Data from: A novel brief therapy for patients who attempt suicide: a 24-months follow-up randomized controlled study of the Attempted Suicide Short Intervention Program (ASSIP)
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Background: Attempted suicide is the main risk factor for repeated suicidal behavior. However, the evidence for follow-up treatments of these patients is limited. The objective of the present study was to evaluate the efficacy of ASSIP (Attempted Suicide Short Intervention Program) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance. Methods and Findings: Patients who had recently attempted suicide were randomly allocated to treatment as usual (N=60) or treatment as usual plus ASSIP (N=60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-months follow-up period. The study represents a real-world clinical setting at an outpatient clinic of an university hospital of psychiatry. Primary outcome measure was repeat suicide attempts during the 24-months follow-up period. Secondary outcome measures were suicidal ideation and healthcare utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated. During the 24-months follow-up period, 5 repeat attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n=5) and 26.7% (n=16). ASSIP was associated with an approximately 80% reduced risk of repeat episodes (Wald ?21=13.1; 95% CI 12.4-13.7; p=.0004). ASSIP participants spent 72% fewer days in hospital during follow-up (ASSIP: 29 days; control group: 105 days; W=94.5, p=.038). Higher scores of patient-rated therapeutic alliance in this group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n=20) had more previous suicide attempts and a higher number of reattempts. Key study limitations were missing data and dropout rates. Although both were generally low they increased during follow-up. At 24 months the group difference between the dropout rates was significant: ASSIP: 7% (n=4), control: 22% (n=13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from the 6-monthly self-reports on the setting and the duration of treatment as usual. Conclusions: ASSIP, a manual-based brief therapy for patients who had recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy to administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings. ClinicalTrials.gov Identifier: NCT02505373
背景：自杀未遂是重复自杀行为的主要危险因素。然而，目前针对此类患者的随访治疗相关证据仍较为匮乏。本研究旨在评估ASSIP（自杀未遂简短干预方案，Attempted Suicide Short Intervention Program）在减少自杀行为方面的有效性。ASSIP是一种基于自杀行为患者中心模型的新型短程心理治疗，其核心强调早期治疗联盟（therapeutic alliance）的建立。 方法与结果：近期有自杀未遂史的患者被随机分配至常规治疗（treatment as usual）组（N=60），以及常规治疗联合ASSIP组（N=60）。ASSIP组患者需接受3次治疗访谈，并在24个月随访期间通过个性化信函定期保持联系。本研究纳入了被评估为自杀高风险的参与者，其中63%被诊断为情感障碍，50%有既往自杀未遂史。本研究的临床排除标准包括习惯性自伤、严重认知障碍及精神障碍。研究参与者在24个月的随访期内每6个月完成一套社会心理与临床问卷。本研究在某大学附属精神科门诊的真实临床场景中开展。主要结局指标为24个月随访期内的重复自杀未遂发生情况；次要结局指标包括自杀意念（suicidal ideation）与医疗资源利用情况。此外，本研究还探讨了既往自杀未遂史、基线抑郁状态、诊断结果及治疗联盟对结局的影响。 在24个月随访期内，ASSIP组记录到5例重复自杀未遂，对照组则为41例。两组至少发生1次重复自杀行为的参与者占比分别为8.3%（n=5）与26.7%（n=16）。ASSIP组的重复自杀发作风险降低约80%（Wald χ²₁=13.1；95%置信区间CI：12.4~13.7；p=0.0004）。随访期间，ASSIP组患者的住院天数较对照组减少72%（ASSIP组：29天；对照组：105天；W=94.5，p=0.038）。该组中患者自评的治疗联盟得分越高，其重复自杀未遂的发生率越低。既往自杀未遂史、基线抑郁状态及基线人格障碍诊断并未对结局产生显著影响。其中，边缘型人格障碍（borderline personality disorder）患者（n=20）既往自杀未遂次数更多，重复自杀未遂的数量也更高。 本研究的主要局限性为缺失数据与脱落率问题：尽管两者整体水平较低，但在随访期间均有所升高。至24个月随访时，两组脱落率的组间差异具有统计学意义：ASSIP组为7%（n=4），对照组为22%（n=13）。另一项局限性在于，除了每6个月一次的常规治疗场景与时长的自我报告外，我们未能获取关于联合随访治疗的详细信息。 结论：ASSIP是一种基于操作手册的短程心理治疗，针对近期有自杀未遂史的患者，在常规临床治疗基础上联合应用ASSIP，可在真实临床场景中有效减少自杀行为。ASSIP满足了对易于实施、低成本干预手段的需求。未来仍需开展大规模实用性试验，以明确ASSIP的有效性，并在其他临床场景中重复本研究结果。临床试验注册号（ClinicalTrials.gov Identifier）：NCT02505373
