12/11/2012. The problem of recurrent suicide Recurrent suicide attempters: A unique population. Treatment options for suicidality

Transcription

1 Dr Aileen O Reilly & Dr Evelyn Gordon School of Nursing & Human Sciences, Dublin City University Dr Maeve Kenny, Principal Clinical Psychologist, St Vincent's Hospital, Fairview The problem of recurrent suicide Recurrent suicide attempters: A unique population Fluid vulnerability theory (FVT; Rudd, 2006) Treatment options for suicidality The PISA intervention: A unique response Suicide is major global problem Some repeatedly attempt suicide 40% patients presenting for medical care are repeaters (Kreitman & Casey, 1988) 20% those in Irish A&E repeaters (NSRF, 2012) Risk of fatal suicide increases 32% with each attempt (Leon et al., 1999) Elevated risk for completed suicide 1

2 Research suggests meaningful differences between single attempters and RSA (Forman et al., 2004; Gibb et al., 2009) RSA defined as those with two or more genuine suicide attempts in lifetime (Rudd et al., 1996; Rudd, 2006) RSA represent more serious suicide problem (Laget et al., 2006, p.165) but little research with this specific population Severe and complex psychopathology (Rudd et al., 2004) Psychiatric diagnosis (Forman et al., 2004) with longer duration and earlier onset (Gibbs et al., 2009) Depression (Forman et al., 2004) Social phobia, panic disorder, PTSD (Rudd et al., 1996) Anxiety disorders (Pagura et al., 2008) Personality disorders such as BPD (Pompili et al., n.d.) Psychotic disorders (Forman et al., 2004) Alcohol and drug abuse (Rosenberg et al., 2005) Childhood history of anxiety disorder/major depression (Rudd et al., 2004) Comorbidity more prevalent among RSA (Goldston et al., 2009; Pagura et al., 2008) Lower perceived support (Merchant et al., 2009) Higher levels of interpersonal dependency (Laget et al., 2006) Higher level of interpersonal dysfunction (Forman et al., 2004) Poor problem solving skills (Rudd et al., 1996) Trouble concentrating, understanding or remembering (Hakansson et al., 2011) Hopelessness (Esposito et al., 2003) Alexithymia (Bergmans & Links, 2002) 2

3 More frequent histories of sexual abuse (Mandelli et al., 2011; Sutton, 2011) Childhood maltreatment Emotional abuse (Forman et al., 2004) More traumatic life events such as parental loss (De Lao et al., 2002) Family history of suicidal behaviours (Lizardi et al., 2009) and psychiatric problems (Hakansson et al., 2011) Understand chronic suicidality Predisposing vulnerabilities Trigger Suicidal mode Affective Behavioural Cognitive Physiological Baseline risk Threshold value = suicidal mode activated Threshold value 3

4 Recurrent suicide attempters Threshold value Threshold value Chronic suicidality = recurrent and discrete episodes of imminent risk Acute risk resolves when aggravating factors are effectively targeted; longterm treatment needed to address chronic risk Systematic reviews DBT effective in reducing parasuicide & suicide attempts with BPD(Linehan et al., 1997) CBT effective in reducing suicide attempts (Van der Sande et al., 1997) No psychosocial intervention effective reducing repetition of self-injury (Hawton et al., 1998, 2009) BUT problem-solving therapies hold promise as they reduce hopelessness and depression (Gray and Otto, 2001; Townsend et al., 2001; Links et al., 2003) Impact on reducing RSA not proven (Links et al., 2003) and CBT gains short-term Evidence-based interventions for RSA regardless of diagnosis are lacking (Bergmans & Links, 2009; van der Sande et al., 1997) 4

5 Psychosocial/psychoeducational Intervention for people with recurrent Suicide Attempts (PISA; Yvonne Bergmans & Paul Links, St. Michael s Hospital Toronto, Canada) A 20 week group intervention (8-12 members, min.6, meet for 1.5 hours) Draws on range of social, educational and psychological theories (e.g., Shneidman s theory of psychache ) Comprises 4 modules of skills and strategies: Emotional literacy; Problem solving; Crisis management ; Interpersonal relationships Facilitated by 2 trained PISA facilitators Experts by experience involvement Mixed methods study with three aims: 1. Explore effectiveness of PISA intervention 2. Identify individual factors in terms of response/non-response to PISA 3. Examine acceptability of PISA in an Irish context 5

6 Recurrent suicide attempters are a unique population They require therapeutic responses that take into account their unique profiles Bergmans, Y., & Links, P. (2002). A description of a psychosocial/psychoeducational intervention for persons with recurrent suicide attempts. Crisis, 23(4), Bergmans, Y., & Links, P. (2009). Reducing potential risk factors for suicide-related behavior with a group intervention for clients with recurrent suicide-related behavior. Annals of Clinical Psychiatry, 21(1), Esposito, C., Spirito, A., & Boergers, J. (2003). Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Suicide and Life Threatening Behavior, 33(4), Fine, G., Alison, H.C., van der Westhuizen, D., & Kruger, C. (2012). Predicting frequency of suicide attempts of adolescent outpatients at Weskoppies Hospital using clinical and demographic characteristics. South African Journal of Psychiatry, 18(1), Forman, E.M., Berk, M.S., Henriques, G.R., Brown, G.K., & Beck, A.T. (2004). History of multiple suicide attempts as a behavioural marker of severe psychopathology. American Journal of Psychiatry, 161(3), Gibb, B. E., Andover, M. S., Miller, I. W. (2009). Depressive characteristics of adult psychiatric inpatients with a history of multiple versus one or no suicide attempts. Depression and Anxiety, 26, Goldston, D.B., Sergent Daniel, S., Erkanli, A., Reboussin, B.A., Mayfield, A., Frazier, P.H., & Treadway, S.L. (2009). Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: Developmental changes. Journal of Consulting and Clinical Psychology, 77(2), Gray, S.M., & Otto, M.W. (2001). Psychosocial approaches to suicide prevention: Applications to patients with bipolar disorder. Journal of Clinical Psychiatry, 62(25), Hakansson, A., Bradvik, L., Schlyter, F., & Berglund, M. (2011). Variables associated with repeated suicide attempt in a criminal justice population. Suicide and Life-Threatening Behavior, 41(5), Harris, E.C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders. A meta-analysis. The British Journal of Psychiatry, 170, Hawton, K.E., Townsend, E., Arensman, E., Gunnell, P., Hazell, P.,... van Heeringen, K. (2009). Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database for Systematic Reviews, (4), CD Laget, J., Plancherel, B., Stèphan, P., Bologini, M., Corcos, M., Jeammet, P., & Halfon, O. (2006). Personality and repeated suicide attempts in dependent adolescents and young adults. Crisis, 27(4), Links, P., Bergmans, Y., & Cook, M. (2003). Psychotherapeutic interventions to prevent repeated suicide behaviour. Brief Treatment and Crisis Intervention, 3:4, Lizardi, D., Sher L., Sullivan, G.M., Stanley, B., Burke, A., & Oquendo, M. A. (2009). Association between familial suicidal behavior and frequency of attempts among depressed suicide attempters. Acta Psychiatrica Scandinavica, 119(5), Mandelli, L., Carli, V., Roy, A., Serretti, A., & Sarchiapone, M. (2011). The influence of childhood trauma on the onset and repetition of suicidal behavior: An investigation in a high risk sample of male prisoners. Journal of Psychiatric Research, 45, Merchant, C., Kramer, A., Joe, S., Venkataraman, S., & King, C. A. (2009). Predictors of multiple suicide attempts among suicidal black adolescents. Suicide and Life Threatening Behavior, 39(2), Nrugham, L., Holen, A., & Sund, A.M. (2012). Suicide attempters and repeaters: Depression and coping. Journal of Nervous and Mental Disease, 200(3), Pagura, J., Cox, B.J., Sareen, J., & Enns, M.W. (2008). Factors associated with multiple versus single episode suicide attempts in the and United States national comorbidity surveys. Journal of Nervous & Mental Disease, 196 (11), Pena, J.B., Matthieu, M.M., Zayas, L.H., Masyn, K.E., & Caine, E.D. (2012). Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention, : Implications for future prevention initiatives. Social Psychiatry and Psychiatric Epidemiology, 47, Rudd, M. D., Joiner, T. E. Jr., & Rumzek, H. (2004) Childhood diagnoses and later risk for multiple suicide attempts. Suicide and Life-threatening Behavior, 34(2), Rudd, D. (2006, October). Plenary presentation. Canadian Association for Suicide Prevention (CASP) Conference. Toronto, Canada. Sutton, S. (2011). Characteristics of patients who make repeated suicide attempts. Retrieved 13 July 2011 from HoronSutton.pdf Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P.,... van Heeringen, K. (2001). The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine, 31, Van der Sande, R., Buskens, E., Allart, E., van der Graaf, Y., & van Engeland, H. (1997). Psychosocial intervention following suicide attempt: A systematic review of treatment interventions. Acta Psychiatrica Scandinavica, 96, World Health Organisation (2010). Retrieved 19 April 2011 from 6

7 For more information about the PISA project please visit Any questions can be directed to Dr Aileen O Reilly, School of Nursing, DCU Phone: Mobile: aileen.oreilly@dcu.ie 7