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Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams DR. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008; 192:98-105. [PMID: 18245022 PMCID: PMC2259024 DOI: 10.1192/bjp.bp.107.040113] [Citation(s) in RCA: 1659] [Impact Index Per Article: 103.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide - suicidal ideation, plans and attempts - are not wellknown, especially in low- and middle-income countries. AIMS To report on the prevalence and risk factors for suicidal behaviours across 17 countries. METHOD A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors. RESULTS The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries. CONCLUSION There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.
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Affiliation(s)
| | - Guilherme Borges
- Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, State University of New York, Stony Brook
| | - Jordi Alonso
- Health Services Research Unit, Institut Municipal d'Investigacio Medica (IMIM), Barcelona, Spain
| | | | | | - Ronny Bruffaerts
- Department of Neurosciences and Psychiatry, University Hospitals, Gasthuisberg, Belgium
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School
| | | | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yueqin Huang
- Institute of Mental Health, Peking University, People’s Republic of China
| | - Elie Karam
- Department of Psychiatry and Psychology, St. George Hospital University Medical Center, Beirut, Lebanon
| | | | - Jean Pierre Lepine
- Hôpital Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot
| | - Daphna Levinson
- Research and planning, Mental health services, Ministry of Health, Jerusalem, Israel
| | - Maria Elena Medina-Mora
- Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico
| | | | - José Posada-Villa
- Colegio Mayor de Cundinamarca University; Saldarriaga Concha Foundation, Bogota, Colombia
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Tarrier N, Taylor K, Gooding P. Cognitive-Behavioral Interventions to Reduce Suicide Behavior. Behav Modif 2008; 32:77-108. [DOI: 10.1177/0145445507304728] [Citation(s) in RCA: 258] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Suicide behavior is a serious clinical problem worldwide, and understanding ways of reducing it is a priority. A systematic review and meta-analysis were carried out to investigate whether Cognitive-behavioral therapies (CBTs) would reduce suicide behavior. From 123 potential articles, 28 studies met the entry criteria. Overall, there was a highly significant effect for CBT in reducing suicide behavior. Subgroup analysis indicates a significant treatment effect for adult samples (but not adolescent), for individual treatments (but not group), and for CBT when compared to minimal treatment or treatment as usual (but not when compared to another active treatment). There was evidence for treatment effects, albeit reduced, over the medium term. Although these results appear optimistic in advocating the use of CBT in ameliorating suicidal thoughts, plans, and behaviors, evidence of a publication bias tempers such optimism.
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Pitman A. Policy on the prevention of suicidal behaviour; one treatment for all may be an unrealistic expectation. J R Soc Med 2007; 100:461-4. [PMID: 17911128 PMCID: PMC1997274 DOI: 10.1177/014107680710001014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In the absence of clear guidelines on suicide prevention there is a pressing need to translate existing and future evidence into policy. Suicide is a behaviour, not a diagnosis, and has diverse underlying pathologies. Interventions have differential effects in specific risk groups, which may include paradoxical increases in risk. For these reasons, policy makers may need to abandon the goal of one treatment for all and focus on the distinct subgroups of patients at risk when selecting, evaluating and implementing preventive interventions. This has implications for the design of future research, but has the potential to increase the utility and cost-effectiveness of the data available, thereby benefiting policy makers, clinicians and patients.
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Affiliation(s)
- Alexandra Pitman
- Department of Mental Health Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW3 4QP, UK.
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Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C. Postcards from the EDge: 24-month outcomes of a randomised controlled trial for hospital-treated self-poisoning. Br J Psychiatry 2007; 191:548-53. [PMID: 18055960 DOI: 10.1192/bjp.bp.107.038406] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Repetition of self-poisoning is common. AIMS To report the 24-month outcomes of a non-obligatory postcard intervention (plus treatment as usual) compared with treatment as usual. METHOD In a randomised-controlled trial (Zelen design) conducted in Newcastle, Australia, eight postcards were sent to participants over a 12-month period. The principal outcomes were the proportion of participants with one or more repeat episodes of self-poisoning and the number of repeat episodes per person. RESULTS No significant reduction was observed in the proportion of people repeating self-poisoning in the intervention group (21.2%, 95% CI 17.0-25.3) compared with the control group (22.8%, 95% CI 18.7-27.0; chi(2)=0.32, d.f.=1, P=0.57); the difference between groups was -1.7% (95% CI -7.5 to 4.2). There was a significant reduction in the rate of repetition, with an incidence risk ratio of 0.49 (95% CI 0.33-0.73). CONCLUSIONS A postcard intervention maintained the halving of the rate of repetition of hospital-treated self-poisoning events over a 2-year period, although it did not significantly reduce the proportion of individuals who repeated self-poisoning.
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Affiliation(s)
- Gregory L Carter
- Department of Consultation-Liaison Psychiatry, Locked Bag 7, Hunter Region Mail Centre, NSW 2310, Australia.
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Pitman A. Policy on the prevention of suicidal behaviour; one treatment for all may be an unrealistic expectation. J R Soc Med 2007. [PMID: 17911128 DOI: 10.1258/jrsm.100.10.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the absence of clear guidelines on suicide prevention there is a pressing need to translate existing and future evidence into policy. Suicide is a behaviour, not a diagnosis, and has diverse underlying pathologies. Interventions have differential effects in specific risk groups, which may include paradoxical increases in risk. For these reasons, policy makers may need to abandon the goal of one treatment for all and focus on the distinct subgroups of patients at risk when selecting, evaluating and implementing preventive interventions. This has implications for the design of future research, but has the potential to increase the utility and cost-effectiveness of the data available, thereby benefiting policy makers, clinicians and patients.
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Affiliation(s)
- Alexandra Pitman
- Department of Mental Health Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW3 4QP, UK.
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Rizvi S, Zaretsky AE. Psychotherapy through the phases of bipolar disorder: Evidence for general efficacy and differential effects. J Clin Psychol 2007; 63:491-506. [PMID: 17417815 DOI: 10.1002/jclp.20370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The obstacle facing pharmacotherapy for bipolar disorder is that almost half of the patients do not achieve recovery over the duration of treatment. Although the reason for this disappointing clinical outcome remains unclear, structured psychotherapy has helped to fill these gaps in the treatment of bipolar disorder. Psychoeducation, family-focused therapy, interpersonal and social rhythm therapy, and cognitive behavior therapy have all received attention in the research literature. In this review, by assessing the outcomes from randomized control trials across the phases of bipolar disorder, we demonstrate that psychotherapy is an effective adjunctive treatment. We also show that the use of psychotherapy for bipolar disorder has differential results depending on when and under what conditions it is administered.
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Affiliation(s)
- Sakina Rizvi
- Department of Psychiatry, University of Toronto, Head Cognitive Behavior Therapy Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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