A brief psychological intervention to reduce repetition of self-harm in patients admitted to hospital following a suicide attempt: a randomised controlled trial

O’Connor, Rory C.; Ferguson, Eamonn; Scott, Fiona J.; Smyth, Roger; McDaid, David; Park, A‐La; Beautrais, Annette L.; Armitage, Christopher J.

doi:10.1016/s2215-0366(17)30129-3

Cited by 54 publications

(40 citation statements)

References 33 publications

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“…For example, safety planning [ 58 ] is one such promising intervention which targets VMs. Another is a volitional helpsheet (VHS) [ 102 ] that encourages an individual to make if-then plans to reduce the likelihood that their suicidal thoughts trigger a suicide attempt. Recent evidence suggests that a VHS may offer promise (as an adjunct to usual care), especially among those with a past history of self-harm [ 102 , 103 ].…”

Section: Implications For Intervention and Suicide Preventionmentioning

confidence: 99%

“…Another is a volitional helpsheet (VHS) [ 102 ] that encourages an individual to make if-then plans to reduce the likelihood that their suicidal thoughts trigger a suicide attempt. Recent evidence suggests that a VHS may offer promise (as an adjunct to usual care), especially among those with a past history of self-harm [ 102 , 103 ]. More generally though, theoretical models such as the IMV model should be a starting point for the development of interventions, because they specify the potential mechanisms that should be targeted, thereby increasing the likelihood of interventions being effective [ 104 ].…”

Section: Implications For Intervention and Suicide Preventionmentioning

confidence: 99%

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The integrated motivational–volitional model of suicidal behaviour

O’Connor

Kirtley

2018

Phil. Trans. R. Soc. B

899

802

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Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.This article is part of the theme issue ‘Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.

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Section: Implications For Intervention and Suicide Preventionmentioning

confidence: 99%

Section: Implications For Intervention and Suicide Preventionmentioning

confidence: 99%

The integrated motivational–volitional model of suicidal behaviour

O’Connor

Kirtley

2018

Phil. Trans. R. Soc. B

899

802

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“…dialectical behaviour therapy, cognitive behaviour therapy) to address suicide [ 6 , 7 ] and self-harm [ 8 ]. However, it is not clear if limited brief interventions that can be administered in routine frontline encounters where healthcare professionals encounter people at risk of suicide can be effective [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of brief psychological interventions for suicidal presentations: a systematic review

et al. 2018

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BackgroundEvery year, more than 800,000 people worldwide die by suicide. The aim of this study was to conduct a systematic review of the effectiveness of brief psychological interventions in addressing suicidal thoughts and behaviour in healthcare settings.MethodsFollowing PRISMA guidelines, systematic searches were conducted in MEDLINE, CINAHL, EMBASE, the Cochrane Central Register of Controlled Trials and PsycINFO databases. A predefined search strategy was used. Two independent reviewers screened titles and abstracts followed by full texts against predefined inclusion criteria. Backward and forward citation tracking of included papers was conducted. Quality appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Controlled Trials and the CASP tool for randomised controlled trials. The small number and heterogeneity of studies did not allow for meta-analysis to be conducted. A narrative synthesis was conducted.ResultsFour controlled studies of brief psychological interventions were included, conducted in Switzerland, the U.S. and across low and middle-income countries. Three studies were conducted with adults and one with adolescents. All studies were judged to be at low risk of bias. All of the interventions were implemented with patients after attending emergency departments and involved 3412 participants. The main outcomes were suicide, suicide attempts, suicidal ideation, depression and hospitalization. The components of the interventions were early therapeutic engagement, information provision, safety planning and follow-up contact for at least 12 months. The interventions drew to, different degrees, on psychological theory and techniques. Two trials that measured suicidal ideation found no impact. Two studies showed fewer suicide attempts, one showed fewer suicides and one found an effect on depression.ConclusionsAlthough the evidence base is small, brief psychological interventions appear to be effective in reducing suicide and suicide attempts. All studies to date have been conducted with people who had attended the ED but the interventions could potentially be adopted for inpatient and other outpatient settings. Early engagement and therapeutic intervention based on psychological theories of suicidal behaviour, sustained in follow-up contacts, may be particularly beneficial.Trial registrationSystematic review registration: PROSPERO CRD42015025867.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1663-5) contains supplementary material, which is available to authorized users.

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“…Forty studies were further excluded because of identical or overlapping patient samples. A total of 115 studies reporting 167 samples were included in the meta‐analysis (SM 2, Table of Included Studies, and SM 3 Data used in meta‐analysis). The samples included 46 samples of females, 46 samples of males and 75 samples of both sexes.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Wang

Swaraj

Chung

et al. 2019

Acta Psychiatr Scand

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analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours.Objective: To quantify the suicide rate among people discharged from nonpsychiatric settings after presentations with suicidal thoughts or behaviours. Method: Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. Results: A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I 2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). Conclusions: People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades. Summations• The pooled suicide rate among patients with suicidal thoughts or behaviours following discharge from a non-psychiatric setting was 483 per 100 000 person-years (95% CI 445-520).• Suicide rates were lower among samples of younger people (<25 years of age) and among more recently published studies, but were higher in the first year after discharge, among older people (>55 years of age), and men.• All patients presenting to emergency departments and general hospitals with suicidal thoughts or behaviours warrant a careful assessment and individualized treatment planning. Considerations• High between-study heterogeneity limits the extent to which the results can be regarded as generalizable.• The meta-analysis could not examine a range of clinical factors that might contribute to variation in suicide rates.• Few studies from low-and middle-income countries could be included.

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A brief psychological intervention to reduce repetition of self-harm in patients admitted to hospital following a suicide attempt: a randomised controlled trial

Cited by 54 publications

References 33 publications

The integrated motivational–volitional model of suicidal behaviour

The integrated motivational–volitional model of suicidal behaviour

Effectiveness of brief psychological interventions for suicidal presentations: a systematic review

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

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