Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial
Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial
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DOI：
10.1017/s0033291716002798
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发表时间：
2017-04-01
影响因子：
6.9
通讯作者：
Huffman, J. C.
中科院分区：
文献类型：
--
作者：
Celano, C. M.;Beale, E. E.;Huffman, J. C.
背景。积极的心理结构与减少自杀意念有关，培养积极情绪的干预措施有可能降低自杀风险。本研究比较了在最近因抑郁症和自杀意念或行为住院的患者中，以电话为基础的6周积极心理学（PP）干预与以认知为中心（CF）控制干预的效果。共有65名报告有自杀意念或最近有自杀企图的重度抑郁的成年人从参与的精神科住院病人中入选。出院前，参与者被随机分为PP （n = 32）或CF （n = 33）干预组。在这两项干预中，参与者都收到了治疗手册，每周进行PP（如感谢信）或CF（如回忆日常事件）练习，并在6周内每周完成一对一的电话会议。在第6周和第12周，使用混合效应模型检验了绝望（主要结局）、抑郁、自杀和积极心理构念的组间差异，考虑了住院后精神治疗的强度。与PP相比，CF干预与6周时绝望的显著改善相关（beta=-3.15, 95%置信区间-6.18至-0.12，效应值= -0.84,p = 0.04），但与12周无关。同样，在第6周和第12周，CF干预在抑郁、自杀意念、乐观和感恩方面也有更大的改善。与我们的假设相反，CF干预在改善抑郁症自杀患者出院后关键时期的绝望感、其他自杀风险因素和积极心理构建方面优于PP。对高自杀风险人群进行CF干预的进一步研究是有必要的。
Background. Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior.Method. A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of posthospitalization psychiatric treatment.Results. Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (beta=-3.15, 95% confidence interval -6.18 to -0.12, effect size = -0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks.Conclusions. Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.