10.5061/DRYAD.85NF3
Gysin-Maillart, Anja
University of Bern
Schwab, Simon
University of Bern
Soravia, Leila Maria
Megert, Millie
Michel, Konrad
University of Bern
Soravia, Leila
University of Bern
Data from: A novel brief therapy for patients who attempt suicide: a
24-months follow-up randomized controlled study of the Attempted Suicide
Short Intervention Program (ASSIP)
Dryad
dataset
2017
Suicide Prevention
Suicide Risk
Therapeutic Alliance
Psychotherapy
Attempted Suicide
Suicide
Brief Therapy
Randomized Controlled Trial
2017-01-26T00:00:00Z
2017-01-26T00:00:00Z
en
https://doi.org/10.1371/journal.pmed.1001968
8273 bytes
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CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
Background: Attempted suicide is the main risk factor for repeated
suicidal behavior. However, the evidence for follow-up treatments of these
patients is limited. The objective of the present study was to evaluate
the efficacy of ASSIP (Attempted Suicide Short Intervention Program) in
reducing suicidal behavior. ASSIP is a novel brief therapy based on a
patient-centered model of suicidal behavior, with an emphasis on early
therapeutic alliance. Methods and Findings: Patients who had recently
attempted suicide were randomly allocated to treatment as usual (N=60) or
treatment as usual plus ASSIP (N=60). ASSIP participants received three
therapy sessions followed by regular contact through personalized letters
over 24 months. Participants considered to be at high risk of suicide were
included, 63% were diagnosed with an affective disorder, and 50% had a
history of prior suicide attempts. Clinical exclusion criteria were
habitual self-harm, serious cognitive impairment, and psychotic disorder.
Study participants completed a set of psychosocial and clinical
questionnaires every 6 months over a 24-months follow-up period. The study
represents a real-world clinical setting at an outpatient clinic of an
university hospital of psychiatry. Primary outcome measure was repeat
suicide attempts during the 24-months follow-up period. Secondary outcome
measures were suicidal ideation and healthcare utilization. Furthermore,
effects of prior suicide attempts, depression at baseline, diagnosis, and
therapeutic alliance on outcome were investigated. During the 24-months
follow-up period, 5 repeat attempts were recorded in the ASSIP group and
41 attempts in the control group. The rates of participants reattempting
suicide at least once were 8.3% (n=5) and 26.7% (n=16). ASSIP was
associated with an approximately 80% reduced risk of repeat episodes (Wald
?21=13.1; 95% CI 12.4-13.7; p=.0004). ASSIP participants spent 72% fewer
days in hospital during follow-up (ASSIP: 29 days; control group: 105
days; W=94.5, p=.038). Higher scores of patient-rated therapeutic alliance
in this group were associated with a lower rate of repeat suicide
attempts. Prior suicide attempts, depression, and a diagnosis of
personality disorder at baseline did not significantly affect outcome.
Participants with a diagnosis of borderline personality disorder (n=20)
had more previous suicide attempts and a higher number of reattempts. Key
study limitations were missing data and dropout rates. Although both were
generally low they increased during follow-up. At 24 months the group
difference between the dropout rates was significant: ASSIP: 7% (n=4),
control: 22% (n=13). A further limitation is that we do not have detailed
information of the co-active follow-up treatment apart from the 6-monthly
self-reports on the setting and the duration of treatment as usual.
Conclusions: ASSIP, a manual-based brief therapy for patients who had
recently attempted suicide, administered in addition to the usual clinical
treatment, was efficacious in reducing suicidal behavior in a real-world
clinical setting. ASSIP fulfills the need for an easy to administer
low-cost intervention. Large pragmatic trials will be needed to
conclusively establish the efficacy of ASSIP and replicate our findings in
other clinical settings. ClinicalTrials.gov Identifier: NCT02505373
ASSIP Data fileData file from the ASSIP 24-months follow-up randomized
controlled study.assip.RDataAnalysis script for ASSIPWe provide a short
analysis script (survival.R) to replicate the main findings of our study
using the original data (assip.RData).survival.R