Psychotherapeutic interventions for the prevention of suicide re-attempts: a systematic review

Abstract

A history of suicide attempt (SA) is a strong predictor of future suicide re-attempts or suicide. The aim of this systematic review is to evaluate the efficacy of psychotherapeutic interventions specifically designed for the prevention of suicide re-attempts. A systematic search from 1980 to June 2020 was performed via the databases PubMed and Google Scholar. Only randomized controlled trials were included which clearly differentiated suicidal self-harm from non-suicidal self-injury in terms of intent to die. Moreover, psychotherapeutic interventions had to be focused on suicidal behaviour and the numbers of suicide re-attempts had to be used as outcome variables. By this procedure, 18 studies were identified. Statistical comparison of all studies revealed that psychotherapeutic interventions in general were significantly more efficacious than control conditions in reducing the risk of future suicidal behaviour nearly by a third. Separate analyses revealed that cognitive-behavioural therapy as well as two different psychodynamic approaches were significantly more efficacious than control conditions. Dialectical behaviour therapy and elementary problem-solving therapy were not superior to control conditions in reducing the number of SAs. However, methodological reasons may explain to some extent these negative results. Considering the great significance of suicidal behaviour, there is unquestionably an urgent need for further development of psychotherapeutic techniques for the prevention of suicide re-attempts. Based on the encouraging results of this systematic review, it can be assumed that laying the focus on suicidal episodes might be the key intervention for preventing suicide re-attempts and suicides.

Relapse Prevention Intervention after Suicidal Event (RISE): Feasibility study of a psychotherapeutic short-term program for inpatients after a recent suicide attempt

“…Both patients had a history of multiple attempts. This number is similar or even lower compared to the ratios of suicide re-attempts after psychotherapeutic interventions as reported in previous studies (18). Furthermore, considering that our sample included 60 percent of multiple suicide attempters, the present result that nearly 90 percent of patients have not committed or attempted suicide during the 6 months after RISE treatment is promising.…”

“…RISE is a brief and structured psychotherapeutic intervention specifically designed for patients after a suicide attempt in an acute psychiatric inpatient setting with the goal to prevent future suicidal behavior. The RISE program was created after systematically reviewing studies on previous psychotherapeutic and psychosocial interventions for suicidal behavior (18,20,21). In the present study, feasibility and acceptance of RISE program were investigated as well as its effect on suicidal ideations, mental pain, self-efficacy and depressive symptoms.…”

“…However, mixed findings were reported regarding suicide re-attempts (16,17). In our recent meta-analysis and systematic review (18) we solely focused on psychotherapeutic interventions to reduce suicide re-attempts, which included patients with a suicide attempt as defined by DSM-5. Our main finding was that cognitive behavioral therapy (CBT) based interventions were significantly more efficacious than the applied control conditions in reducing the number of suicide re-attempts in the investigated follow-up period.…”

“…in suicidal behavior than those receiving usual care during the 6-month follow-up period. Thus, in the newly developed Relapse Prevention Intervention after Suicidal Event (RISE) psychotherapeutic program, we selected key elements of the previous CBT interventions based on our meta-analysis (18). The core overlapping elements of these interventions were (1) helping the individual to detect and understand the triggering conditions for one's prior suicide attempt(s), e.g., in terms of a cognitivebehavioral case conceptualization; (2) training the individual specific strategies for preventing and managing a future suicidal crisis; and (3) testing the individual to manage future suicidal crises by employing a relapse prevention task (22)(23)(24).…”

Characterization of suicidal depression: A 1 year prospective study

“…Specific pharmacological treatments (e.g., ketamine and buprenorphine) [ 13 , 14 ] and psychotherapies (e.g., acceptance and commitment therapy) [ 15 ] are showing promising results on suicidal risk. Similarly, suicide-focused cognitive behavioral therapy efficiently reduces SA and/or SI [ 16 ], but not depression-focused psychotherapies [ 3 , 17 , 18 ]. This suggests that moderate to severe depression with active SI (i.e., suicidal depression) could be a specific subtype of depression with its own pathophysiology, clinical features, and management [ 19 , 20 ].…”