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Randomized Controlled Trial
. 2020 Apr 1:266:686-694.
doi: 10.1016/j.jad.2020.01.178. Epub 2020 Jan 30.

Cognitive behavioral therapy for suicide prevention in youth admitted to hospital following an episode of self-harm: A pilot randomized controlled trial

Mark Sinyor  1 , Marissa Williams  2 , Rachel Mitchell  3 , Rabia Zaheer  4 , Craig J Bryan  5 , Ayal Schaffer  3 , Neal Westreich  6 , Janet Ellis  3 , Benjamin I Goldstein  3 , Amy H Cheung  3 , Steven Selchen  3 , Alex Kiss  7 , Homer Tien  8
Affiliations
Randomized Controlled Trial

Cognitive behavioral therapy for suicide prevention in youth admitted to hospital following an episode of self-harm: A pilot randomized controlled trial

Mark Sinyor et al. J Affect Disord. .

Abstract

Background: Self-harm (SH) is among the strongest risk factors for eventual suicide death yet there are limited data on which interventions are most effective for treating SH in youth.

Methods: This single-blind, pilot randomized controlled trial examined brief cognitive behavioral therapy (BCBT) for suicide prevention vs. minimally-directive supportive psychotherapy in youth (aged 16-26) hospitalized following SH. Both therapies included 10 acute sessions over 15 weeks with three booster sessions occurring at three month intervals thereafter. The primary feasibility outcome was ≥70% retention at study endpoint. Efficacy measures, including repeat SH, were secondary outcomes.

Results: Twenty-four subjects were enrolled (12 per group) with one BCBT subject and two controls dropping out prior to the first therapy session. Five (45%) of the remaining BCBT subjects and seven (70%) control subjects completed all 10 acute therapy sessions. All subjects who completed five sessions went on to complete 10. There were significantly fewer instances of repeat SH in BCBT subjects (7 of 62 weeks of acute follow-up; 11%) compared to control subjects (24 of 79 weeks; 30%)(OR 0.34, 95%CI:0.13-0.92). Three subjects, all in the control condition, made a total of five suicide attempts during the study.

Limitations: This study had a modest sample size and retention rate.

Conclusions: This study failed to achieve its primary feasibility retention goal for BCBT. However, it did demonstrate that initial adherence to follow-up predicted study completion. Despite small numbers, it also found a significant reduction in repeat SH in the BCBT group, a finding which requires replication.

Keywords: Cognitive behavioural therapy; Non-suicidal self- injury; Self-harm; Suicide; Suicide attempt; Youth.

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Conflict of interest statement

Declaration of Competing Interest All authors report no financial relationships with commercial interests of relevance to this study. Dr. Sinyor reports that he has received grant support from the Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario, the American Foundation for Suicide Prevention, the Ontario Ministry of Research and Innovation, and the University of Toronto, Department of Psychiatry Excellence Fund. Dr. Bryan reports that he has received grant support from the Department of Defense, Department of the Air Force, National Institute of Mental Health, Bob Woodruff Foundation, and the Boeing company; and consulting fees from Oui Therapeutics and Neurostat Analytical Solutions.

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