Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus.
Department of Psychology, Louisiana State University, Baton Rouge.
JAMA Netw Open. 2024 Nov 4;7(11):e2445913. doi: 10.1001/jamanetworkopen.2024.45913.
Suicide rates continue to increase in the US. Evidence-based treatments for suicide risk exist, but their effectiveness when delivered via telehealth remains unknown.
To test the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts and suicidal ideation among high-risk adults when delivered via telehealth.
DESIGN, SETTING, AND PARTICIPANTS: This 2-group parallel randomized clinical trial comparing BCBT with present-centered therapy (PCT) was conducted from April 2021 to September 2023 with 1-year follow-up at an outpatient psychiatry and behavioral health clinic located in the midwestern US. Participants reporting suicidal ideation during the past week and/or suicidal behavior during the past month were recruited from clinic waiting lists, inpatient service, intermediate care, research match, and direct referrals from clinicians. A total of 768 participants were invited to participate, 112 were assessed for eligibility, and 98 were eligible and randomly assigned to a treatment condition. Data analysis was from April to September 2024.
Participants received either BCBT, an evidence-based suicide-focused treatment that teaches emotion regulation and reappraisal skills, or PCT, a goal-oriented treatment that helps participants identify adaptive responses to stressors. Participants were randomized using a computerized stratified randomization algorithm with 2 strata (sex and history of suicide attempts).
The primary outcome was suicide attempts as measured by the Self-Injurious Thoughts and Behaviors Interview-Revised. The secondary outcome was severity of suicidal ideation as measured by the Scale for Suicide Ideation.
Participants included 96 adults (mean [SD] age, 31.8 [12.6] years; 64 female [66.7%] and 32 male [33.3%]), with 51 receiving BCBT and 45 receiving PCT. Of all participants, 85 (88.5%) completed at least 1 session. From baseline to 12 months, 12 participants receiving PCT (estimated percentage, 35.6%) made 56 suicide attempts and 11 participants receiving BCBT (estimated percentage, 30.0%) made 36 suicide attempts. Participants randomized to BCBT made significantly fewer suicide attempts than participants randomized to PCT (mean [range], 0.70 [0.00-8.00] attempts per participant vs 1.40 [0.00-10.00] per participant) and had a 41% reduced risk for suicide attempts (hazard ratio, 0.59; 95% CI, 0.36-0.96; P = .03). Severity of suicidal ideation significantly decreased in both treatments (F4,330 = 50.1; P < .001) but did not differ between groups (F4,330 = 0.2; P = .91).
The findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts among adults with recent suicidal thoughts and/or behaviors.
ClinicalTrials.gov Identifier: NCT04844294.
美国的自杀率持续上升。存在针对自杀风险的循证治疗方法，但它们通过远程医疗提供的有效性尚不清楚。
测试通过远程医疗为高风险成年人提供简短认知行为疗法 (BCBT) 以减少自杀企图和自杀意念的效果。
设计、地点和参与者：这项比较 BCBT 与以当下为中心疗法 (PCT) 的 2 组平行随机临床试验于 2021 年 4 月至 2023 年 9 月在位于美国中西部的门诊精神病学和行为健康诊所进行，为期 1 年的随访。参与者是从诊所等候名单、住院服务、中级护理、研究匹配和临床医生的直接转诊中招募的，他们在过去一周报告有自杀意念和/或过去一个月有自杀行为。共邀请了 768 名参与者参加，有 112 名参与者接受了资格评估，有 98 名符合条件并随机分配到治疗组。数据分析于 2024 年 4 月至 9 月进行。
参与者接受了 BCBT 或 PCT 治疗。BCBT 是一种基于证据的专注于自杀的治疗方法，可教授情绪调节和重新评估技能；PCT 是一种以目标为导向的治疗方法，帮助参与者识别应对压力源的适应性反应。参与者使用计算机分层随机化算法进行随机分组，分为 2 个分层（性别和自杀企图史）。
主要结局是通过修订后的自我伤害思维和行为访谈评估的自杀企图。次要结局是通过自杀意念量表评估的自杀意念严重程度。
参与者包括 96 名成年人（平均[SD]年龄，31.8[12.6]岁；64 名女性[66.7%]和 32 名男性[33.3%]），51 名接受 BCBT，45 名接受 PCT。所有参与者中，有 85 名（88.5%）至少完成了 1 次治疗。从基线到 12 个月，45 名接受 PCT 的参与者（估计百分比，35.6%）有 56 次自杀企图，51 名接受 BCBT 的参与者（估计百分比，30.0%）有 36 次自杀企图。接受 BCBT 的参与者的自杀企图明显少于接受 PCT 的参与者（平均[范围]，0.70[0.00-8.00]次/参与者与 1.40[0.00-10.00]次/参与者），自杀企图风险降低 41%（风险比，0.59；95%CI，0.36-0.96；P=0.03）。两种治疗方法的自杀意念严重程度均显著下降（F4,330=50.1；P<0.001），但组间无差异（F4,330=0.2；P=0.91）。
这项随机临床试验的结果表明，通过视频远程医疗提供的 BCBT 可有效减少有近期自杀意念和/或行为的成年人的自杀企图。
ClinicalTrials.gov 标识符：NCT04844294。
