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

Published online by Cambridge University Press:  23 November 2016

C. M. Celano ,
E. E. Beale ,
C. A. Mastromauro ,
J. G. Stewart ,
R. A. Millstein ,
R. P. Auerbach ,
C. A. Bedoya  and
J. C. Huffman
C. M. Celano*
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
E. E. Beale
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
C. A. Mastromauro
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
J. G. Stewart
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, McLean Hospital, Belmont, MA, USA
R. A. Millstein
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
R. P. Auerbach
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, McLean Hospital, Belmont, MA, USA
C. A. Bedoya
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
J. C. Huffman
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
*
*Address for correspondence: C. M. Celano, M.D., Massachusetts General Hospital/Blake 11, 55 Fruit Street, Boston, MA 02114, USA. (Email: ccelano@partners.org)
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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

Cognitiondepressionoptimismpositive psychologysuicide
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 5 , April 2017 , pp. 810 - 821
Copyright
Copyright © Cambridge University Press 2016 

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Footnotes

Previous presentation: An abstract was presented at the 62nd Annual Meeting of the Academy of Psychosomatic Medicine, New Orleans, LA, 11–14 November 2015.

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