared with a control group who received usual psychological care (UPC). The sample consisted of 32 depressed patients and 32 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory, Three-Dimensional Psychological Pain Scale (TDPPS), and Problem Solving Inventory(PSI), and Automatic Thoughts Questionnaire (ATQ). All measures differed significantly between depressed patients and healthy controls. Then clinical participants were assigned randomly to the PPTBCT (n=19) and control (n=13) groups. During the 8-week intervention, scores related to depression, suicidal ideation, psychological pain, and automatic thoughts were decreased in both groups at the post-intervention and 4-week follow-up time points, compared with pre-intervention scores. BSI scores remained low at follow up and did not differ significantly from post-intervention scores in the PPTBCT group, but were significantly higher at follow up than at post-intervention in the control group. PPTBCT may effectively reduce suicide risk in patients with major depressive disorder, although the effects of its application need to be confirmed.
Psychiatry Research, 249 : 23-29
- Year: 2017
- 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)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T., Williams, S. R., Maney, E., Rudd, M.
Objective: To evaluate the effectiveness of crisis response planning for the prevention of suicide attempts. Method: Randomized clinical trial of active duty Army Soldiers (N = 97) at Fort Carson, Colorado, presenting for an emergency behavioral health appointment. Participants were randomly assigned to receive a contract for safety, a standard crisis response plan, or an enhanced crisis response plan. Incidence of suicide attempts during follow-up was assessed with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation during the past week and/or a lifetime history of suicide attempt. Exclusion criteria were the presence of a medical condition that precluded informed consent (e.g., active psychosis, mania). Survival curve analyses were used to determine efficacy on time to first suicide attempt. Longitudinal mixed effects models were used to determine efficacy on severity of suicide ideation and follow-up mental health care utilization. Results: From baseline to the 6-month follow-up, 3 participants receiving a crisis response plan (estimated proportion: 5%) and 5 participants receiving a contract for safety (estimated proportion: 19%) attempted suicide (log-rank chi2(1) = 4.85, p = 0.028; hazard ratio = 0.24, 95% CI = 0.06-0.96), suggesting a 76% reduction in suicide attempts. Crisis response planning was associated with significantly faster decline in suicide ideation (F(3,195) = 18.64, p < 0.001) and fewer inpatient hospitalization days (F(1,82) = 7.41, p < 0.001). There were no differences between the enhanced and standard crisis response plan conditions. Conclusion: Crisis response planning was more effective than a contract for safety in preventing suicide attempts, resolving suicide ideation, and reducing inpatient hospitalization among high-risk active duty Soldiers. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Affective Disorders, 212 : 64-72
- Year: 2017
- 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
Esposito-Smythers, C., Hadley, W., Curby, T. W., Brown, L. K.
Adolescents with mental health conditions represent a high-risk group for substance use, deliberate self-harm (DSH), and risky sexual behavior. Mental health treatment does not uniformly decrease these risks. Effective prevention efforts are needed to offset the developmental trajectory from mental health problems to these behaviors. This study tested an adjunctive cognitive-behavioral family-based alcohol, DSH, and HIV prevention program (ASH-P) for adolescents in mental healthcare. A two group randomized design was used to compare ASH-P to an assessment only control (AO-C). Participants included 81 adolescents and a parent. Assessments were completed at pre-intervention as well as 1, 6, and 12-months post-enrollment, and included measures of family-based mechanisms and high-risk behaviors. ASH-P relative to AO-C was associated with greater improvements in most family process variables (perceptions of communication and parental disapproval of alcohol use and sexual behavior) as well as less DSH and greater refusal of sex to avoid a sexually transmitted infection. It also had a moderate (but non-significant) effect on odds of binge drinking. No differences were found in suicidal ideation, alcohol use, or sexual intercourse. ASH-P showed initial promise in preventing multiple high-risk behaviors. Further testing of prevention protocols that target multiple high-risk behaviors in clinical samples is warranted.
Copyright © 2016 Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 89 : 49-56
- Year: 2017
- 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)
, Other Psychological Interventions
Cox, G., Hetrick, S.
We reviewed the evidence for the effectiveness of indicated individual psychosocial interventions for the treatment of self-harm, suicidal ideation and suicide attempts in children and young people, with a particular emphasis on the emerging use of electronic methods to deliver psychological interventions. In total, 16 randomised controlled trials (RCTs) were identified, none of which included children under the age of 12 years. Cognitive-behavioural therapy is the most commonly implemented approach in RCTs until now, although problem-solving therapy, interpersonal psychotherapy, social support and distal support methods by provision of a green card and regular receipt of postcards have also been investigated. Young people have been recruited into RCTs within schools, outpatient clinics, emergency departments and inpatient facilities. Face-to-face delivery of therapy has dominated the intervention trials thus far; however, the use of the internet, social media and mobile devices to deliver interventions to young people and other family members allows for a more novel approach to suicide prevention in youth going forward.
Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Evidence-Based Mental Health, 20(2) : 35-40
- Year: 2017
- 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)
Hetrick, S. E., Yuen, H. P., Bailey, E., Cox, G. R., Templer, K., Rice, S. M., Bendall, S., Robinson, J.
BACKGROUND: Suicide-related behaviours are common in young people and associated with a range of negative outcomes. There are few evidence-based interventions; however, cognitive behavioural therapy (CBT) shows promise. Internet delivery of CBT is popular, with potential to increase reach and accessibility.
OBJECTIVE: To test the effectiveness of an internet-based CBT program (Reframe-IT) in reducing suicide-related behaviours, depression, anxiety, hopelessness and improving problem solving and cognitive and behavioural skills in school students with suicide-related behaviours.
METHODS: A parallel randomised controlled trial testing the effectiveness of Reframe-IT plus treatment as usual (TAU) compared with TAU alone in reducing suicidal ideation, suicide attempts, depression, hopelessness, symptoms of anxiety, negative problem orientation and cognitive and behavioural skill acquisition was undertaken. We recruited students experiencing suicidal ideation from 18 schools in Melbourne, Australia, between August 2013 and December 2016. The intervention comprised eight modules of CBT delivered online over 10 weeks with assessments conducted at baseline, 10 weeks and 22 weeks.
FINDINGS: Only 50 of the planned 169 participants were recruited. There were larger improvements in the Reframe-IT group compared with the TAU group for the primary outcome of suicidal ideation (intervention -61.6, SD 41.6; control -47.1, SD 42.3, from baseline to 22-week follow-up intervention); however, differences were non-significant (p=0.593). There were no increases in distress in the majority of participants (91.1%) after completion of each module. Changes in depression and hopelessness partly mediated the effect of acquisition of CBT skills on suicidal ideation.
CONCLUSIONS: The trial was underpowered due to difficulties recruiting participants as a result of the complex recruitment procedures that were used to ensure safety of participants. Although there were no significant differences between groups, young people were safely and generally well engaged in Reframe-IT and experienced decreases in suicidal ideation and other symptoms as well as improvements in CBT skills. The study is the first online intervention trial internationally to include young people demonstrating all levels of suicide risk.
CLINICAL IMPLICATIONS: Integration of internet-delivered interventions for young people with suicide-related behaviour may result in reductions in these behaviours. Further research is needed, but researchers should feel more confident about being able to safely undertake research with young people who experience these behaviours.
Trial registration number: actrn12613000864729.
, 12 : 12
- Year: 2017
- 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)
Hazell, P.
Background: About 25% of adolescents self-harm at some time, and one in three of those will be repeaters. Historically, interventions to prevent the recurrence of deliberate self-harm (DSH) by adolescents have been ineffective. Objectives: To critically examine systematic evidence for the effectiveness of interventions designed to reduce the recurrence of DSH among clinically referred populations of adolescents. Methods: Electronic search of PubMed (to April 2014) using the following terms: self-harm AND review AND adolescent. We also contacted the authors of a Cochrane Review in revision to determine if there were relevant unpublished studies. Findings: From four systematic reviews, we identified 14 relevant randomized controlled trials (RCTs), with a total of 1965 participants. We identified three further RCTs: Small, single studies of modified cognitive behavioural therapy (CBT), mentalization-based therapy (MBT) and dialectical behaviour therapy (DBT). DBT showed superiority over treatment as usual (TAU) in reducing the rate of repetition of DSH. The reviews found none of the following interventions any more effective than TAU: family intervention for suicide prevention; token allowing re-admission; home-based family intervention; compliance enhancement in hospital; skills-based treatment; youthnominated support team; therapeutic assessment at point of presentation; and developmental group psychotherapy. Conclusions: Modified CBT, MBT and DBT may be effective in reducing the repetition of DSH among adolescents, but the findings require replication before the treatments can be widely recommended. The goals of treatment need also to be reconsidered, since a reduction in the frequency and severity of DSH may be a more realistic outcome than complete cessation.
Australian and New Zealand Journal of Psychiatry, 51 (1 Supplement 1) : 82
- Year: 2017
- 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)