Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial
Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial
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DOI：
10.1136/bmj.39161.457431.55
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发表时间：
2007-05-12
影响因子：
105.7
通讯作者：
Burger, Hubert
中科院分区：
文献类型：
--
作者：
de Groot, Marieke;de Keijser, Jos;Burger, Hubert
目的探讨以家庭为基础的悲伤辅导方案在自杀者一级亲属和配偶中预防复杂悲伤的有效性。设计组群随机对照试验，自杀后随访13个月。设置荷兰的一般做法。参与者：70名自杀者的122名一级亲属和配偶；干预组为39个家庭（68名参与者），对照组为31个家庭（54名参与者）。干预在自杀后的三至六个月内，由一名训练有素的精神科护士辅导员进行四次以家庭为基础的认知行为辅导。对照组接受常规护理。主要观察指标：自我报告复杂悲伤。次要结果是出现不适应的悲伤反应、抑郁、自杀意念和认为自己是自杀的罪魁祸首。结果干预与复杂性悲伤的减少无关（平均差异为-0.61,95%可信区间为-6.05 ~ 4.83;P = 0.82）。次要结果也不受影响。当对基线不平等进行调整后，干预降低了自责感的风险（优势比0.18,0.05至0.67;P = 0.01）和不适应悲伤反应的风险（优势比0.39,0.15至1.01;P = 0.06）。结论：自杀丧亲家庭的认知行为悲伤咨询方案并不能降低复杂悲伤或自杀意念的风险，也不能降低抑郁水平。该计划可能有助于防止一级亲属和配偶的不适应悲伤反应和指责观念。
Objective To examine the effectiveness of a family based grief counselling programme to prevent complicated grief among first degree relatives and spouses of someone who had committed suicide.Design Cluster randomised controlled trial with follow-up at 13 months after the suicide.Setting General practices in the Netherlands.Participants 122 first degree relatives and spouses of 70 people who committed suicide; 39 families (68 participants) were allocated to intervention, 31 families (54 participants) to control.Intervention A family based, cognitive behaviour counselling programme of four sessions with a trained psychiatric nurse counsellor between three to six months after the suicide. Control participants received usual care.Main outcome measures Self report complicated grief. Secondary outcomes were the presence of maladaptive grief reactions, depression, suicidal ideation, and perceptions of being to blame for the suicide.Results The intervention was not associated with a reduction in complicated grief (mean difference -0.61, 95% confidence interval -6.05 to 4.83; P = 0.82). Secondary outcomes were not affected either. When adjusted for baseline inequalities, the intervention reduced the risk of perceptions of being to blame (odds ratio 0.18, 0.05 to 0.67; P = 0.01) and maladaptive grief reactions (0.39, 0.15 to 1.01; P = 0.06).Conclusions A cognitive behaviour grief counselling programme for families bereaved by suicide did not reduce the risk of complicated grief or suicidal ideation or the level of depression. The programme may help to prevent maladaptive grief reactions and perceptions of blame among first degree relatives and spouses.