For people who have attempted suicide, a 10-session course of cognitive therapy aimed at coping with factors that trigger suicidal ideas, reduces the rate of subsequent suicide attempts by 50 percent. The intervention also reduces levels of depression and hopelessness, investigators report in this week’s Journal of the American Medical Association.

Suicide is the fourth leading cause of death for adults, and attempted suicide often leads eventually to completed suicide, lead author Dr. Gregory K. Brown and his colleagues note. However, “empirical evidence for treatments that effectively prevent repetition of suicide attempts is limited,” they point out.

The researchers recruited 120 patients, ages 18 to 66, treated at the Hospital of the University of Pennsylvania, Philadelphia, who had attempted suicide. All subjects were encouraged to seek additional mental health and substance abuse treatment in the community. Sixty patients were randomly assigned to usual care and 60 to cognitive therapy.

“The central feature of this psychotherapy was the identification of proximal thoughts, images, and core beliefs that were activated prior to the suicide attempt,” Brown’s team explains. “Cognitive and behavioral strategies were applied to address the identified thoughts and beliefs and participants were helped to develop adaptive ways of coping with stressors.”

Those receiving cognitive therapy had a significantly lower rate of new suicide attempts during the following 18 months -13 (24 percent) versus 23 (42 percent) in the usual-care group.

Standardized screening also showed significant reductions in depression and hopelessness at 6, 12, and 18 months following cognitive therapy.

“The short-term feature of cognitive therapy would make it particularly applicable for the treatment of suicide attempters at community mental health centers, which typically provide relatively short-term therapy,” Brown and his associates suggest.

SOURCE: Journal of the American Medical Association, August 3, 2005.

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