Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
Evid Based Ment Health. 2017 Aug;20(3):76-82. doi: 10.1136/eb-2017-102719. Epub 2017 Jul 12.
Suicide-related behaviours are common in young people and associated with a range of negative outcomes. There are few evidence-based interventions; however, cognitive behavioural therapy (CBT) shows promise. Internet delivery of CBT is popular, with potential to increase reach and accessibility.
To test the effectiveness of an internet-based CBT program (Reframe-IT) in reducing suicide-related behaviours, depression, anxiety, hopelessness and improving problem solving and cognitive and behavioural skills in school students with suicide-related behaviours.
A parallel randomised controlled trial testing the effectiveness of Reframe-IT plus treatment as usual (TAU) compared with TAU alone in reducing suicidal ideation, suicide attempts, depression, hopelessness, symptoms of anxiety, negative problem orientation and cognitive and behavioural skill acquisition was undertaken. We recruited students experiencing suicidal ideation from 18 schools in Melbourne, Australia, between August 2013 and December 2016. The intervention comprised eight modules of CBT delivered online over 10 weeks with assessments conducted at baseline, 10 weeks and 22 weeks.
Only 50 of the planned 169 participants were recruited. There were larger improvements in the Reframe-IT group compared with the TAU group for the primary outcome of suicidal ideation (intervention -61.6, SD 41.6; control -47.1, SD 42.3, from baseline to 22-week follow-up intervention); however, differences were non-significant (p=0.593). There were no increases in distress in the majority of participants (91.1%) after completion of each module. Changes in depression and hopelessness partly mediated the effect of acquisition of CBT skills on suicidal ideation.
The trial was underpowered due to difficulties recruiting participants as a result of the complex recruitment procedures that were used to ensure safety of participants. Although there were no significant differences between groups, young people were safely and generally well engaged in Reframe-IT and experienced decreases in suicidal ideation and other symptoms as well as improvements in CBT skills. The study is the first online intervention trial internationally to include young people demonstrating all levels of suicide risk.
Integration of internet-delivered interventions for young people with suicide-related behaviour may result in reductions in these behaviours. Further research is needed, but researchers should feel more confident about being able to safely undertake research with young people who experience these behaviours.
ACTRN12613000864729.
自杀相关行为在年轻人中很常见，并且与一系列负面后果相关。目前干预措施有限，但认知行为疗法（CBT）显示出一定的前景。CBT 的互联网交付方式很受欢迎，具有增加覆盖面和可及性的潜力。
测试基于互联网的 CBT 计划（Reframe-IT）在减少有自杀相关行为的学生中的自杀相关行为、抑郁、焦虑、绝望以及改善解决问题和认知行为技能方面的有效性。
我们进行了一项平行随机对照试验，测试 Reframe-IT 加常规治疗（TAU）与单独 TAU 相比在减少自杀意念、自杀企图、抑郁、绝望、焦虑症状、消极问题取向和认知行为技能获得方面的有效性。我们从 2013 年 8 月至 2016 年 12 月在澳大利亚墨尔本的 18 所学校招募有自杀意念的学生。干预措施包括 10 周内在线提供 8 个 CBT 模块，在基线、10 周和 22 周进行评估。
仅招募了计划的 169 名参与者中的 50 名。Reframe-IT 组的自杀意念主要结局较 TAU 组改善更大（干预组-61.6，SD 41.6；对照组-47.1，SD 42.3，从基线到 22 周随访）；然而，差异无统计学意义（p=0.593）。在大多数参与者（91.1%）完成每个模块后，没有出现更多的痛苦。抑郁和绝望的变化部分中介了认知行为技能获得对自杀意念的影响。
由于使用了复杂的招募程序以确保参与者的安全，导致参与者招募困难，试验因此力度不足。尽管组间无显著差异，但年轻人安全且普遍很好地参与了 Reframe-IT，自杀意念和其他症状减少，认知行为技能提高。该研究是国际上第一个包括所有自杀风险水平的年轻人的在线干预试验。
将互联网干预措施整合到有自杀相关行为的年轻人中，可能会减少这些行为。需要进一步研究，但研究人员应该更有信心能够安全地对有这些行为的年轻人进行研究。
ACTRN12613000864729。
