针对有自杀倾向的住院病人的简短认知行为疗法

IF 22.5 1区 医学 Q1 PSYCHIATRY
Gretchen J. Diefenbach, Kayla A. Lord, Jessica Stubbing, M. David Rudd, Hannah C. Levy, Blaise Worden, Kimberly S. Sain, Jessica G. Bimstein, Tyler B. Rice, Kate Everhardt, Ralitza Gueorguieva, David F. Tolin
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Empirically supported inpatient suicide prevention treatments are needed.ObjectiveTo determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether substance use disorder moderates treatment effects.Design, Setting, and ParticipantsThis randomized clinical trial compared treatment as usual (n = 106) to treatment as usual plus brief cognitive behavioral therapy for inpatients (n = 94) at a private psychiatric hospital in Connecticut. Follow-up assessments were completed monthly for 6 months postdischarge. Participants were enrolled from January 2020 through February 2023. Inpatients admitted following a suicidal crisis (past-week suicide attempt or ideation with plan on admission and attempt within previous 2 years) were included. 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引用次数: 0

摘要

重要性住院病人出院后自杀风险升高。目标确定在常规治疗的基础上增加预防自杀的住院版简短认知行为疗法是否会减少出院后的自杀企图、自杀意念和精神病再入院率,并确定药物使用障碍是否会调节治疗效果。这项随机临床试验比较了康涅狄格州一家私立精神病医院为住院病人提供的常规治疗(n = 106)和常规治疗加简短认知行为疗法(n = 94)。出院后 6 个月内每月完成一次随访评估。参与者的登记时间为 2020 年 1 月至 2023 年 2 月。住院患者均在发生自杀危机(上一周自杀未遂或入院时有自杀意念,且在过去两年内有自杀未遂的计划)后入院。筛选了连续入院的医疗记录(n = 4137),213 人符合研究条件并进行了随机化,200 人接受了分析。共有 114 名参与者(57.0%)完成了 6 个月的随访评估。干预针对住院病人设计的预防自杀的简短认知行为疗法,最多4次单独疗程。主要结果和测量自杀企图和再入院情况通过盲人访谈和病历审查进行评估。结果200名接受分析的参与者的平均年龄为32.8 (12.6)岁,其中117人为女性,83人为男性。在整个患者群体中,住院简短认知行为疗法将出院后6个月内自杀未遂的发生率降低了60%(几率比为0.40;95% CI为0.20-0.80;治疗所需人数为7),而在没有药物使用障碍的患者中,精神科再住院率降低了71%(几率比为0.29;95% CI为0.09-0.90)。治疗条件对自杀意念的影响不太明显,但事后分析表明,在出院后1个月和2个月,接受住院简短认知行为疗法与常规治疗的患者自杀意念较轻。药物使用障碍调节了治疗对再入院率的影响。治疗对自杀意念的影响不太明显。需要开展实施研究以促进推广。还需要开展更多研究,以优化药物使用障碍患者的治疗效果:NCT04168645
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Brief Cognitive Behavioral Therapy for Suicidal Inpatients
ImportanceSuicide risk is elevated after discharge from inpatient level of care. Empirically supported inpatient suicide prevention treatments are needed.ObjectiveTo determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether substance use disorder moderates treatment effects.Design, Setting, and ParticipantsThis randomized clinical trial compared treatment as usual (n = 106) to treatment as usual plus brief cognitive behavioral therapy for inpatients (n = 94) at a private psychiatric hospital in Connecticut. Follow-up assessments were completed monthly for 6 months postdischarge. Participants were enrolled from January 2020 through February 2023. Inpatients admitted following a suicidal crisis (past-week suicide attempt or ideation with plan on admission and attempt within previous 2 years) were included. Medical records of consecutive admissions (n = 4137) were screened, 213 were study eligible and randomized, and 200 were analyzed. A total of 114 participants (57.0%) completed 6-month follow-up assessments. Data from medical records were also obtained through 6-month follow-up.InterventionUp to 4 individual sessions of brief cognitive behavioral therapy for suicide prevention designed for inpatients.Main Outcomes and MeasuresSuicide attempts and readmissions were assessed via blind interviews and medical record review. Suicidal ideation was assessed via self-report.ResultsThe mean (SD) age among 200 analyzed participants was 32.8 (12.6) years; 117 participants were female and 83 were male. Brief cognitive behavioral therapy–inpatient reduced the occurrence of suicide attempt over 6 months postdischarge by 60% (odds ratio, 0.40; 95% CI, 0.20-0.80; number needed to treat, 7) in the entire patient group, and the rate of psychiatric readmissions by 71% (rate ratio, 0.29; 95% CI, 0.09-0.90) in those without a substance use disorder. The effect of treatment condition on suicidal ideation was less clear, although post hoc analyses indicated less severe suicidal ideation following brief cognitive behavioral therapy–inpatient vs treatment as usual at 1 and 2 months postdischarge.Conclusions and RelevanceBrief cognitive behavioral therapy–inpatient reduced 6-month postdischarge suicide reattempts and rate of readmissions when added to treatment as usual. Substance use disorder moderated the treatment’s effect on readmission rates. Treatment effects on suicidal ideation were less clear. Implementation research is needed to facilitate dissemination. Additional research is also needed to optimize outcomes for individuals with substance use disorders.Trial RegistrationClinicalTrials.gov Identifier: NCT04168645
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来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
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