Adding four sessions of cognitive-behavioral therapy (CBT) to standard suicide prevention treatment at an inpatient hospital can significantly reduce the risk of future suicide attempts, reports a study in JAMA Psychiatry. Among psychiatric inpatients without a substance use disorder (SUD), brief CBT was also found to significantly reduce the risk of hospital readmission.
Gretchen J. Diefenbach, Ph.D., of Yale University School of Medicine, and colleagues randomized 200 adults admitted to a private psychiatric hospital in Connecticut to receive either treatment as usual (n = 106) or usual treatment plus brief CBT (n = 94) during their stay. Study participants—recruited between January 2020 and February 2023—all had a suicide attempt within one week of admission or current suicidal ideation along with a suicide attempt in the past two years. Although adults with current mania or a history of schizophrenia were excluded from participation, individuals with an existing SUD were included, comprising 60% of participants.
Usual treatment entailed 24-hour multidisciplinary care that included safety planning, psychosocial services, and medications as needed. The CBT group also received up to four individual CBT sessions (depending on length of stay) that included components such as developing a crisis response plan, inventorying reasons for living, creating a hope kit, and reducing access to lethal means.
The researchers conducted monthly follow-up assessments with participants upon discharge for six months; overall, 114 participants completed the full six months of assessments.
At six months, participants who had received brief CBT had 60% lower odds of a suicide attempt compared with those only receiving usual treatment. Participants in the CBT group also reported lower levels of suicidal ideation, although only at one and two months post-discharge.
Brief CBT was also associated with 71% decreased odds of psychiatric readmission at six months among participants who did not have an SUD at admission. “These findings are consistent with previous research identifying SUD as a suicide risk factor and poor prognostic indicator,” Diefenbach and colleagues wrote. “Research is needed to disentangle the complex and bidirectional interplay between substance use and its medical, social, and psychiatric correlates to inform the development of SUD-specific treatment enhancements in the future.”
The researchers acknowledged that broad uptake of inpatient CBT is a challenge. “In addition to short lengths of stay, workflows can be chaotic, with frequent, often abrupt changes in schedules and discharge plans,” they wrote. “Dissemination of this treatment protocol may not be possible without substantial hospital investment, for example, by creating new positions for specialist suicide prevention staff, who have been trained to administer the [brief] CBT-inpatient protocol with high fidelity.
“Alternatively, adaptations … such as administration by nonexpert clinicians, utilizing a group format, or integrating the use of technology such as mobile applications, may be needed before widespread uptake can occur.”
For related information, see the Psychiatric News article “Peer Specialists Can Aid in Suicide Prevention.”
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