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Press Release From National Institute of Mental Health
August 2, 2005
Contact: Jules Asher_NIMH Press Office_301-443-4536_NIMHpress@nih.gov
Cognitive Therapy Reduces Repeat Suicide Attempts By 50 Percent
Recent suicide attempters treated with cognitive therapy were 50 percent less
likely to try to kill themselves again within 18 months than those who did not
receive the therapy, report researchers supported by the National Institutes of
Health's (NIH) National Institute of Mental Health (NIMH) and the Center for Disease
Control and Prevention (CDC). A targeted form of cognitive therapy designed to
prevent suicide proved better at lifting depression and feelings of hopelessness
than the usual care available in the community, according to Gregory Brown, Ph.D.,
Aaron Beck, M.D., University of Pennsylvania, and colleagues, who published their
findings in the August 3, 2005 Journal of the American Medical Association (JAMA).
"Since even one previous attempt multiplies suicide risk by 38-40 times and
suicide is the fourth leading cause of death for adults under 65, a proven way
to prevent repeat attempts has important public health implications," said
NIMH Director Thomas Insel, M.D.
To achieve a large enough sample to reliably detect differences in the effectiveness
of interventions, the researchers first screened hundreds of potential suicide
attempters admitted to the emergency room of the Hospital of the University of
Pennsylvania in Philadelphia, ultimately recruiting 120 patients into the study.
Averaging in their mid-thirties, 61 percent of the participants were female, 60
percent black, 35 percent white, and 5 percent Hispanic and other ethnicities.
Most had attempted to kill themselves by drug overdosing (58 percent), with 17
percent by stabbing, 7 percent by jumping, and 4 percent by hanging, shooting
or drowning. Seventy-seven percent had major depression and 68 percent a substance
use disorder.
After a clinical evaluation, each participant was randomly assigned to one of
two conditions: cognitive therapy or usual care services available in the
community. Cognitive therapy was developed by Beck in the 1970s and has been applied
successfully in a wide variety of psychiatric disorders. Those in the cognitive
group were scheduled to receive 10 outpatient weekly or biweekly cognitive therapy
sessions specifically developed for preventing suicide attempts. The sessions
helped patients find a more effective way of looking at their problems by learning
new ways to handle negative thoughts and feelings of hopelessness. In a relapse-prevention
task near the end of their therapy, they were asked to focus directly on the events,
thoughts, feelings and behaviors that led to their previous suicide attempts and
explain how they would respond in a more adaptive way. If they passed this task
successfully, their cognitive therapy ended; if they were unsuccessful, additional
sessions were provided.
Both groups were encouraged to receive usual care from clinicians in the community
and were tracked by study case managers by mail and phone throughout the 18 month
follow-up period. The case managers offered referrals to but not payment
for local mental health and drug abuse treatment and social services.
About half of the participants in both groups took psychotropic medications and
about 13 to 16 percent received drug abuse treatment. About 27 percent of those
in the usual care group received psychotherapy outside of the study, compared
to 21 percent of those also receiving cognitive therapy.
Over the year-and-a-half follow-up period, only 24 percent (13) of those in the
cognitive therapy group made repeat suicide attempts, compared to 42 percent (23)
of the usual care group. Although the groups did not differ significantly in suicidal
thoughts, those who received cognitive therapy scored better on measures of depression
severity and hopelessness, which the researchers suggest "may be more highly
associated with a reduced risk of repeat suicide attempts."
"We were surprised by the amount of energy and resources it takes to reach
out to individuals who attempt suicide," noted Brown. "This population
lacks a positive attitude toward the mental health system and often fails to show
up for scheduled appointments. However, the combination of cognitive therapy plus
case management services was effective in preventing suicide attempts." He
suggests that cognitive therapy's short-term nature makes it a good fit for treatment
of suicide attempters at community mental health centers.
"Suicide and suicide attempts are serous public health problems that devastate
individuals, families and communities," added Dr. Ileana Aria, Director,
CDC's National Center for Injury Prevention and Control. "This research provides
valuable insight for those treating people at risk, so that they can learn adaptive
ways to handle stress and resolve their problems and thereby reduce the likelihood
they will resort to suicidal behavior as a solution."
Also participating in the study were: Drs. Thomas Ten Have, Sharon Xie, and Judd
Hollander, University of Pennsylvania, and Dr. Gregg Henriques, James Madison
University.
Posted: 08/02/2005
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