Blog
The Psychotherapy Practice Research Network (PPRNet) blog began in 2013 in response to psychotherapy clinicians, researchers, and educators who expressed interest in receiving regular information about current practice-oriented psychotherapy research. It offers a monthly summary of two or three published psychotherapy research articles. Each summary is authored by Dr. Tasca and highlights practice implications of selected articles. Past blogs are available in the archives. This content is only available in English.
This month...
…I blog about therapist empathy, psychotherapeutic treatment for borderline personality disorder, and research on psychological treatment of depression.
Type of Research
Topics
- ALL Topics (clear)
- Adherance
- Alliance and Therapeutic Relationship
- Anxiety Disorders
- Attachment
- Attendance, Attrition, and Drop-Out
- Client Factors
- Client Preferences
- Cognitive Therapy (CT) and Cognitive-Behavioural Therapy (CBT)
- Combination Therapy
- Common Factors
- Cost-effectiveness
- Depression and Depressive Symptoms
- Efficacy of Treatments
- Empathy
- Feedback and Progress Monitoring
- Group Psychotherapy
- Illness and Medical Comorbidities
- Interpersonal Psychotherapy (IPT)
- Long-term Outcomes
- Medications/Pharmacotherapy
- Miscellaneous
- Neuroscience and Brain
- Outcomes and Deterioration
- Personality Disorders
- Placebo Effect
- Practice-Based Research and Practice Research Networks
- Psychodynamic Therapy (PDT)
- Resistance and Reactance
- Self-Reflection and Awareness
- Suicide and Crisis Intervention
- Termination
- Therapist Factors
- Training
- Transference and Countertransference
- Trauma and/or PTSD
- Treatment Length and Frequency
May 2016
Organizational Factors That Reduce Suicide Rates in the Population
Kapur, N., Ibrahim, S., While, D., Baird, A.,... Appleby, L. (2016). Mental health service changes, organisational factors, and patient suicide in England in 1997–2012: a before-and-after study. The Lancet Psychiatry.
Suicide is a major cause of death worldwide, and many recent public health efforts have focused on suicide prevention. Many studies have looked at social, psychological, and biological factors that may cause suicide, but few studies have examined the effects of health service contexts on suicide rates. In this large retrospective population-based study, Kapur and colleagues looked at over 19,000 suicides that occurred within England’s health services from 1997 to 2012. This represented 26% of all suicides in England. The researchers: evaluated economic climate, surveyed the clinic administrators and clinicians involved, and they reviewed policy, service, and staffing changes at each time point. Health care in England is organized nationally through the National Health Service, and the government also collected confidential survey data on deaths by suicide between 1997 and 2012. The researchers examined if specific policy changes and organizational factors affected suicide rates. Health system changes such as: (a) implementing the National Institute for Health and Care Excellence depression guidelines, (b) making available crisis and home treatment teams, (c) implementing policies on transfer from youth to adult care and (d) new procedures for managing patients with dual diagnosis were all associated with reduced suicide rates during the study period. One of the most interesting findings was that these changes to the treatment and management of depression, youth, crises, and dual diagnoses were much more effective in reducing suicide rates under two organizational contexts: (1) when non-medical staff turnover was low, and (2) when there was greater reporting of patient safety incidents. Lower staff turnover likely means that patients in those organizations received greater continuity of care and that suicidal or depressed patients were more likely to receive treatment from highly trained and experienced professionals. Greater reporting of patient safety incidents tend to occur in organizations in which the staff feels sufficiently safe and secure to report and discuss negative clinical events without fear of reprisal or punishment. Such reflective practice is likely critical to increasing staff expertise in providing psychological treatment.
Practice Implications
Psychotherapists often do not think about the organizational context within which they work when considering the treatment they provide to those with mental health issues including people who may attempt suicide. Yet many psychotherapists work within an organizational context (e.g., hospitals, group practices, clinics, community health care centers, etc.). The findings from this study indicate that stability in staffing (i.e. low turnover) and working within a system that encourages reporting and discussing negative events likely has a positive impact on mental health outcomes like suicide.
January 2015
Psychological Therapy After a Suicide Attempt: A Nationwide Study
Erlangsen, A., Lind, B. D., Stuart, E. A., Qin, P., Stenager, E., Larsen, K. J., ... & Nordentoft, M. (2014). Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: A register-based, nationwide multicentre study using propensity score matching. The Lancet Psychiatry. Early Online Publication: doi:10.1016/S2215-0366(14)00083-2.
Between 9 million and 35 million suicide attempts occur yearly in the world, and suicide accounts for over 800,000 deaths every year worldwide. Suicide attempts are associated with future attempts and with mortality. Within the first year, 16% of people attempt suicide again. Despite the occurrence of suicide attempts and its effects, there has been inconclusive evidence of the effectiveness of interventions to reduce future attempts and death. That is why this Danish nationwide study by Erlangsen is so important. Another impressive aspect of this study is its size and scope. Since 1992, psychological therapies have been offered to people at risk of suicide in specialized clinics throughout Denmark. The aim of Erlangsen and colleagues’ study was to assess if those who received these psychological interventions had a reduced risk of suicidal behavior and mortality compared to people who did not receive the interventions. The authors collected data from 1992 to 2010 from Danish national health registries. This procedure was possible in Denmark because the health system is nationally coordinated and each individual has a traceable national health ID. In order to be included in the study, those who were offered specialized psychological interventions had to receive at least one session of treatment. Therapy included cognitive behavioral therapy, problem solving therapy, dialectical behavior therapy, psychodynamic therapy, systemic therapy and others. The interventions consisted of up to 8 to 10 individual outpatient sessions. The comparison group received “standard care” that consisted of admission to hospital, referral to a general practitioner, or discharge with no referral. The primary outcomes were: repeated self-harm, death by suicide, and death by any other cause. Of the people receiving psychotherapy, 5,678 had useable data. The “standard care” sample was much larger and consisted of 58,281 individuals who were matched to the psychological intervention group on many variables including sex, age, education, antidepressant medications, and psychiatric diagnosis. For those receiving psychotherapy, the rate of repeated suicide attempts in the first year was 6.7% and 15.5% at 10 years. For those receiving standard care, rate of repeated suicide attempts in the first year was 9.0% and 18.4% at 10 years. The odds of another suicide attempt one year post treatment was 73% lower among those receiving psychotherapy. Death by any other cause at the 10 year mark was also significantly lower in the psychological therapy group (5.3%) versus the no-therapy group (7.9%). The authors estimated that over the 20 year span of their data, psychological therapy: prevented repeated suicide attempts in 145 people, prevented deaths by any other cause in 153 people, and prevented 30 suicide deaths. Psychosocial interventions were associated with fewer repeated suicide attempts in women but not in men, and adolescents and young adults benefited most from psychological therapies.
Practice Implications
This is the largest long term follow up study ever of psychological interventions after a suicide attempt. Psychotherapy was associated with reduced risk of self-harm and mortality in the short and long term. This was especially true for women and in adolescents and young adults. Those receiving psychotherapy might have been a select group resulting in biased results. However, the extensive matching of the psychotherapy group to the no-therapy control group reduced the likelihood that factors other than psychotherapy influenced the findings. The study indicates strong support for providing psychological interventions to people at risk of suicide.