Suicide and Self-Harm

Brown, G. K., Have, T. T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive Therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563-570.

Correspondence Address:
Gregory K. Brown, Department of Psychiatry, University of Pennsylvania, 3535 Market St, Room 2030, Philadelphia, PA 19104, gregbrow@mail.med.upenn.edu.

Abstract
Context- Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated. Objective- To determine the effectiveness of a 10-session cognitive therapy intervention designed to prevent repeat suicide attempts in adults who recently attempted suicide. Design, Setting, and Participants- Randomized controlled trial of adults (N = 120) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Potential participants (N = 350) were consecutively recruited from October 1999 to September 2002; 66 refused to participate and 164 were ineligible. Participants were followed up for 18 months. Intervention- Cognitive therapy or enhanced usual care with tracking and referral services. Main Outcome Measures- Incidence of repeat suicide attempts and number of days until a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and depression severity at 1, 3, 6, 12, and 18 months. Results- From baseline to the 18-month assessment, 13 participants (24.1%) in the cognitive therapy group and 23 participants (41.6%) in the usual care group made at least 1 subsequent suicide attempt (asymptotic z score, 1.97; P = .049). Using the Kaplan-Meier method, the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 (95% confidence interval [CI], 0.62-0.85) and in the usual care group was 0.58 (95% CI, 0.44-0.70). Participants in the cognitive therapy group had a significantly lower reattempt rate (Wald 21 = 3.9; P = .049) and were 50% less likely to reattempt suicide than participants in the usual care group (hazard ratio, 0.51; 95% CI, 0.26-0.997). The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months (P= .02), 12 months (P = .009), and 18 months (P = .046). The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months (P = .045). There were no significant differences between groups based on rates of suicide ideation at any assessment point. Conclusion- Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Weinberg, I., Gunderson, J. G., Hennen, J., & Cutter, C. J., Jr. (2006). Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. Journal of Personality Disorders, 20, 482-492.

Correspondence Address:
Igor Weinberg, McLean Hospital, 115 Mill St., Belmont, Massachusetts, USA, 02478, iweinberg@mclean.harvard.edu.

Abstract
This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Winter, D., Sireling, L., Riley, T., Metcalfe, C., Quaite, A., & Bhandari, S. (2007). A controlled trial of personal construct psychotherapy for deliberate self-harm. Psychology and Psychotherapy: Theory, Research and Practice, 80, 23-37.

Correspondence Address:
David Winter, School of Psychology, University of Hertfordshire, College Lane, Hatfield, Herts, HRT, United Kingdom, AL10 9AB, d.winter@herts.ac.uk.

Abstract
Evidence for the effectiveness of psychological therapies for people who self-harm is limited. Personal construct theory provides a model of self-harm and a framework for therapeutic intervention, which was evaluated in the present study. Sixty-four adults presenting to Accident and Emergency departments following self-harm were allocated to a personal construct psychotherapy or a 'normal clinical practice' condition. They completed various measures at assessment points pre- and post-therapy. Repetition of self-harm was assessed over a 3-year period. Participants in the intervention condition showed significantly greater reduction in suicidal ideation, hopelessness and depression post-treatment than the control group; and significantly more reconstruing at this point and 6-month follow-up. There was some evidence suggestive of a lower frequency of repetition of self-harm in the intervention than in the control group. It is concluded that brief personal construct psychotherapy may be effective for people who self-harm and merits further exploration. (PsycINFO Database Record (c) 2007 APA, all rights reserved)