Problem-solving therapy may reduce attempted suicides

Problem-solving therapy may help people who attempt suicide or self-harm according to a study by University of Auckland researchers published in the British Journal of Psychiatry this month.

The study is the world’s largest trial assessing the efficacy of problem-solving therapy for people who presented to hospital following attempted suicide or an intentional self-harm incident. It showed that patients who received problem-solving therapy were less hopeless, less depressed and had fewer suicidal thoughts than those who did not receive the treatment.

The randomised controlled trial, funded by ACC, looked at 1094 people who presented to emergency departments between September 2005 and June 2008 at four district health boards (DHBs) in New Zealand.

Findings showed that all people who received problem-solving therapy reported greater improvements in depression, hopelessness, suicidal thinking and problem-solving skills than people who received usual care alone. (Usual care following self-harm varies and may involve referral to multidisciplinary teams for psychiatric or psychological intervention, referral to mental health crisis teams, recommendations for engagement with alcohol and drug treatment centres or other health and non-health services.)

Although problem-solving therapy did not lead to a lower rates of repeat self-harm incidences for all people, for those who had a previous history of attempted suicide or self harm (around 40% of the group) the therapy significantly lowered their risk of presenting to hospital again with self-harm over the following year.

Lead investigator Associate Professor in Psychological Medicine Dr Simon Hatcher says:“Self-harm is common and those admitted to hospital because of this are an easily identifiable high-risk group so there is an important opportunity for intervention, particularly in relation to suicide prevention. Despite this, there is no generally accepted evidence-based intervention.

“The findings offer hope for those people who repeated self-harm that something can be done to help them, it shows that the burden of this problem on hospital emergency departments can be reduced and potentially it could help reduce New Zealand’s suicide rate.”

The team at The University of Auckland is currently investigating whether other factors in conjunction with therapy, such as receiving regular postcards, would further improve patients’ wellbeing.

They are also looking at the effectiveness of similar treatments delivered by Māori
for Māori.


Notes:

– Hospitals involved in the study:North Shore Hospital, Waitakere Hospital (Waitemata DHB); Middlemore Hospital (Counties Manukau DHB); Whangarei Hospital (Northland DHB); Wellington and Kenepuru Hospitals (Capital and Coast DHB)

– 1094 people were randomised to receive either usual care (572 people) or were offered problem solving therapy (522 people). 420 people had a history of presenting to hospital with self harm.They were followed up for a year after they presented to hospital.

– The people who received problem-solving therapy each had about five one-hour sessions. Problem-solving therapy reduced the number of self harm attempts by 40% in people who presented with a repeat attempt. (Problem-solving therapy is a brief face to face talking therapy that teaches people a structured way to identify and solve problems in their lives.)

– For more information on the intervention go to www.problemsolvingtherapy.ac.nz