Screening for Suicide Risk in Adults: Summary of the Evidence: Table 1. Randomized Controlled Trials of Interventions to Decrease Deliberate Self-Harm in Adults and Older Adolescents

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Table 1. Randomized Controlled Trials of Interventions to Decrease Deliberate Self-Harm in Adults and Older Adolescents^a

Treatment Compared	Study, Year	Population	Age Range (Yrs)	Intervention and Control Groups	Followup Period (After Enrollment)	Number (%) of Participants with DSH during Followup	Odds Ratio (95% CI)
Problem-solving Therapy vs Standard Aftercare	Gibbons, et al., 1978³⁷	Southampton, UK Self-poisoning patients with no immediate suicide risk and no formal psychiatric diagnosis	> 17	Intervention: Home-based crisis-oriented problem-solving therapy by social workers over 3 mos Control: Standard aftercare	12 mos	Intervention: 27/200 (13.5) Control: 29/200 (14.5)	0.92 (0.52-1.62)
	Hawton, et al., 1987³⁸	Oxford, UK Deliberate self-poisoning patients who were not in psychiatric care, did not require treatment for alcohol or drug addiction, and did not need inpatient psychiatric care	> 16	Intervention: Outpatient therapy by non-medical clinicians for ≤ 8 sessions Control: Standard aftercare	12 mos	Intervention: 3/41 (7.3) Control: 6/39 (15.4)	0.43 (0.10-1.87)
	Salkovskis, et al., 1990³⁹	Leeds, UK Non-psychotic patients referred by psychiatrist after admission to an emergency department after antidepressant self-poisoning; ≥4 on Buglass and Hawton Risk of Repetition Scale or ≥2 previous attempts	16-65	Intervention: Home-based therapy by community psychiatric nurse for 5 sessions Control: Standard aftercare	12 mos	Intervention: 3/12 (25.0) Control: 4/8 (50.0)	0.33 (0.05-2.24)
	McLeavey, et al., 1994⁴⁰	Cork, Ireland Non-psychotic, non-suicidal patients without cognitive impairment and not needing psychiatric inpatient care who were admitted to an emergency department for self-poisoning	15-45	Intervention: Interpersonal problem-solving skills training by trained therapists for approximately 5 sessions Control: Brief problem-solving therapy	12 mos	Intervention: 2/19 (10.5) Control: 5/20 (25.0)	0.35 (0.06-2.09)
	Evans, et al., 1999⁴¹	London, UK Patients with self-harm episode in previous 12 mos with a personality disturbance but no alcohol or drug dependence or schizophrenia who were admitted to Paddington, Westminster or Chelsea, Westminister, emergency department	16-50	Intervention: Manual-assisted cognitive-behavioral therapy by trained therapists for 2-6 sessions Control: Standard psychiatric treatment	6 mos	Intervention: 10/18 (55.6) Control: 10/14 (71.4)	OR not calculated
	Overall					0.70 (0.45-1.11)
Intensive Care Plus Outreach vs Standard Care	Chowdhury, et al., 1973⁴²	Edinburgh, UK Patients with a previous DSH episode admitted for DSH to a general hospital; included patients with psychiatric disturbance, alcohol dependence, and drug addiction	> 16	Intervention: Enhanced aftercare with aggressive outreach and followup Control: Standard aftercare	6 mos	Intervention: 17/71 (23.9) Control: 19/84 (22.6)	1.08 (0.51-2.27)
	Welu, 1977⁴³	Pittsburgh, PA Patients admitted to an emergency department for DSH	≥16	Intervention: Special outreach program with weekly or bi-weekly contact with trained mental health professionals for 4 mos Control: Standard aftercare	4 mos	Intervention: 3/62 (4.8) Control: 9/57 (15.8)	0.27 (0.07-1.06)
	Hawton, et al., 1981⁴⁴	Oxford, UK Patients not receiving current psychiatric care or treatment for alcohol or drug addiction admitted to a general hospital after DSH	≥15	Intervention: Home-based therapy as often as therapist felt necessary for ≤ 3 mos by mental health professionals Control: Weekly outpatient therapy	12 mos	Intervention: 5/48 (10.4) Control: 7/48 (14.6)	0.68 (0.20-2.32)
	Allard, et al., 1992⁴⁵	Montreal, Canada Non-sociopathic patients with a recent suicide attempt who presented to hospital for another suicide attempt	NR	Intervention: Enhanced aftercare with aggressive outreach and followup by mental health professionals for 12 mos Control: Standard aftercare	12 mos	Intervention: 22/63 (34.9) Control: 19/63 (30.2)	1.24 (0.59-2.62)
	Van Heeringen, et al., 1995⁴⁶	Ghent, Belgium Patients treated in an emergency department after a suicide attempt	≥15	Intervention: Enhanced aftercare with aggressive outreach and followup by mental health professionals for unspecified period Control: Standard aftercare	12 mos	Intervention: 21/196 (10.7) Control: 34/195 (17.4)	0.57 (0.32-1.02)
	van der Sande, et al., 1997⁴⁷	Utrecht, the Netherlands Patients without drug or alcohol addiction and obvious psychiatric comorbidity admitted to the hospital after a suicide attempt	≥16	Intervention: Brief psychiatric admission with outpatient therapy by mental health professionals and 24 hr hospital access for unspecified period Control: Standard aftercare	12 mos	Intervention: 24/140 (17.1) Control: 20/134 (14.9)	1.18 (0.62-2.25)
	Overall						0.83 (0.61-1.14)
Emergency Care vs Standard Aftercare	Morgan, et al., 1993⁴⁸	Bristol, UK Patients admitted to the hospital after first DSH episode	Mean age, 30	Intervention: Standard care plus card indicating 24-hr access to mental health professional for 12 mos Control: Standard aftercare	12 mos	Intervention: 5/101 (5.0) Control: 12/111 (10.8)	0.43 (0.15-1.27)
Dialectical Behavior Therapy vs Standard Aftercare	Linehan, et al., 1991⁴⁹	Seattle, WA Female patients with borderline personality disorder and ≥2 suicide attempts in last 5 yrs, current suicide attempt within past 8 wks	18-45	Intervention: Dialectical behavioral therapy (individual and group) with mental health professional for 1 yr Control: Standard aftercare	12 mos	Intervention: 5/19 (26.3) Control: 12/20 (60.0)	0.24 (0.06-0.93)
Inpatient Behavior Therapy vs Inpatient Insight-Oriented Therapy	Liberman and Eckman, 1981⁵⁰	Los Angeles, CA Patients with ≥1 suicide attempt who were not psychotic or addicted to alcohol or drugs and were referred by psychiatrist after admission to emergency department for DSH	18-47	Intervention: Inpatient psychiatric treatment with behavior therapy for 10 days Control: Inpatient psychiatric treatment with insight-oriented therapy for 10 days	12 mos	Intervention: 2/12 (16.7) Control: 3/12 (25.0)	0.60 (0.08-4.45)
Same Therapist (Continuity of Care) vs Different Therapist (Change of Care)	Torhorst, et al., 1987⁵¹	Munich, Germany Non-psychotic patients hospitalized after a self-poisoning suicide attempt	NR	Intervention: Outpatient appointment with same therapist as seen in hospital for 3-mo treatment Control: Outpatient appointment with different therapist than seen in hospital for 3-mo treatment	12 mos	Intervention: 12/68 (17.6) Control: 4/73 (5.5)	3.70 (1.13-12.09)
General Hospital Admission vs Discharge	Waterhouse and Platt, 1990⁵²	York, UK Patients without current medical or psychiatric treatment needs admitted to an emergency department for DSH	≥16	Intervention: General hospital admission for about 1 day Control: Discharge from hospital	4 mos	Intervention: 3/38 (7.9) Control: 4/39 (10.3)	0.75 (0.16-3.60)
Flupenthixol (Antipsychotic) vs Placebo	Montgomery, et al., 1979⁵³	Maidstone, UK Patients with ≥2 DSH episodes without overt depression or schizophrenia admitted to a general hospital after a suicide attempt	18-68	Intervention: Monthly intramuscular administration for 6 mos Control: Monthly placebo administration	6 mos	Intervention: 3/14 (21.4) Control: 12/16 (75.0)	0.09 (0.02-0.50)
Antidepressants vs Placebo	Hirsch, et al., 1982⁵⁴	London, UK Patients with a GHQ score ≥20 and not on antidepressant or antipsychotic medication and were admitted to a hospital after deliberate self-poisoning	16-65	Intervention: Mianserin or nomifensine therapy for 6 wks Control: Placebo	3 mos	Intervention: 16/76 (21.1) Control: 5/38 (13.2)	1.76 (0.59-5.24)
	Montgomery, et al., 1983⁵⁵	London, UK Patients with personality disorder and no depression or schizophrenia with previous DSH, admitted after DSH	Mean age, 35.7	Intervention: Mianserin therapy for 6 mos Control: Placebo	6 mos	Intervention: 8/17 (47.1) Control: 12/21 (57.1)	0.67 (0.18-2.41)
	Verkes, et al., 1998⁵⁶	Leiden, Rotterdam, the Netherlands Patients with repeated DSH without current diagnosis of major depression who were admitted to emergency departments of university hospitals	≥18	Intervention: Paroxetine plus psychotherapy (therapy and therapist not described) for 12 mos Control: Placebo plus psychotherapy	12 mos	Intervention: 15/46 (32.6) Control: 21/45 (46.7)	0.70 (no CI, P= 0.12)
	Overall						0.83 (0.47-1.48)
Long-term Therapy vs Short-term Therapy	Torhorst, et al., 1988⁵⁷	Munich, Germany Patients with repeat DSH without psychosis, current psychiatric treatment, or drug addiction admitted for deliberate self-poisoning episode	NR	Intervention: 1 session per month by a mental health professional for 12 mos Control: 12 weekly therapy sessions by a mental health professional over 3 mos	12 mos	Intervention: 9/40 (22.5) Control: 9/40 (22.5)	1.0 (0.35-2.86)
Note: CI, confidence interval; DSH, deliberate self-harm; GHQ, Generalized Health Questionnaire; NR, not reported; OR, odds ratio. ^a Adapted from Hawton, et al., 2001.¹⁸

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Table 1. Randomized Controlled Trials of Interventions to Decrease Deliberate Self-Harm in Adults and Older Adolescentsa

Table 1. Randomized Controlled Trials of Interventions to Decrease Deliberate Self-Harm in Adults and Older Adolescents^a