What is the second phase of intervention for patients with suicidal behaviors?

Updated: Aug 29, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

After the initial intervention, which usually includes hospitalization, it is critical that there be in place an ongoing management treatment plan. The heart of the second phase of the intervention is addressing the underlying cause of the self-destructive behavior. If the patient has selected suicide to escape physical pain, then a comprehensive pain management program must be initiated. If the patient is depressed, then the depression must be treated with medication and psychotherapy. If the suicide attempt has been in response to the patient with schizophrenia struggling with destructive hallucinations and delusions, then these must be aggressively treated. The key remains an accurate assessment and diagnosis followed by a comprehensive treatment plan.

One would expect that intense intervention efforts following a suicide attempt would be effective in lowing morbidity and mortality. To test this theory, Morthorst et al assessed the efficacy of outpatient intervention in patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days. Intervention consisted of assertive outreach that provided crisis intervention and flexible problem solving. This approach, assertive intervention for deliberate self-harm, incorporated motivational support and actively assisted patients to scheduled appointments. The study followed 243 patients for 12 months. Rates of subsequent suicide attempts did not differ significantly between the intervention and control groups. Although this study did not show the advantage of an intensive follow-up care, it does point out the need for a clear, definite, and defined postsuicide attempt treatment plan. [136]

A study of brief CBT in a cohort of active-duty military personnel in Colorado who either attempted suicide or experienced suicidal ideation found the treatment effective in preventing follow-up suicide attempts. Over the course of two years, 8 out of 76 participants (13.8%) in treatment as usual combined with brief CBT and 18 participants out of 76 (40.2%) who did not receive CBT made at least one attempt at suicide. Data show that soldiers treated with brief CBT were approximately 60% less likely to attempt suicide than soldiers who did not receive the therapy. [137]


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