Suicide prevention in first episode psychosis: the development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis
Article first published online: 23 JUL 2003
Australian and New Zealand Journal of Psychiatry
Volume 37, Issue 4, pages 414–420, August 2003
How to Cite
Power, P.J.R., Bell, R.J., Mills, R., Herrman-Doig, T., Davern, M., Henry, L., Yuen, H.P., Khademy-Deljo, A. and McGorry, P.D. (2003), Suicide prevention in first episode psychosis: the development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis. Australian and New Zealand Journal of Psychiatry, 37: 414–420. doi: 10.1046/j.1440-1614.2003.01209.x
- Issue published online: 23 JUL 2003
- Article first published online: 23 JUL 2003
- Received 29 August 2002; revision 2 May 2003; accepted 9 May 2003.
- cognitive therapy;
- early intervention;
- first episode psychosis;
- suicide prevention;
Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper.
Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial.
Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation.
Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.