Novel Therapy Leads to Significant Reduction in Suicide Re-Attempts

The Attempted Suicide Short Intervention Program is a low-cost psychiatric intervention for patients in a hospital after an attempt.
The Attempted Suicide Short Intervention Program is a low-cost psychiatric intervention for patients in a hospital after an attempt.

Researchers in Switzerland have found that a relatively inexpensive therapy for people who have made a suicide attempt and have been hospitalized as a result may help to reduce the likelihood these patients will attempt suicide again in the future.

A group at Bern University General Hospital in Switzerland investigated the efficacy of a low-cost psychiatric intervention for patients admitted to the emergency department following a suicide attempt.1 The Attempted Suicide Short Intervention Program (ASSIP) is a manualized “novel brief therapy based on a patient-centered model of suicidal behavior, which emphasizes an early therapeutic alliance, combined with psychoeducation, a cognitive case conceptualization, safety planning, and continued long-term outreach contact,” that aims to reduce subsequent suicide attempts, according to the paper published in PLoS Medicine.

 

Suicide rates have recently increased in the US,2 and it is estimated that the annual number of suicide attempts in adults is 1.3 million.3 Among individuals who have attempted suicide, the risk of completed suicide exceeds that of the general population by 40 to 100 times4,5 and  increases with each additional attempt.6 “Attempted suicide is the main risk factor for suicide and repeated suicide attempts,” report the authors. Despite the grim statistics, there are few interventions shown to reduce suicidal behavior in the long term.

Patients admitted to the emergency room after a suicide attempt were randomized to one of two groups: treatment as usual (TAU), in which the therapists in the study were not involved, or TAU plus ASSIP. Suicidality was assessed at baseline using the Suicide Status Form (SSF-III), and questionnaires about the TAU were completed by participants at 6, 12, 18, and 24 months following the initial session.

The initial sample size initially consisted of 80 patients and was ultimately increased to 120. The comparative efficacy of ASSIP plus TAU to TAU alone was the primary outcome measure of the study.

ASSIP consisted of three weekly sessions lasting 60 to 90 minutes, with the addition of a fourth session if necessary. For the remainder of the 24-month study period, patients received personalized letters from the ASSIP therapist on a regular basis reminding them of safety strategies, as well as risks associated with suicidal behaviors. Results show that the ASSIP group had an 80% lower rate of repeat suicide attempts during the study period, and the spent 72% fewer days in the hospital than the control group.

Though larger trials are required to replicate and expand upon the findings, ASSIP “fulfills the need for a brief, easy-to-implement, and low-cost intervention,” the authors conclude. “We believe that ASSIP has the potential for dissemination in various treatment settings and for reducing of the costs of health care for patients attempting suicide.”

References

  1. Gysin-Maillart A, Schwab S, Soravia L, Megert M, Michel K. A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP). PLoS Med. 2016. 13(3): e1001968.M.
  2. Drapeau CW, McIntosh JL. U.S.A. suicide: 2013 official final data. Washington (District of Columbia): American Association of Suicidology; 2015.
  3. Substance Abuse and Mental Health Services Administration. The NSDUH report: substance use and mental health estimates from the 2013 national survey on drug use and health—overview of findings. Rockville (Maryland): Substance Abuse and Mental Health Services Administration; 2014.

  4. Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. BJPsych. 2003.182:537–542.

  5. Runeson BS. Suicide after parasuicide. BMJ. 2002. 325(7373): 1125–1126.

  6. Haw C, Bergen H, Casey D, Hawton K. Repetition of deliberate self‐harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition. Suicide Life Threat Behav. 2007. 37(4):379-96.

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