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Reducing Suicide: A National Imperative
with a problem-solving component (Joiner et al., 2001; Rudd et al., 1996) and the other used social problem-solving therapy (Lerner and Clum, 1990). Harrington et al. (1998) used a brief, home-based intervention targeting family-based problem solving. The positive effects of these interventions held even among high-risk, multiple-attempt patients and patients with comorbid mood and anxiety disorders (Joiner et al., 2001; Rudd et al., 1996). In addition, treatment adherence in such interventions appears to be greater for high-risk, multiple-attempt patients. However, these interventions do not appear to have a significant impact on the long-term rate of suicide attempts. Harrington and colleagues’ (1998) study also found that their short-term family-based therapy specifically reduced suicidal ideation for those youth without major depression, pointing to a need for more research on the differential effects of interventions on suicidal subtypes.
Similar positive outcomes have been reported among adults receiving short-term, problem-solving and/or CBT treatments. In general, CBT and problem-solving treatment led to increased treatment adherence, reduced levels of suicidal ideation and attempts, and reductions in related symptomatology (Evans et al., 1999; Hawton et al., 1981; Hawton et al., 1987; Liberman and Eckman, 1981; McLeavey et al., 1994; Patsiokas and Clum, 1985; Salkovskis et al., 1990; van der Sande et al., 1997b). Reductions in suicide attempt rates, however, did not remain significant in long-term evaluations. Such short-term treatment approaches may prove cost effective, as indicated by Evans et al.’s (1999) pilot study.
These brief therapies in adults, as with youths, were effective even among high-risk, repeat suicide attempters, but with limitations. Liberman and Eckman (1981) compared brief (10-day) behavioral therapy including a problem-solving component versus insight-oriented therapy. The behavioral therapy group showed greater reductions in depression and suicidal ideation, but no between-group differences emerged with respect to suicide attempts over a 9-month follow-up. Patsiokas and Clum (1985) found similar results for cognitive therapy, problem-solving therapy, and supportive therapy over the course of 10 individual sessions, as all three groups showed reductions in hopelessness and suicide intent. Notably, patients who received problem-solving therapy demonstrated significantly greater reductions in hopelessness than patients who received supportive therapy. Other between-groups differences may have emerged if a larger sample had been used. Salkovskis et al. (1990) compared the relative efficacy of five sessions of CBT with a problem-solving component versus a referral to a general practitioner. Despite using a small sample (n=20), they found significantly reduced rates of suicidal ideation, depression, and hopelessness over a 12-month follow-up for the CBT group. The CBT group also showed a greater reduction in the rates of