Health Technology Assessment of the Psychotherapy Effect on Prevention of Suicide and Self-Harm: A Rapid Review of Secondary Studies

Authors

1 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Young Researchers and Elites Club, Science and Research Branch, Islamic Azad University, Tehran, Iran.

3 Health Management and Economics Sciences Re-search Center, Iran University of Medical Sciences, Tehran, Iran

4 Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran

5 Qazvin University of Medical Sciences, Qazvin, Iran

6 Armed Forces Medical Services Insurance Organization, Tehran, Iran

7 Department of Health Service Management, School of Management and Economics, Science and Re-search Branch, Islamic Azad University, Tehran, Iran

Abstract

Introduction: According to the World Health Organization (WHO) report, acute depression disorders are the second largest health problem in the world which can cause disability and imposes huge costs on individuals and societies. This study aims to investigate the effectiveness and cost-effectiveness of using psychotherapy in patients with depression for prevention of suicide and self harm commitment.

Methods: Cochrane library (Issue 10, 2012) and CRD (Centre for Review and Dissemination) were searched using Mesh. Studies that compared psychotherapy with different alternative methods such as antidepressant drugs and used outcomes such as self-harm or suicide rates were included.

Results: Eighteen articles were included in this review. Most of them showed that using psychotherapy as only suicide preventive method cannot be sufficiently effective, so that in the one of the included meta-analysis was shown that the effect of psychotherapy on suicide imagination and the risk of suicide were small. In terms of cost-effectiveness, it seems that MACT (Manual-assisted cognitive behavior therapy) is a cost-effective method in prevention of self-harm.

Conclusion: Generally, it seems that using combination of therapeutic methods will increase the effectiveness of suicide and self-harm prevention methods.

Keywords


Jakobsen JC, Hansen JL, Simonsen S, Simonsen E, Gluud C. Effects of cognitive therapy versus interpersonal psychotherapy in patients with major depressive disorder: a systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. Psychological medicine. 2012;42(7):1343-57. PubMed PMID: 22051174
Crawford MJ, Thomas O, Khan N, Kulinskaya E. Psychosocial interventions following self-harm: systematic review of their efficacy in preventing suicide. The British journal of psychiatry: the journal of mental science. 2007;190:11-7. PubMed PMID: 17197651
Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, et al. Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. Bmj. 1998;317(7156):441-7. PubMed PMID: 9703526
Byford S, Knapp M, Greenshields J, Ukoumunne OC, Jones V, Thompson S, et al. Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach. Psychological medicine. 2003;33(6):977-86. PubMed PMID: 12946082
Burns J, Dudley M, Hazell P, Patton G. Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition. The Australian and New Zealand journal of psychiatry. 2005;39(3):121-8. PubMed PMID: 15701059
Cuijpers P, de Beurs DP, van Spijker BA, Berking M, Andersson G, Kerkhof AJ. The effects of psychotherapy for adult depression on suicidality and hopelessness: a systematic review and meta-analysis. Journal of affective disorders. 2013;144(3):183-90.PubMed PMID: 22832172
Ougrin D, Latif S. Specific psychological treatment versus treatment as usual in adolescents with self-harm: systematic review and meta-analysis. Crisis. 2011;32(2):74-80.PubMed PMID: 21616756
Linehan MM. Behavioral treatments of suicidal behaviors. Definitional obfuscation and treatment outcomes. Annals of the New York Academy of Sciences. 1997;836:302-28. PubMed PMID: 9616806
Arensman E, Townsend E, Hawton K, Bremner S, Feldman E, Goldney R, et al. Psychosocial and pharmacological treatment of patients following deliberate self-harm: the methodological issues involved in evaluating effectiveness. Suicide & life-threatening behavior. 2001;31(2):169-80. PubMed PMID: 11459249
Tyrer P, Tom B, Byford S, Schmidt U, Jones V, Davidson K, et al. Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study. Journal of personality disorders. 2004;18(1):102-16. PubMed PMID: 15061347
Vos T, Corry J, Haby MM, Carter R, Andrews G. Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression. The Australian and New Zealand journal of psychiatry. 2005;39(8):683-92. PubMed PMID: 16050922
Palmer S, Davidson K, Tyrer P, Gumley A, Tata P, Norrie J, et al. The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial. Journal of personality disorders. 2006;20(5):466-81.PubMed PMID: 17032159
Sobocki P, Ekman M, Agren H, Jonsson B, Rehnberg C. Model to assess the cost-effectiveness of new treatments for depression. International journal of technology assessment in health care. 2006;22(4):469-77.  PubMed PMID: 16984680
National Collaborating Centre for Mental H. National Institute for Health and Clinical Excellence: Guidance.  Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. Leicester (UK): British Psychological SocietyThe British Psychological Society & The Royal College of Psychiatrists.; 2004. PubMed PMID: 21834185
Donker T, Griffiths KM, Cuijpers P, Christensen H. Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. BMC medicine. 2009;7:79.7. PubMed PMID: 20015347               
National Collaborating Centre for Mental Health. National Institute for Health and Clinical Excellence: Guidance.  Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care. Leicester (UK): British Psychological Society; 2005. PubMed PMID: 21834190
Townsend E, Hawton K, Altman DG, Arensman E, Gunnell D, Hazell P, et al. The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological medicine. 2001;31(6):979-88. PubMed PMID: 11513383
Guo B, Scott A, Bowker S. Suicide prevention strategies: evidence from systematic reviews. Edmonton: Alberta Heritage Foundation for Medical Research (AHFMR). HTA 28. 2003.