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Psychol Med. 2017 Apr;47(5):810-821. doi: 10.1017/S0033291716002798. Epub 2016 Nov 23.

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

Author information

1
Harvard Medical School,Boston, MA,USA.
2
Department of Psychiatry,Massachusetts General Hospital,Boston, MA,USA.

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

PMID:
27876105
PMCID:
PMC5340604
DOI:
10.1017/S0033291716002798
[Indexed for MEDLINE]
Free PMC Article

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