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Cognitive Therapy Prevents Future Suicide Attempts

Sometimes, treatment is most powerful when focused on specific behaviors and symptoms rather than on overall disorders or syndromes.

Suicide is the fourth-leading cause of death in adults ages 18 to 65, and attempted suicide increases the risk for completed suicide by a factor of 40. However, empirical data on preventive interventions are limited. In this study, 120 adults (60% black) who presented at a hospital emergency department after attempting suicide were randomized to receive usual clinical care plus case management with or without cognitive therapy (CT).

CT focused on related thoughts, images, and core beliefs and on adaptive ways to cope with life problems. Case management facilitated access to mental health care, substance-abuse treatment, and social services. Seventy-seven percent of patients had major depression, 68% had a substance-use disorder, and 58% had attempted suicide by overdosing.

Half of the CT recipients received at least 10 CT sessions. The two groups had similar rates of dropout (by 18 months: CT, 25%; usual care, 34%), use of psychotropic medication (52% vs. 54%), and addiction treatment (16% vs. 13%). The usual-care group had slightly higher rates of other psychotherapy than did the CT group (27% vs. 21%) and significantly higher rates of no treatment at all (32% vs. 17%). At 18 months, the CT group had significantly fewer suicide attempts (24%) than did the usual-care group (42%). In a survival analysis, overall suicide risk was 50% lower with CT than with usual care. The impact of CT remained significant even after adjustment for self- and observer-rated depression, which also significantly improved with CT.

Comment: Treatment targeted at suicidal behavior, rather than the underlying condition (e.g., depression, substance abuse), is a powerful strategy for reducing risk for subsequent attempts. Other suicide-specific interventions, such as dialectic behavior therapy, also have empirically supported efficacy in preventing suicide. Sometimes, treatment should be aimed at individuals’ specific behaviors and symptoms.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry September 7, 2005

Citation(s):

Brown GK et al. Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA 2005 Aug 3; 294:563-70.

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