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Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial. JAMA. 2005;294(5):563–570. doi:10.1001/jama.294.5.563
Author Affiliations: Departments of Psychiatry
(Drs Brown and Beck) and Emergency Medicine (Dr Hollander) and Center for
Clinical Epidemiology and Biostatistics (Drs Ten Have and Xie), University
of Pennsylvania, Philadelphia; and Department of Graduate Psychology, James
Madison University, Harrisonburg, Va (Dr Henriques).
Context Suicide attempts constitute a major risk factor for completed suicide,
yet few interventions specifically designed to prevent suicide attempts have
Objective To determine the effectiveness of a 10-session cognitive therapy intervention
designed to prevent repeat suicide attempts in adults who recently attempted
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
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 least 1 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% CI, 0.44-0.70). Participants in the cognitive
therapy group had a significantly lower reattempt rate (Wald χ21 = 3.9; P = .049)
and were 50% less likely to reattempt suicide than participants in the usual
care group (hazard ratio, 0.51; 95% CI, 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.
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