Cognitive therapy for the prevention of suicide attempts - A randomized controlled trial
Cognitive therapy for the prevention of suicide attempts - A randomized controlled trial
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DOI：
10.1001/jama.294.5.563
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发表时间：
2005-08-03
影响因子：
120.7
通讯作者：
Beck, AT
中科院分区：
文献类型：
--
作者：
Brown, GK;Ten Have, T;Beck, AT
研究背景自杀未遂是自杀未遂的主要危险因素，但很少有专门设计的预防自杀未遂的干预措施被评估。目的确定10次认知疗法干预的有效性，旨在防止最近自杀未遂的成年人再次自杀未遂。设计、设置和参与者随机对照试验(N=120)，对自杀未遂的成年人(N=120)在自杀未遂后48小时内在医院急诊科接受评估。从1999年10月至2002年9月连续招募了350名潜在参与者；66名拒绝参加，164名不符合资格。参与者被跟踪18个月。干预认知治疗或加强日常护理，跟踪和转介服务。主要结果衡量重复自杀未遂的发生率和再次自杀未遂的天数。结果从基线到18个月的评估，认知治疗组有13名参与者(24.1%)和常规护理组的23名参与者(41.6%)至少有一次随后的自杀企图(渐近z分，1.97；P=.049)。使用Kaplan-Meier方法，认知治疗组18个月无再尝试的估计概率为0.76(95%可信区间[CI]，0.62-0.85)，而常规护理组为0.58(95%CI，0.44-0.70)。认知治疗组的参与者再自杀的几率显著低于常规护理组的参与者(Wald chi(2)(1)=3.90；P=.049)，并且再次自杀的可能性比普通护理组的参与者低50%(风险比，0.51；95%CI，0.26-0.997)。认知治疗组在6个月(P=.02)、12个月(P=.009)和18个月(P=.046)时的抑郁程度显著低于常规护理组。认知治疗组在6个月时报告的绝望程度明显低于常规护理组(P=.045)。结论认知疗法能有效地预防新近自杀未遂的成人自杀未遂。
Context Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated.Objective To determine the effectiveness of a 10-session cognitive therapy intervention designed to prevent repeat suicide attempts in adults who recently attempted suicide.Design, Setting, and Participants Randomized controlled trial of adults (N=120) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Potential participants (N = 350) were consecutively recruited from October 1999 to September 2002; 66 refused to participate and 164 were ineligible. Participants were followed up for 18 months.Intervention Cognitive therapy or enhanced usual care with, tracking and referral services.Main Outcome Measures Incidence of repeat suicide attempts and number of days until a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and depression severity at 1, 3, 6, 12, and 18 months.Results From baseline to the 18-month assessment, 13 participants (24.1%) in the cognitive therapy group and 23 participants (41.6%) in the usual care group made at least1 subsequent suicide attempt (asymptotic z score, 1.97; P=.049). Using the Kaplan-Meier method, the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 (95% confidence interval [CI], 0.62-0.85) and in the usual care group was 0.58 (95% Cl, 0.44-0.70). Participants in the cognitive therapy group had a significantly lower reattempt rate (Wald chi(2)(1)=3.9; P=.049) and were 50% less likely to reattempt suicide than participants in the usual care group (hazard ratio, 0.51; 95% Cl, 0.26-0.997). The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months (P=.02),12 months(P=.009), and 18 months (P=.046). The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months (P=.045). There were no significant differences between groups based on rates of suicide ideation at any assessment point.Conclusion Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide.