Monday, October 5, 2009

New Approach to Reducing Suicide Attempts Among Depressed Teens

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Science Update
September 29, 2009

Hi Everyone, I hope you are doing well. I am doing great. Our week in Aruba was beautiful. I felt this update was important to post about. I remember during my teen years I did lose a few friends to suicide. At the time I was still naive about mental illness even though I was living with it. As a grew I realized my friends were suffering from a mental illness as well. I felt sad that there was no recognition of this disorder in teenager back then. Today I am glad to see that more and more teenagers are getting treatment but I am glad that they are still working in ways to prevent the attempts in the first place. Thanks for visiting my blog, Take Care, Janet :)

A novel treatment approach that includes medication plus a newly developed type of psychotherapy that targets suicidal thinking and behavior shows promise in treating depressed adolescents who had recently attempted suicide, according to a treatment development and pilot study funded by the National Institute of Mental Health (NIMH). The study, described in three articles, was published in the October 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Background
Youth who attempt suicide are particularly difficult to treat because they often leave treatment prematurely, and no specific interventions exist that reliably reduce suicidal thinking and behavior (suicidality). In addition, these teens often are excluded from clinical trials testing depression treatments. The Treatment of Adolescent Suicide Attempters Study (TASA) was developed to address this need and identify factors that may predict and mediate suicide reattempts among this vulnerable population. A novel psychotherapy used in the study—cognitive behavioral therapy for suicide prevention (CBT-SP—was developed to address the need for a specific psychotherapy that would prevent or reduce the risk for suicide reattempts among teens. CBT-SP consisted of a 12-week acute treatment phase focusing on safety planning, understanding the circumstances and vulnerabilities that lead to suicidal behavior, and building life skills to prevent a reattempt. A maintenance continuation phase followed the acute phase.

In the six-month, multisite pilot study, 124 adolescents who had recently attempted suicide were either randomized to or given the option of choosing one of three interventions—antidepressant medication only, CBT-SP only, or a combination of the two. Most participants preferred to choose their intervention, and most (93) chose combination therapy. Participants were assessed for suicidality at weeks six, 12, 18 and 24.

Results of the Study
During the six-month treatment, 24 participants experienced a new suicidal event, defined as new onset or worsening of suicidal thinking or a suicide attempt. This rate of recurrence is lower than what previous studies among suicidal patients have found, suggesting that this treatment approach may be a promising intervention. In addition, more than 70 percent of these teens—a population that is typically difficult to keep in treatment—completed the acute phase of the therapy. However, many participants discontinued the treatment during the continuation phase, suggesting that treatment may need to include more frequent sessions during the acute phase, and limited sessions during the continuation phase.

The study revealed some characteristics that could predict recurrent suicidality, including high levels of self-reported suicidal thinking and depression, a history of abuse, two or more previous suicide attempts, and a strong sense of hopelessness. In addition, a high degree of family conflict predicted suicidality, while family support and cohesion acted as a protective factor against suicide reattempts. Other studies have found similar results, according to the researchers.

Significance
Although the study cannot address effectiveness of the treatment because it was not randomized, it sheds light on characteristics that identify who is most at risk for suicide reattempts, and what circumstances may help protect teens from attempting suicide again. In addition, the study found that 10 of the 24 suicide events occurred within four weeks of the beginning of the study—before they could receive adequate treatment. This suggests that a "front-loaded" intervention in which the most intense treatment is given early on, would likely reduce the risk of suicide reattempt even more.

What's Next
The effectiveness of CBT-SP—alone or in conjunction with antidepressant medication—will need to be tested in randomized clinical trials. In the meantime, because many suicide events occurred shortly after the beginning of the trial, the researchers suggest that clinicians emphasize safety planning and provide more intense therapy in the beginning of treatment. In addition, they note that therapy should focus on helping teens develop a tolerance for distress; work to improve the teen's home, school and social environment; and rigorously pursue coping strategies for teens who experienced childhood trauma such as abuse.

References
Vitiello B, Brent D, Greenhill L, Emslie G, Wells K, Walkup J, et al.. Depressive symptoms and clinical status during the treatment of adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry 2009;48(10):997-1004.

Brent D, Greenhill L, Compton S,Emslie G, Wells K, Walkup J, et al. The treatment of adolescent suicide attempters (TASA): predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(10):987-996.

Stanley B, Brown G, Brent D, Wells K, Poling K, Curry J, et al. Cognitive behavior therapy for suicide prevention (CBT-SP): treatment model, feasibility and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(10):1005-1013.

5 comments:

  1. If only they would listen, maybe she would still be alive. You see, this is not working, i know this. People die around me, all the time. Its wahts eating me, its my disease.

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  2. i'm doing a project on teen suicide and i read so many stories on it and it touched me lol i might sound dumb....but i really want to help out. in my town there's not much suicide going on, but i hear about other places and i dont like it at all but i cant do nothing about it. i once thought of suicide and i attempt it once but failed. im glad i failed because i would of been missing so much in life. i was 13 years old. now im 15 and a half and im enjoying life. i mean hings could be better but when i think about it i say some people have it worse out there and im over here thinking about this small problem of mine......i want ti help!!!

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  3. Hi Auftumm, I am so happy to hear from you, you are wise for your age. Your right about it could always be worst and suicide is a permanent solution to a temporary problem. I have had that feeling too of wanting to end it all when things got really bad in my life when I was younger and one time recently. But I hung in there and it passed. I am doing a walk for suicide prevention I am enclosiing thel ink to my donation page. There you can get to the organization to find out how to help out in your area. I am very proud of you and I hope you continue to visit and talk with me.
    Thanks again,
    Janet :)

    http://www.theovernight.org/index.cfm?fuseaction=extranet.personalpage&confirmid=10015804

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  4. how come no one posts an email address to try and help people who want to kill themselves, like me?

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  5. Dear Anonymous you should call the hotline
    1-800-273-8255

    ReplyDelete