# Suicidal ideation in patients



## cookies4marilyn (Jun 30, 2000)

I found this interesting, because there was also a recent study regarding suicidal ideation with IBS patients - so I thought I would include this here, as I know many many IBS patients have contimplated this - though the article does not suggest IBS patients as part of their study, the term hopelessness is one used in both this study and the one about the IBS patients.-------------------------------------------Cognitive Therapy May Prevent Suicide Attemptshttp://www.medscape.com/viewarticle/509866?src=nldneNews Author: Laurie Barclay, MDCME Author: Charles Vega, MD, FAAFPDisclosuresTo earn CME credit, read the news brief along with the CME information that follows and answer the test questions.Release Date: August 2, 2005; Valid for credit through August 2, 2006 Credits Available Physicians - up to 0.25 AMA PRA Category 1 continuing physician education credits Aug. 2, 2005 â€" Cognitive therapy can prevent recurrent suicide attempts, according to the results of a randomized trial reported in the Aug. 3 issue of The Journal of the American Medical Association."Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated," write Gregory K. Brown, PhD, from the University of Pennsylvania in Philadelphia, and colleagues. "Randomized controlled trials of individuals who have attempted suicide have used intensive follow-up treatment or intensive case management, interpersonal psychotherapy, or cognitive behavior therapy. Several studies supporting the efficacy of cognitive behavior therapy or problem-solving therapy for reducing suicide behavior have highlighted the need for randomized controlled trials with sufficient power to detect treatment differences."Between October 1999 and September 2002, adults who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt were consecutively recruited. Of 350 potential participants, 120 were randomized to receive either cognitive therapy or enhanced usual care with tracking and referral services, 66 refused to participate, and 164 were ineligible. Duration of follow-up was 18 months. Endpoints were incidence of repeat suicide attempts, number of days until a repeat suicide attempt, dichotomized suicide ideation, hopelessness, and depression severity at one, three, six, 12, and 18 months.From baseline to 18 months, 13 patients (24.1%) in the cognitive therapy group and 23 (41.6%) in the usual-care group made at least one subsequent suicide attempt (asymptotic z score, 1.97; P = .049). Estimated probability of freedom from reattempts at 18 months was 0.76 (95% confidence interval [CI], 0.62 - 0.85) in the cognitive therapy group and 0.58 (95% CI, 0.44 - 0.70) in the usual-care group.Compared with the usual-care group, the cognitive therapy group had a lower reattempt rate (P = .049), had a 50% lower chance of suicide reattempt (hazard ratio, 0.51; 95% CI, 0.26 - 0.997), and had lower severity of self-reported depression at six months (P = .02), 12 months (P = .009), and 18 months (P = .046). Although the cognitive therapy group reported less hopelessness than the usual-care group at six months (P = .045), rates of suicide ideation did not differ significantly between groups at any assessment point."Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide," the authors write.Study limitations include generalizability limited to suicide attempters in an urban setting who are evaluated at an emergency department, a greater proportion of blacks in the sample who consented to the study, and the possibility that small changes in the number of suicide attempts during follow-up may affect the significance of the results."An important goal of the National Strategy for Suicide Prevention is to improve community linkages with primary care and mental health/substance abuse health systems for translating evidence-based treatments into community-based settings," the authors write. "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. Additional studies are warranted to examine the feasibility, effectiveness, and cost effectiveness of this intervention in community-based mental health and substance use treatment settings."The National Institute of Mental Health and Centers for Disease Control and Prevention supported this study. The authors report no financial disclosures.In an accompanying editorial, Thomas B. Cole, MD, MPH, and Richard M. Glass, MD, from The Journal of the American Medical Association, review the epidemiology and risk factors for suicide and homicide."A severely anxious, depressed, impulsive, or hopeless person whose violent actions are interrupted before he or she harms himself or herself or someone else would be considered a good outcome from the perspective of violence prevention," Drs. Cole and Glass write. "But without effective psychiatric treatment, such a person will still be in distress and is likely to remain at risk for violence. From this public health perspective, society should devote adequate resources to developing and evaluating psychiatric treatments and lowering barriers to their delivery."JAMA. 2005;294:563-570, 623-624Learning Objectives for This Educational ActivityUpon completion of this activity, participants will be able to: Describe the epidemiology of suicide in the United States. Specify the benefits of cognitive therapy in patients who have attempted suicide. Clinical ContextSuicide occurs with an annual average frequency of approximately 11 cases per 100,000 persons in the United States, and it is one of the leading causes of death in young and middle-aged adults. According to an editorial by Cole and Glass, which accompanies the current article, more than 3% of Americans have seriously considered suicide in the past year, and nearly one third of these individuals have created a plan for suicide. Four of five persons with suicidal ideation meet standard criteria for mental illness.Although suicide is a relatively common and very tragic phenomenon, the use of psychotherapy in its prevention has not received extensive scientific analysis. The authors of the current study compare cognitive therapy and usual care in a cohort of patients recovering from a suicide attempt.Study HighlightsPatients were eligible for study participation if they had attempted suicide within 48 hours of being evaluated in 1 urban emergency department. All patients were at least 16 years of age. Study participants were randomized to receive either 10 cognitive psychotherapy sessions aimed at preventing future suicide attempts, or usual care. The cognitive sessions were held weekly or biweekly and focused on hopelessness, problem solving, impulse control, treatment noncompliance, and social isolation. Both the cognitive therapy and usual-care groups were monitored by case managers. Study outcomes were assessed during an 18-month follow-up period and included repeat suicide attempt, along with measures of depression, suicidal ideation, and hopelessness. Study assessment followed an intent-to-treat model. 186 patients were eligible for study participation, and 120 underwent randomization to either the cognitive therapy group or the usual-care group. Blacks were more likely to participate in the study than whites. 61% of the cohort was female, and 60% were African Americans. Rates of major depressive disorder and substance abuse disorder for the entire cohort were 77% and 68% at baseline, respectively. Most study subjects had tried to commit suicide through overdose. Baseline demographic data were similar between the cognitive therapy and usual-care groups. Rates of study completion at 18 months were 75% in the cognitive therapy group and 66% in the usual-care group. Participants in the cognitive therapy group attended a mean of 8.92 sessions. Slightly more than one half of participants in each treatment group received psychotropic medication. Rates of repeat suicide attempts were 24.1% and 41.6% in the cognitive therapy group and usual-care group, respectively. The adjusted hazard ratio of repeat suicide attempts was 0.51, significantly favoring cognitive therapy. The benefit of cognitive therapy persisted after controlling for baseline levels of depression and hopelessness. Cumulative measures of the severity of depression were improved with cognitive therapy vs usual care. Cognitive therapy was also superior in the cumulative measure of hopelessness. However, rates of suicidal ideation decreased in the entire cohort with time and were not significantly different between groups. Pearls for PracticeMore than 3% of Americans contemplate suicide each year, and nearly one third of these individuals have formulated a suicide plan. The majority of them have a mental illness. In patients with a history of suicide attempts, cognitive therapy can decrease the risk of repeat suicide attempt as well as measures of depression and hopelessness.=========================================Here is the study with reference to Suicidal Ideation with IBS - Dr. Whorwell is known for his studies using clinical hypnotherapy to treat IBS patients.======================================Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004 Dec;2(12):1064-8.BACKGROUND & AIMS: Irritable bowel syndrome (IBS) traditionally is considered as more of a nuisance than having especially serious consequences. However, this is not the picture witnessed in tertiary care where we have encountered some tragic cases, prompting an assessment of suicidal ideation in such patients. METHODS: One hundred follow-up, tertiary care IBS (tIBS) patients were compared with 100 secondary IBS (sIBS), 100 primary IBS (pIBS) care patients, and 100 patients with active inflammatory bowel disease (IBD). Patients were asked if they had either seriously contemplated or attempted suicide specifically because of their bowel problem as opposed to other issues. The hospital anxiety depression score was recorded, as were other clinical details on all patients. RESULTS: A total of 38% of tIBS patients had contemplated suicide because of their symptoms compared with 16% and 4% in the sIBS and pIBS groups (tIBS vs. sIBS vs. pIBS, P = .002, P < .001). The figure for IBD was 15% (tIBS v. IBD, P < .001). Five tIBS and 1 IBD patient had attempted suicide for gastrointestinal reasons. Mean depression scores did not exceed threshold (10) in the sIBS group contemplating suicide (9.7), but were increased in the equivalent tIBS group (11.7). Hopelessness because of symptom severity, interference with life, and inadequacy of treatment were highlighted as crucial issues for all IBS patients. CONCLUSIONS: IBS has the potential for a fatal outcome from suicide with depression not accounting for all the variance in suicidal ideation. Our observations emphasize the level of hopelessness felt by these patients and the need for improvement in the services provided to them.=============================================


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## 22144 (Aug 6, 2005)

I've been there.


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