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Hetrick SE, Robinson J, Spittal MJ, Carter G. Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression. BMJ Open 2016; 6:e011024. [PMID: 27660314 PMCID: PMC5051331 DOI: 10.1136/bmjopen-2016-011024] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm. DESIGN We conducted a systematic review, meta-analysis and meta-regression to examine the efficacy of psychological and psychosocial interventions to reduce repeat self-harm in adults. We included a sensitivity analysis of studies with a low risk of bias for the meta-analysis. For the meta-regression, we examined whether the type, intensity (primary analyses) and other components of intervention or methodology (secondary analyses) modified the overall intervention effect. DATA SOURCES A comprehensive search of MEDLINE, PsycInfo and EMBASE (from 1999 to June 2016) was performed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of psychological and psychosocial interventions for adult self-harm patients. RESULTS Forty-five trials were included with data available from 36 (7354 participants) for the primary analysis. Meta-analysis showed a significant benefit of all psychological and psychosocial interventions combined (risk ratio 0.84; 95% CI 0.74 to 0.96; number needed to treat=33); however, sensitivity analyses showed that this benefit was non-significant when restricted to a limited number of high-quality studies. Meta-regression showed that the type of intervention did not modify the treatment effects. CONCLUSIONS Consideration of a psychological or psychosocial intervention over and above treatment as usual is worthwhile; with the public health benefits of ensuring that this practice is widely adopted potentially worth the investment. However, the specific type and nature of the intervention that should be delivered is not yet clear. Cognitive-behavioural therapy or interventions with an interpersonal focus and targeted on the precipitants to self-harm may be the best candidates on the current evidence. Further research is required.
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Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Greg Carter
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, New South Wales, Australia
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Alonzo D. Suicidal Individuals and Mental Health Treatment: A Novel Approach to Engagement. Community Ment Health J 2016; 52:527-33. [PMID: 26748654 DOI: 10.1007/s10597-015-9980-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
To determine the feasibility and acceptability of a novel, manualized problem-solving and comprehensive contact intervention (PS-CCI) aimed at improving treatment engagement of suicidal individuals. The PS-CCI was administered to 44 individuals with mood disorders presenting to the ER with suicidal ideation and/or behavior. The PS-CCI has two components: (1) a problem-solving interview administered upon admission to the emergency room (ER), and (2) follow-up contact post-discharge from the ER. The average age of participants was 33.45 years (SD = ±12.30). The PS-CCI was completed by 75 % of patients. No subject (0 %) withdrew during the 3-month follow-up period; however, 27.2 % were unable to be reached for follow-up assessment. We have concluded that the intervention has a good feasibility because of high acceptability and adherence and further testing of its efficacy seems feasible.
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Affiliation(s)
- Dana Alonzo
- Fordham University Graduate School of Social Work, 113 West 60th Street, New York, NY, 10023, USA.
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Grimholt TK, Jacobsen D, Haavet OR, Sandvik L, Jorgensen T, Norheim AB, Ekeberg O. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial. PLoS One 2015; 10:e0143934. [PMID: 26629812 PMCID: PMC4667913 DOI: 10.1371/journal.pone.0143934] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. Design Randomised clinical trial with two parallel groups. Setting General practices in Oslo and the eastern part of Akershus County. Participants Patients aged 18–75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. Intervention The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). Main Outcome Measures Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. Results There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). Conclusion Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in hospitals or EMAs. However, the total number of incidents of deliberate self-harm reported by the patients was significantly higher in the intervention group. Trial registration Trial registration ClinicalTrials.gov Identifier: NCT01342809
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Affiliation(s)
- Tine K. Grimholt
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Regional Centre of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway
- * E-mail:
| | - Dag Jacobsen
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Ole Rikard Haavet
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Leiv Sandvik
- Department of Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Trond Jorgensen
- Psychiatric Consultation Team, Akershus University Hospital, Akershus,Norway
| | - Astrid Berge Norheim
- Regional Centre of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway
- Diakonhjemmet Hospital, Oslo,Norway
| | - Oivind Ekeberg
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Wollweber B, Keck ME, Schmidt U. Improvement of nonsuicidal self-injury following treatment with antipsychotics possessing strong D1 antagonistic activity: evidence from a report of three cases. Ther Adv Psychopharmacol 2015; 5:208-13. [PMID: 26301076 PMCID: PMC4535046 DOI: 10.1177/2045125315585652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION There is no drug treatment for nonsuicidal self-injury (NSSI), a highly prevalent and burdensome symptom of several psychiatric diseases like posttraumatic stress disorder (PTSD), personality disorders, and major depression (MD). METHODS Here, we present a retrospective series of three patients demonstrating a persistent remission in MD-associated NSSI in response to treatment with antipsychotics possessing marked D1 receptor antagonistic activity. RESULTS To the best of the authors' knowledge, the case series presented is only the second clinical paper suggesting a role for D1 antagonists in NSSI drug therapy. CONCLUSIONS Together with previously published data from rodent models, the findings suggest a role for D1 antagonists in NSSI drug therapy and hence for the D1 receptor in NSSI pathogenesis. This conclusion is limited by the facts that the patients presented here received polypharmacy and that the D1 receptor antagonistic antipsychotics suggested here as effective 'anti-auto-aggressants' do not address D1 receptors only but multiple neurotransmitter receptors/systems.
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Affiliation(s)
- Bastian Wollweber
- Max Planck Institute of Psychiatry, RG Molecular Psychotraumatology, Munich, Germany
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Director of the Clinical Department, Munich, Germany
| | - Ulrike Schmidt
- Max Planck Institute of Psychiatry, Clinical Department, Head of Trauma Outpatient Clinic and RG Molecular Psychotraumatology and Closed Ward, Kraepelinstrasse 10, 80804 Munich, Germany
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Bennett K, Rhodes AE, Duda S, Cheung AH, Manassis K, Links P, Mushquash C, Braunberger P, Newton AS, Kutcher S, Bridge JA, Santos RG, Manion IG, McLennan JD, Bagnell A, Lipman E, Rice M, Szatmari P. A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:245-57. [PMID: 26175322 PMCID: PMC4501582 DOI: 10.1177/070674371506000603] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/01/2014] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
| | - Anne E Rhodes
- Research Scientist, St Michael’s Hospital, Toronto, Ontario; Associate Professor, University of Toronto, Toronto, Ontario
| | - Stephanie Duda
- Research Coordinator, McMaster University, Hamilton, Ontario
| | - Amy H Cheung
- Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario; Associate Professor, University of Toronto, Toronto, Ontario
| | - Katharina Manassis
- Psychiatrist and Director, Anxiety Disorders, Hospital for Sick Children, Toronto, Ontario; Professor, University of Toronto, Toronto, Ontario
| | - Paul Links
- Chief of Psychiatry, London Health Sciences Centre, London, Ontario; Professor and Chair, Department of Psychiatry, The University of Western Ontario, London, Ontario
| | - Christopher Mushquash
- Assistant Professor, Lakehead University and Northern Ontario School of Medicine, Thunder Bay, Ontario
| | - Peter Braunberger
- Psychiatrist, St Joseph’s Care Group, Thunder Bay, Ontario; Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, Ontario
| | - Amanda S Newton
- Assistant Professor, University of Alberta, Edmonton, Alberta
| | - Stanley Kutcher
- Professor, Dalhousie University, Halifax, Nova Scotia; Psychiatrist, IWK Health Centre, Halifax, Nova Scotia
| | - Jeffrey A Bridge
- Investigator, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; Associate Professor, The Ohio State University College of Medicine, Columbus, Ohio
| | - Robert G Santos
- Executive Director of Science and Policy, Healthy Child Manitoba Office, Government of Manitoba, Winnipeg, Manitoba; Assistant Professor, University of Manitoba, Winnipeg, Manitoba
| | - Ian G Manion
- Clinical Psychologist, Researcher, and Executive Director, Provincial Centre of Excellence for Child and Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; Clinical Professor, University of Ottawa, Ottawa, Ontario
| | - John D McLennan
- Assistant Professor, University of Calgary, Calgary, Alberta; Child Psychiatry Consultant, Alberta Health Services, Edmonton, Alberta
| | - Alexa Bagnell
- Psychiatrist, IWK Health Centre, Halifax, Nova Scotia; Associate Professor, Dalhousie University, Halifax, Nova Scotia
| | - Ellen Lipman
- Psychiatrist, McMaster Children’s Hospital, Hamilton, Ontario; Professor, McMaster University, Hamilton, Ontario
| | - Maureen Rice
- Librarian and Research Coordinator, McMaster University, Hamilton, Ontario
| | - Peter Szatmari
- Chief, Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health, Hospital for Sick Children, and University of Toronto, Toronto, Ontario
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Collinson M, Owens D, Blenkiron P, Burton K, Graham L, Hatcher S, House A, Martin K, Pembroke L, Protheroe D, Tubeuf S, Farrin A. MIDSHIPS: multicentre intervention designed for self-harm using interpersonal problem-solving: protocol for a randomised controlled feasibility study. Trials 2014; 15:163. [PMID: 24886683 PMCID: PMC4020387 DOI: 10.1186/1745-6215-15-163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around 150,000 people each year attend hospitals in England due to self-harm, many of them more than once. Over 5,000 people die by suicide each year in the UK, a quarter of them having attended hospital in the previous year because of self-harm. Self-harm is a major identifiable risk factor for suicide. People receive variable care at hospital; many are not assessed for their psychological needs and little psychological therapy is offered. Despite its frequent occurrence, we have no clear research evidence about how to reduce the repetition of self-harm. Some people who have self-harmed show less active ways of solving problems, and brief problem-solving therapies are considered the most promising psychological treatments. METHODS/DESIGN This is a pragmatic, individually randomised, controlled, feasibility study comparing interpersonal problem-solving therapy plus treatment-as-usual with treatment-as-usual alone, for adults attending a general hospital following self-harm. A total of 60 participants will be randomised equally between the treatment arms, which will be balanced with respect to the type of most recent self-harm event, number of previous self-harm events, gender and age. Feasibility objectives are as follows: a) To establish and field test procedures for implementing the problem-solving intervention; b) To determine the feasibility and best method of participant recruitment and follow up; c) To assess therapeutic delivery; d) To assess the feasibility of obtaining the definitive trial's primary and secondary outcomes; e) To assess the perceived burden and acceptability of obtaining the trial's self-reported outcome data; f) To inform the sample size calculation for the definitive trial. DISCUSSION The results of this feasibility study will be used to determine the appropriateness of proceeding to a definitive trial and will allow us to design an achievable trial of interpersonal problem-solving therapy for adults who self-harm. TRIAL REGISTRATION Current Controlled Trials (ISRCTN54036115).
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Affiliation(s)
- Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK.
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van Spijker BAJ, van Straten A, Kerkhof AJFM. Effectiveness of online self-help for suicidal thoughts: results of a randomised controlled trial. PLoS One 2014; 9:e90118. [PMID: 24587233 PMCID: PMC3937447 DOI: 10.1371/journal.pone.0090118] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/24/2014] [Indexed: 01/02/2023] Open
Abstract
Background Many people with suicidal thoughts do not receive treatment. The Internet can be used to reach more people in need of support. Objective To test the effectiveness of unguided online self-help to reduce suicidal thoughts. Method 236 adults with mild to moderate suicidal thoughts were randomised to the intervention (n = 116) or a waitlist control group (n = 120). Assessments took place at baseline, and 2, 4 and 6 weeks later. Primary outcome was suicidal thoughts. Secondary outcomes were depressive symptoms, anxiety, hopelessness, worry, and health status. Results The intervention group showed a small significant effect in reducing suicidal thoughts (d = 0.28). Effects were more pronounced for those with a history of repeated suicide attempts. There was also a significant reduction in worry (d = 0.33). All other secondary outcomes showed small but non-significant improvements. Conclusions Although effect sizes were small, the reach of the internet could enable this intervention to help many people reduce their suicidal thoughts. Trial Registration Netherlands Trial Register NTR1689
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Affiliation(s)
- Bregje A. J. van Spijker
- Centre for Mental Health Research, Australian National University, Canberra, Australia
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Annemieke van Straten
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ad J. F. M. Kerkhof
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
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Pavulans KS, Bolmsjö I, Edberg AK, Ojehagen A. Being in want of control: Experiences of being on the road to, and making, a suicide attempt. Int J Qual Stud Health Well-being 2012; 7:QHW-7-16228. [PMID: 22567037 PMCID: PMC3345936 DOI: 10.3402/qhw.v7i0.16228] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2012] [Indexed: 11/14/2022] Open
Abstract
Attempted suicide is a risk factor for future suicidal behaviour, but understanding suicidality from the perspective of people who have experienced attempted suicide is limited. The aim of the study was to explore the lived experience of being suicidal and having made a suicide attempt, in order to identify possible implications for health care professionals. Semi-structured individual interviews were held with 10 persons shortly after they attempted suicide and were analysed through qualitative content analysis. The participants' experience of being suicidal and of having attempted suicide could be described as "Being on the road towards suicidal action", which culminated in an experience of either chaos or turned off emotions, "Making sense of the suicide attempt", and "Opening the door to possible life lines". An overall theme, "Being in want of control", captured their all-embracing lack of sense of control and was seen in relation to different aspects of oneself, overall life-situation, the immediate suicide attempt situation and in the outlook on the future. Being in want of control may be a relevant and general feature of being suicidal. People who have attempted suicide need more adequate help to break vicious circles before they reach a point of no return and enter an acute suicidal state of mind. Patients' experience-based knowledge is highly important to listen to and use clinically as well as theoretically when constructing suicide prevention programs.
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Watts S, Newby JM, Mewton L, Andrews G. A clinical audit of changes in suicide ideas with internet treatment for depression. BMJ Open 2012; 2:bmjopen-2012-001558. [PMID: 22983787 PMCID: PMC3467611 DOI: 10.1136/bmjopen-2012-001558] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine reductions in suicidal ideation among a sample of patients who were prescribed an internet cognitive behavior therapy (iCBT) course for depression. DESIGN Effectiveness study within a quality assurance framework. SETTING Primary care. PARTICIPANTS 299 patients who were prescribed an iCBT course for depression by primary care clinicians. INTERVENTION Six lesson, fully automated cognitive behaviour therapy course delivered over the internet. PRIMARY OUTCOME suicidal ideation as measured by question 9 on the Patient Health Questionnaire (PHQ-9). RESULTS Suicidal ideation was common (54%) among primary care patients prescribed iCBT treatment for depression but dropped to 30% post-treatment despite minimal clinician contact and the absence of an intervention focused on suicidal ideation. This reduction in suicidal ideation was evident regardless of sex and age. CONCLUSIONS The findings do not support the exclusion of patients with significant suicidal ideation.
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Affiliation(s)
- Sarah Watts
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, New South Wales, Australia
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Green JM, Wood AJ, Kerfoot MJ, Trainor G, Roberts C, Rothwell J, Woodham A, Ayodeji E, Barrett B, Byford S, Harrington R. Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation. BMJ 2011; 342:d682. [PMID: 21459975 PMCID: PMC3069684 DOI: 10.1136/bmj.d682] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people. DESIGN Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress. PARTICIPANTS Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting Eight child and adolescent mental health services in the northwest UK. INTERVENTIONS Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres. MAIN OUTCOME MEASURES Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded. RESULTS 183 adolescents were allocated to each arm (total n = 366). Loss to follow-up was low (<4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P = 0.95) at 6 months and 0.88 (0.59 to 1.33, P = 0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to 1.20, P = 0.29) at 6 months and 0.94 (0.63 to 1.40, P = 0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21,781) than for routine care (£15,372) but the difference was not significant (95% CI -1416 to 10782, P = 0.132). CONCLUSIONS The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations. Trial registration ISRCTN 20496110.
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Affiliation(s)
- J M Green
- Psychiatry Research Group, University of Manchester, Manchester M13 9PL, UK.
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van Spijker BAJ, van Straten A, Kerkhof AJFM. The effectiveness of a web-based self-help intervention to reduce suicidal thoughts: a randomized controlled trial. Trials 2010; 11:25. [PMID: 20214777 PMCID: PMC2841163 DOI: 10.1186/1745-6215-11-25] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 03/09/2010] [Indexed: 11/10/2022] Open
Abstract
Background Suicide, attempted suicide and suicidal thoughts are major public health problems worldwide. Effective face-to-face treatments are Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT) and Problem Solving Treatment (PST). However, about two-thirds of persons who die by suicide have not been in contact with mental health care services in the preceding year, and many have never been treated. Furthermore, many patients do not disclose their suicidal thoughts to their care provider. This may be out of shame, due to fear of stigma or due to lack of trust in (mental) health care. Since many suicidal individuals seek information online, the internet provides an opportunity to reach suicidal individuals who would not be contacted otherwise. By providing a self-help intervention online, persons can anonymously learn to gain control over their suicidal thoughts. There is convincing evidence that self-help is effective for a number of mental disorders. In this study the effectiveness for suicidal thoughts is examined. Methods/Design In this study, a recently developed self-help intervention will be evaluated in a Randomized Controlled Trial. The intervention is based on Cognitive Behavioural Therapy and is aimed at subjects who experience mild to moderate suicidal thoughts. This is defined as a score between 1 and 26 on the Beck Scale for Suicidal Ideation (BSS). Higher and lower scores are excluded. In addition, severely depressed subjects are excluded. In total, 260 subjects will be randomly allocated to the intervention-condition (N = 130) or to the information-control condition (N = 130). Self-report questionnaires will be filled out at baseline, 6 weeks after baseline and 18 weeks after baseline. Primary outcome measure is the reduction in frequency and intensity of suicidal thoughts. Secondary outcome measures are the reduction of hopelessness, anxiety and depression, sleeplessness, worry and quality of life measures. Discussion This study is the first to evaluate the effectiveness of a web-based self-help intervention for suicidal thoughts. Several limitations and strengths of the design are discussed. Trial Registration Netherlands Trial Register, NTR1689
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Affiliation(s)
- Bregje A J van Spijker
- Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
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McLaughlin DF, McGowan IW, Paterson MC, Miller PW. Cessation of deliberate self harm following eye movement desensitisation and reprocessing: A case report. CASES JOURNAL 2008; 1:177. [PMID: 18811970 PMCID: PMC2561011 DOI: 10.1186/1757-1626-1-177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 09/23/2008] [Indexed: 11/29/2022]
Abstract
We present a case report of an eighteen year old female patient presenting with a psychological trauma related complaint. Part of the manifestation of the complaint included acts of self cutting over a number of years. Following two sessions of Eye Movement Desensitization & Reprocessing with one of the authors (DM) her self cutting ceased. This is maintained at thirteen months follow up. We conclude that Eye Movement Desensitization & Reprocessing may be an effective treatment option in reducing repeat self harm where traumatic events are noted to be the precursor to deliberate self harm.
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Dick B, Sitter H, Blau E, Lind N, Wege-Heuser E, Kopp I. [Clinical pathways in psychiatry and psychotherapy]. DER NERVENARZT 2006; 77:12, 14-8, 20-2. [PMID: 15940504 DOI: 10.1007/s00115-005-1916-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementing evidence-based clinical guidelines by means of clinical pathways is one of the key elements of continuous quality management at the University Hospital of Marburg. This paper explains how clinical pathways for suicidal ideation and suicide attempts were developed. METHODS Based upon a review of existing guidelines and literature, optimal standards of care were defined. Step-by-step analysis of the process of care and results of a questionnaire were used to describe the actual processes. A problem-orientated comparison of the actual and the optimal process of care was the basis for developing these pathways. A consensus was achieved with all persons involved in the respective process of care taking into consideration local resources as well as barriers. The most important decisions and interventions were defined and presented as a patient-oriented process. RESULTS The lack of explicit "how to do it"-recommendations of the guidelines for the entire care processes required specific, locally tailored adaptations. Potentials for improvement were identified in the following areas: transfer of patients, consultation, information and coordination within the team, and diagnosis of suicide risk. The pathways include care-oriented algorithms, checklists and assignments of responsibility. CONCLUSIONS The development of clinical pathways as part of quality management and transsectoral integrated care in psychiatry and psychotherapy is feasible. The concept presented incorporates the potential of increasing transparency, efficiency and efficacy of care, and of improving satisfaction of those involved. It offers psychiatric hospitals the chance to guarantee optimal quality of care in face of increasing workload and costs.
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Affiliation(s)
- B Dick
- Klinik für Psychotherapeutische Medizin und Psychosomatik, Zentralinstitut für Seelische Gesundheit Mannheim.
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Kapur N, Cooper J, Rodway C, Kelly J, Guthrie E, Mackway-Jones K. Predicting the risk of repetition after self harm: cohort study. BMJ 2005; 330:394-5. [PMID: 15677364 PMCID: PMC549109 DOI: 10.1136/bmj.38337.584225.82] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Navneet Kapur
- Centre for Suicide Prevention, Department of Psychiatry and Behavioural Sciences, University of Manchester, Manchester M13 9PL.
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Kapur N, House A, Dodgson K, May C, Creed F. Effect of general hospital management on repeat episodes of deliberate self poisoning: cohort study. BMJ 2002; 325:866-7. [PMID: 12386037 PMCID: PMC129633 DOI: 10.1136/bmj.325.7369.866] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2002] [Indexed: 11/04/2022]
Affiliation(s)
- Navneet Kapur
- Department of Psychiatry and Behavioural Sciences, Manchester Royal Infirmary, Manchester M13 9WL.
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