Testing an App-Assisted Treatment for Suicide Prevention in a Randomized Controlled Trial: Effects on Suicide Risk and Depression

Suicide is a global public health problem and effective psychological interventions are needed. The objective of the present study was to evaluate the effect of an app-assisted suicide prevention treatment on suicide risk and depression. One hundred twenty-nine participants were randomized to treatment as usual (TAU), consisting of psychotherapy adhering to the framework of Collaborative Assessment and Management of Suicidality (CAMS), with (TAU + APP, N = 60) or without (TAU, N = 69) access to a mobile application (i.e., LifeApp’tite). Suicide risk and symptoms of depression were assessed pre- and posttherapy, and at 4-month follow-up. The TAU + APP group showed a smaller decrease on self-reported suicide risk at the end of treatment, corresponding to a medium between-group effect size (p = .008, d = 0.46). At the 4-month follow-up this was the case only at the trend level, where the effect size was also of a smaller magnitude (p = .057, d = 0.30). No differences between the treatment groups were observed on self-reported depressive symptoms, either immediately following treatment (p = .732, d = 0.05) or at follow-up (p = .467, d = 0.11). The unexpected negative effect concerning suicide risk points to crucial consideration of issues pertaining to timing, dosing, and content when adding new technology to existing treatments both in this and other populations.     

Suicide Prevention from a Public Health Perspective

The public health approach to health problems provides a strong framework and rationale for developing and implementing suicide prevention programs. This approach consists of health-event surveillance to describe the problem, epidemiologic analysis to identify risk factors, the design and evaluation of interventions, and the implementation of prevention programs. The application of each of these components to suicide prevention is reviewed. Suggestions for improving surveillance include encouraging the use of appropriate coding, reviewing suicide statistics at the local level, collecting more etiologically useful information, and placing greater emphasis on analysis of morbidity data. For epidemiologic analysis, greater use could be made of observational studies, and uniform definitions and measures should be developed and adopted. Efforts to develop interventions must include evaluating both the process and the outcome. Finally, community suicide prevention programs should include more than one strategy and, where appropriate, should be strongly linked with the community's mental health resources. With adequate planning, coordination, and resources, and the public health approach can help reduce the emotional and economic costs imposed on society by suicide and suicidal behavior.     

Chronic Callers to a Suicide Prevention Center

ABSTRACT: Records of 67 chronic callers to the Cleveland Suicide Prevention Centers over the past 9 years are reviewed. Of this group, 51% were diagnosed as drug or alcohol dependent. It was also noted that 4 of the 67 were known to have committed suicide and that another 37 (55%) had made suicide attempts. A surprising finding was that 47% of the group was eventually referred to an ongoing treatment resource. Agency strategies for dealing with the chronic caller are discussed.     

Mobilizing Schools for Suicide Prevention

ABSTRACT: Experience in providing consultation and survivor counseling to school personnel following student suicides led to the development of a program of prevention through training school personnel. The goal of the program was to increase the ability of resource persons available to adolescents—teachers, counselors and school nurses—to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that program, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents.     

Providing Pastoral Care Services in a Clinical Setting to Veterans At-Risk of Suicide

The value of enhanced spiritual wellbeing has largely been overlooked as part of suicide prevention efforts in Veterans. The aim of this qualitative study is to examine the clinical pastoral care services provided by VA Chaplains to Veterans at-risk of suicide. This study was conducted using in-depth interviews with five Chaplains affiliated with a medical center located in upstate New York. This study was able to show that some at-risk individuals do actively seek out pastoral care, demonstrating a demand for such services. In conclusion, a pastoral care framework may already exist in some clinical settings, giving at-risk Veterans the opportunity to access spiritual care.     

The Effectiveness of Suicide Prevention Centers

The presence of suicide prevention centers in a state in 1970 was negatively associated with changes in the suicide rate from 1970 to 1980 in the USA, indicating a preventive effect from suicide prevention centers. This effect, though weak, was consistently found for most demographic subgroups of the population and when a strong social correlate of suicide rates (divorce rates) was taken into account by means of multiple regression analysis.     

自杀高危人群的识别及预防研究

自杀是由严重心理危机导致的行为.通过描述自杀高危人群存在的时代状况,从社会学与心理-精神病学的维度分析了高危人群的自杀成因,进而对其自杀前的异常言行表现、自杀的方式及当前各种预防措施进行讨论.同时,对中国文化语境下的自杀及其预防展开了反思与展望.     

New Directions for Suicide Prevention Centers*

ABSTRACT: This paper considers a number of questions regarding the epidemiology of suicidal phenomena and discusses some of the efforts of the Cornell Program in Social Psychiatry to study these questions and to explore new directions for suicide prevention work. Particular attention is paid to high suicide risk groups that are outside the network of existing medical services. Strategies for extending the clinical picture differentiating between syndromes assessing individual risk, clarifying etiological factors, and improving the working of the health services are considered.     

A Follow-up Study of 53 Suicides Known to a Suicide Prevention Center

ABSTRACT: The operation of the Cleveland Suicide Prevention Center is reviewed, and 53 known suicides during the Center's first four years of operation are discussed. A suicide rate of 288 per 100,000 suggests that persons contacting the Center represented a high suicide risk group. Of the suicides, 57 percent were women. This high proportion of females was statistically significant when compared to the smaller percentage of female suicides for Cuyahoga County, Ohio. Of the persons who committed suicide, 26 percent initiated direct contact with the Center themselves, and none recontacted the Center just prior to death. The question is raised whether contact initiated by another may in itself be suggestive of greater suicidal risk. Some of the practical problems in evaluation and referral are discussed.     

Gender and the Primary Prevention of Suicide Mortality

Primary prevention aims at reducing the incidence of a disorder. The first step in primary prevention involves documenting the magnitude of the problem and identifying risk factors. Consistent with primary prevention practices, we review the national and international epidemiological data on suicide mortality and then discuss the implications these data hold for primary prevention. Our approach is novel because we systematically examine the suicide epidemiology data by gender and culture. Suicide mortality appears to be highest among individuals (e.g., young adult married females in some Papua New Guinea regions; older adult, isolated, White males in the United States) for whom such behavior is culturally sanctioned. Thus, an important target for primary prevention may be local cultures of gender and suicide.     

Divorced Parents in Family Therapy in a Residential Treatment Setting

Divorced parents are required to participate together in the family therapy of their child placed in a residential treatment center. Different sources of resistance and treatment techniques are identified and discussed through a theoretical analysis and case study material. The therapy of these fractured families contributed to an elimination of recidivism and, according to followup reports, to significant and sustained improvement in the children's functioning in school, home, and community activities.