Disorders - Suicide or self-harm behaviours
Franklin, J. C., Fox, K. R., Franklin, C. R., Kleiman, E. M., Ribeiro, J. D., Jaroszewski, A. C., Hooley, J. M., Nock, M. K.
Objective: Self-injurious thoughts and behaviors (SITBs) are a major public health problem that traditional interventions have been unable to address on a large scale. The goal of this series of studies was to take initial steps toward developing an effective SITB treatment that can be easily delivered on a very large scale. Method: We created a brief (1-2 min), game-like app called Therapeutic Evaluative Conditioning (TEC), designed to increase aversion to SITBs and decrease aversion to the self. In 3 separate studies, we recruited participants with recent and severe histories of SITBs from web forums focused on self-injury and psychopathology (Ns = 114, 131, and 163) and randomly assigned them to receive access to the mobile treatment TEC app or a control app for 1 month. We tested the effect of TEC on the frequency of self-cutting, nonsuicidal self-injury more generally, suicide ideation, suicide plans, and suicidal behaviors. Results: Analyses showed that, compared with the control app, TEC produced moderate reductions for all SITBs except suicide ideation. Across studies, the largest and most consistent reductions were for self-cutting episodes (32%-40%), suicide plans (21%-59%), and suicidal behaviors (33%-77%). Two of the 3 studies showed that TEC impacted its intended treatment targets and that greater change in these targets was associated with greater SITB reductions. TEC effects were not maintained at the 1-month posttreatment follow-up. Conclusions: Future versions of brief, mobile interventions like that tested here may have the potential to reduce SITBs and related behaviors on a large scale. (PsycINFO Database Record (c) 2016 APA, all rights reserved) Impact Statement What is the public health significance of this article?-Across 3 studies, we found that a brief mobile app generated moderate reductions in nonsuicidal and suicidal self-injury. These findings suggest that mobile interventions may have the potential to impact SITBs on a large scale. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Consulting and Clinical Psychology, 84(6) : 544-557
- Year: 2016
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., Mahmood, W., Patel, V., Bhutta, Z. A.
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: -.16; 95% confidence interval [CI]: -.26 to -.05) and anxiety (SMD: -.33; 95% CI: -.59 to -.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57-2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36-1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: -.10; 95% CI: -.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: -.13 to .15); and bulimia (SMD: -.03; 95% CI: -.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16-.81) and reducing depression score (SMD: -.66; 95% CI: -1.25 to -.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31-11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Adolescent Health, 59(4, Suppl) : S49-S60
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any), 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: Biological Interventions (any)
, Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Technology, interventions delivered using technology (e.g. online, SMS)
Connell, A. M., McKillop, H. N., Dishion, T. J.
The impact of the Family Check-Up (FCU), a school-based prevention program, as delivered in public secondary schools on suicide risk across adolescence, was examined. Students were randomly assigned to a family-centered intervention (N = 998) in the sixth grade and offered a multilevel intervention that included (1) a universal classroom-based intervention, (2) the FCU (Dishion, Stormshak, & Kavanagh, 2011), and (3) family management treatment. Engagement with the FCU predicted significant reductions in suicide risk across adolescence and early adulthood. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Suicide and Life-Threatening Behavior, 46(Suppl 1) : S15-S22
- Year: 2016
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Other service delivery and improvement interventions
Calati, R., Courtet, P.
Objective: To determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI). Methods: Meta-analysis of randomized controlled trials (RCTs) comparing psychotherapy interventions and treatment as usual (TAU; including also enhanced usual care, psychotropic treatment alone, cognitive remediation, short-term problem-oriented approach, supportive relationship treatment, community treatment by non-behavioral psychotherapy experts, emergency care enhanced by provider education, no treatment) for SA/NSSI. RCTs were extracted from MEDLINE, EMBASE, PsycINFO and Cochrane Library and analyzed using the Cochrane Collaboration Review Manager Software and Comprehensive Meta-analysis. Results: In the 32 included RCTs, 4114 patients were randomly assigned to receive psychotherapy (n = 2106) or TAU (n = 2008). Patients who received psychotherapy were less likely to attempt suicide during the follow-up. The pooled risk difference for SA was -0.08 (95% confidence intervals = -0.04 to -0.11). The absolute risk reduction was 6.59% (psychotherapy: 9.12%; TAU: 15.71%), yielding an estimated number needed to treat of 15. Sensitivity analyses showed that psychotherapy was effective for SA mainly in adults, outpatients, patients with borderline personality disorder, previously and non-previously suicidal patients (heterogeneous variable that included past history of SA, NSSI, deliberate self-harm, imminent suicidal risk or suicidal ideation), long- and short-term therapies, TAU only as a control condition, and mentalization-based treatment (MBT). No evidence of efficacy was found for NSSI, with the exception of MBT. Between-study heterogeneity and publication bias were detected. In the presence of publication bias, the Duval and Tweedie's "trim and fill" method was applied. Conclusion: Psychotherapy seems to be effective for SA treatment. However, trials with lower risk of bias, more homogeneous outcome measures and longer follow-up are needed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Psychiatric Research, 79 : 8-20
- Year: 2016
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Calear, A. L., Christensen, H., Freeman, A., Fenton, K., Busby-Grant, J., van-Spijker, B., Donker, T.
Youth suicide is a significant public health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12-25 years. PsycInfo, PubMed and Cochrane databases were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a significant effect on suicidal ideation (Cohen's d = 0.16-3.01), suicide attempts (phi = 0.04-0.38) or deliberate self-harm (phi = 0.29-0.33; d = 0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
European Child & Adolescent Psychiatry, 25(5) : 467-482
- Year: 2016
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Carter, G., Page, A., Large, M., Hetrick, S., Milner, A. J., Bendit, N., Walton, C., Draper, B., Hazell, P., Fortune, S., Burns, J., Patton, G., Lawrence, M., Dadd, L., Robinson, J., Christensen, H.
OBJECTIVE: To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations.
METHOD: Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm.
RESULTS: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care.
CONCLUSION: The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
Copyright © The Royal Australian and New Zealand College of Psychiatrists 2016.
Australian & New Zealand Journal of Psychiatry, 50(10) : 939-1000
- Year: 2016
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Cheng, F. K.
Childhood mental health problems not only incur a financial burden but more importantly damages individual and family well-being, which compels mental care practitioners to search for solutions, among which meditation is a more economical method. This integrative review investigates the effectiveness of meditation on psychological problems for adolescents under age of 20 through different types of meditation, though mainly mindfulness-based modes. The 36 reviewed publications include quantitative, qualitative and mixed methods research, conducted in North America, Europe, and the Asia Pacific region, related to developmental disabilities, emotional problems, and mental illnesses. Outcomes indicate a decrease in self-harm thoughts, disruptive behaviour, stress, anxiety, impulsivity, and psychological distress; and improvements in self-control, quality of sleep, emotional regulation, executive function, anger management, and social competence, resulting in better academic performance, quality of life, mental wellness, and child-parent relationships. This review suggests the integration of meditation into physical activities, and music and art therapies, as well as randomised controlled trials to examine such synthesis of these disciplines. In conclusion, meditation is a potential curative and preventive measure, both low cost and non-intrusive, for the promotion of adolescent mental wellness. This sheds light on nurses who look after children with mental health. Copyright © 2016 The Author.
International Journal of Africa Nursing Sciences, 4 : 7-19
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders, Non-suicidal self-harm behaviours
, 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: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Mindfulness based therapy, Meditation
Sandler, I., Tein, J. Y., Wolchik, S., Ayers, T. S.
Findings concerning the long-term effects of the Family Bereavement Program (FBP) to reduce suicide ideation and/or attempts of parentally bereaved children and adolescents are presented. Parental death is a significant risk factor for suicide among offspring (Guldin et al., 2015). This study is a long-term follow-up of 244 children and adolescents who had participated in a randomized trial of the FBP, examining the intervention effects on suicide ideation and/or attempts as assessed through multiple sources.
Suicide & Life-Threatening Behavior, 46 Suppl 1 : S32-8
- Year: 2016
- 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
Saunders, K. E., Smith, K. A.
Self-harm is a major public health concern and a risk factor for future suicide. It predominantly occurs in young people with around 65% of self-harm occurring before the age of 35. Self-harm causes distress to families and is associated with poorer educational outcomes as well as increased health and social care costs. Repetition is common with a quarter of individuals presenting to hospital with a further episode of self-harm within a year. We review the evidence from randomised controlled trials of treatments for self-harm, focusing on pharmacological and psychological approaches. We then contrast this with the current observational evidence and reflect on the challenges and limitations of randomised controlled trials for the treatment of self-harm.
Evidence-Based Mental Health, 19(3) : 69-72
- Year: 2016
- 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)
, Psychological Interventions (any)
Brewer, W. J., Lambert, T. J., Witt, K., Dileo, J., Duff, C., Crlenjak, C., McGorry, P. D., Murphy, B. P.
Background: The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Methods: Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Findings: Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Interpretation: Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community. Funding: National Health & Medical Research Council and the Colonial Foundation.
Lancet Psychiatry, 2(1) : 29-37
- Year: 2015
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Case management
Bennett, K., Rhodes, A. E., Duda, S., Cheung, A. H., Manassis, K., Links, P., Mushquash, C., Braunberger, P., Newton, A. S., Kutcher, S., Bridge, J. A., Santos, R. G., Manion, I. G., McLennan, J. D., Bagnell, A., Lipman, E., Rice, M., Szatmari, P.
Objective: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. Methods: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. Results: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. Conclusions: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Canadian Journal of Psychiatry, 60(6) : 245-257
- Year: 2015
- 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: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
Labelle, Real, Pouliot, Louise, Janelle, Alain
Although cognitive-behavioural (CB) treatments are recognised as evidence-based interventions for depression and other disorders in adolescents, their efficacy in reducing suicidal and self-harm behaviours in this group remains equivocal. First, a systematic review of the literature was carried out (N = 25 studies) on CB treatments for adolescents who presented suicidal ideation, had made suicide attempts, or engaged in self-harm. Results suggest that the scientific quality of past studies is suboptimal. Second, a meta-analysis of the pooled data of 14 CB treatment studies was conducted using a pre-post control group design. Results indicate a significant treatment effect in reducing suicidal ideation (n = 13/14 studies; g = -.40, 95% CI [-.30, .49], z = 7.95, p = .001). A significant effect was observed also with respect to self-harm (n = 8/14 studies; g = -.27, 95% CI [-.17, .38], z = 4.96, p = .001). However, no significant effect was found for suicide attempts (n = 6/14 studies; g = -.01, 95% CI [-.13, .14], z = .07, p = .94). The poor effect observed in this case could be due to low baseline prevalence of suicide attempts in most studies owing to active exclusion of adolescents at high risk for suicide. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Canadian Psychology/Psychologie canadienne, 56(4) : 368-378
- Year: 2015
- 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)
, Cognitive & behavioural therapies (CBT)