Pilot trial of post-admission cognitive therapy: Inpatient program for suicide prevention.

Abstract

Suicide remains a significant public health problem for the United States military. Trauma-related diagnoses such as acute stress disorder (ASD) or posttraumatic stress disorder (PTSD) may exacerbate suicide risk, particularly among service members psychiatrically hospitalized following suicide-related events. To date, treatments to address suicide risk and trauma symptomatology among service members within inpatient milieus have been nonexistent. To address this gap, a randomized controlled pilot trial of Post-Admission Cognitive Therapy (PACT) was conducted to evaluate a targeted cognitive-behavioral program among traumatized military personnel (N = 36) hospitalized following a recent suicide attempt. All participants met criteria for ASD or PTSD and were randomly assigned to receive either PACT and enhanced usual care (PACT + EUC) or EUC alone. PACT consisted of six 60- to 90-min individual psychotherapy sessions, adapted from Brown et al.'s (2005) cognitive therapy protocol for suicide prevention. Blinded follow-up assessments were conducted at 1-, 2-, and 3-months postpsychiatric discharge. The primary outcome was days until repeat suicide attempt. Secondary outcomes included depression, hopelessness, suicide ideation, and PTSD symptoms. Participants did not significantly differ in reattempt status. However, based on reliable change index analyses, a greater proportion of PACT + EUC versus EUC participants met criteria for clinically significant change on measures of depression (100% vs. 78%), hopelessness (83% vs. 57%), and PTSD symptom severity (100% vs. 38%), but not for suicide ideation (60% vs. 67%). PACT is an innovative inpatient protocol, currently under evaluation in a well-powered multisite RCT for its efficacy in reducing subsequent suicidal behaviors. (PsycINFO Database Record

Interventions to reduce self-harm on in-patient wards: systematic review

“…Interventions were conducted on both adult wards 49 , 50 , 54 , 56 , 58 – 70 and adolescent in-patient wards. 43 , 51 – 53 , 55 , 57 Many wards did not have any gender restrictions ( n = 10), 49 , 50 , 53 – 56 , 58 , 60 , 69 , 70 but a few studies conducted interventions on female-only ( n = 3) 62 , 65 , 66 or male-only psychiatric ward ( n = 1), 63 or did not report the gender of the ward ( n = 7).…”

“… 52 , 57 , 59 , 61 , 64 , 67 , 68 In total, 62 in-patient psychiatric wards were included in the present review. Many of these were acute psychiatric wards ( n = 41), 49 , 54 , 56 , 58 – 63 , 65 – 70 followed by forensic ( n = 6), 64 child and adolescent wards ( n = 7), 43 , 51 – 53 , 55 , 57 PICU ( n = 4) 60 and triage/assessment units ( n = 3). 60 One study did not report the number or type of wards.…”

Suicide Prevention Strategies for General Hospital and Psychiatric Inpatients: A Narrative Review

“…We identified two trials that evaluated PACT for the prevention of suicidal behavior in the postadmission acute phase. [4849] Both the trials reported significant reductions in depression, hopelessness, and posttraumatic stress disorder scores. But, only one of them reported a significant reduction in suicidal ideas.…”

Group Post-Admission Cognitive Therapy for Suicidality vs Individual Supportive Therapy for the prevention of repeat suicide attempts: a randomized controlled trial

“…The protocol was adapted from individual face-to-face therapy as described by Ghahramanlou-Holloway et al [11,12] for preventing repeat suicide attempts and known as Post-Admission Cognitive Therapy (PACT). In reference to this work, we named our program GPACTS.…”