Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial

Abstract

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 post-hospitalization psychiatric treatment.

Results: Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = -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.

Keywords: Cognition; depression; optimism; positive psychology; suicide.

Fig. 1

Consolidated Standards Of Reporting Trials (CONSORT) diagram of recruitment. MDD, Major depressive disorder.

Fig. 2

Estimated changes in suicide risk factors and positive psychological constructs (from baseline to 12 weeks). * p < 0.05. BHS, Beck Hopelessness Scale; CHRT, Concise Health Risk Tracking; QIDS, 16-item Quick Inventory of Depressive Symptomatology – Self-Report; LOT-R, Life Orientation Test – Revised; GQ-6, Gratitude Questionnaire-6; PANAS, Positive and Negative Affect Schedule.