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Suicide prevention in first episode psychosis: the development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis

Authors

  • P.J.R. Power,

    Corresponding authorSearch for more papers by this author
  • R.J. Bell,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • R. Mills,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • T. Herrman-Doig,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • M. Davern,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • L. Henry,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • H.P. Yuen,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • A. Khademy-Deljo,

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author
  • P.D. McGorry

    1. Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)
      Department of Psychiatry, Lambeth Early Onset service, South London & Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, U.K. Email: Paddy.Power@slam.nhs.uk

      R.J. Bell, Clinical Co-ordinator
      Metal Health Services for Kids and Youth, Melbourne, ­Australia

      R. Mills, former Clinical Psychologist; T. Herrmann-Doig, Clinical ­­Psychologist, M. Davern, former Research Assistant; L. Henry, Clinical ­Psychologist, A. Khademy-Deljo, former Research Assistant
      Mental Health Services for Kids and Youth, Melbourne, Australia

      H.P. Yuen, Statistician
      Department of Psychiatry, University of Melbourne and MHSKY, ­Melbourne, Australia

      P.D. McGorry, Professor of Psychiatry and Director
      Department of Psychiatry, University of Melbourne and Director, ­ORYGEN Research Centre, Melbourne, Australia
    Search for more papers by this author

Patrick J.R. Power, Honorary Senior Lecturer, (Correspondence)

Abstract

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.

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