The treatment of suicidality in adolescents by psychosocial interventions for depression: A systematic literature review

Abstract

BackgroundThe World Health Organization's (WHO, 2014) first world suicide report identifies suicide as the second leading cause of death in 15-to 29-year-olds. Suicide behaviour consists of death by suicide (self-inflicted and intentional killing of oneself), suicide attempts (self-injurious behaviour with the intent to cause death) and suicidal ideation (persistent, serious thoughts of suicide). Such behaviour can be conceptualized as a continuum, and here, we refer to all these AbstractObjective: Given depression is a significant risk factor for suicidal behaviour, it is possible that interventions for depression may also reduce the risk of suicide in adolescents. The purpose of this literature review is to determine whether psychological interventions aimed to prevent and/or treat depression in adolescents can also reduce suicidality. Methods:We conducted a systematic review of psychological interventions aimed to prevent and/or treat depression in adolescents in which outcomes for suicidality were reported, using five databases: PsycINFO, Embase, Medline, CINAHL and Scopus. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias.Results: A total of 35 articles pertaining to 12 treatment trials, two selective prevention trials and two universal prevention trials met inclusion criteria. No studies were identified that used a no-treatment control. In both intervention and active control groups, suicidality decreased over time; however, most structured psychological depression treatment interventions did not outperform pharmaceutical or treatment as usual control groups. Depression prevention studies demonstrated small but statistically significant reductions in suicidality. Limitations:Analysis of study quality suggested that at least 10 of the 16 studies have a high risk of bias. Conclusive comparisons across studies are problematic due to differences in measures, interventions, population differences and control groups used. Conclusions:It is unclear whether psychological treatments are more effective than no treatment since no study has used a no-treatment control group. There is evidence to suggest that Cognitive Behavioural Therapy interventions produce pre-post reductions in suicidality with moderate effect sizes and are at least as efficacious as pharmacotherapy in reducing suicidality; however, it is unclear whether these effects are sustained. There are several trials showing promising evidence for family-based and interpersonal therapies, with large pre-post effect sizes, and further evaluation with improved methodology is required. Depression prevention interventions show promising short-term effects.

Sexual minority youth and depressive symptoms or depressive disorder: A systematic review and meta-analysis of population-based studies

“…Work in this area has begun, for instance where an existing intervention has been assessed with young people more generally, such as attachment-based family therapy (Devenish, Berk, & Lewis, 2016), which has been modified specifically with suicidal sexual minority youth in mind (Diamond et al, 2013). This approach has also been employed in the treatment of depressive symptoms using a form of computerised cognitive behavioural therapy, called SPARX (Merry et al, 2012), which has been adapted and evaluated amongst sexual minority youth with depressive symptoms Lucassen, Merry, Hatcher, & Frampton, 2015).…”

“…Much is still unknown about the optimal treatment of depressive symptoms in adolescents (Malhi et al, 2015), hence it is time to consider in what ways young people overall can be treated, alongside gaining an understanding of how sexual minority young people can receive more targeted support and assistance, to ensure that their mental health is enhanced. Work in this area has begun, for instance where an existing intervention has been assessed with young people more generally, such as attachment-based family therapy (Devenish et al, 2016), which has been modified specifically with suicidal sexual minority youth in mind (Diamond et al, 2013). This approach has also been employed in the treatment of depressive symptoms using a form of computerized cognitive behavioural therapy, called SPARX (Merry et al, 2012), which has been adapted and evaluated among sexual minority youth with depressive symptoms (Lucassen et al, 2015b(Lucassen et al, , 2015c.…”

Posttraumatic Stress Disorder and Suicidal Ideation Among Sexually Abused Adolescent Girls: The Mediating Role of Shame

“…Depressive mood is a well-known risk factor for suicidal ideation and behaviors, along with PTSD (Beautrais, 2000;Devenish, Berk, & Lewis, 2016;Krysinska & Lester, 2010;Miller & Eckert, 2009). Recent studies also show that among sexually abused adolescents, not only do depressive and PTSD symptoms predict suicidal ideation (Brabant, Hébert, & Chagnon, 2014), but depressed mood also mediates the relationship between sexual abuse and suicidal ideation (Sigfusdottir, Asgeirsdottir, Gudjonsson, & Sigurdsson, 2013).…”

The Mediating Roles of Hostility and Dissociation in the Relationship Between Sexual Assault and Suicidal Thinking in College Students

“…Dysregulated negative mood, such as depression, has been clearly linked to suicidal thinking in the literature (Devenish, Berk, & Lewis, 2016; Dour et al, 2011). However, clarifying other negative mood states, such as anger, related to sexual assault and suicidal thinking may add a more nuanced understanding of sexual assault–related reactions.…”