BMJ 2001;323:135 ( 21 July )

Papers

Randomised controlled trial of brief psychological intervention after deliberate self poisoning

Elspeth Guthrie, senior lecturer in liaison psychiatry, a Navneet Kapur, lecturer in psychiatry, a Kevin Mackway-Jones, consultant, b Carolyn Chew-Graham, senior lecturer, c James Moorey, psychologist, d Elizabeth Mendel, research assistant, a Federica Marino-Francis, research assistant, a Sarah Sanderson, research nurse, a Clive Turpin, research nurse, a Gary Boddy, research nurse, a Barbara Tomenson, statistician. a

a School of Psychiatry and Behavioural Sciences, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Manchester M13 9WL, b Emergency Department, Manchester Royal Infirmary, c Department of General Practice, University of Manchester, Manchester M14 5NP, d Department of Psychology, Manchester Royal Infirmary

Correspondence to: E Guthrie elspeth.a.guthrie{at}man.ac.uk

Objectives: To determine the effects of a brief psychological intervention (brief psychodynamic interpersonal therapy) for patients after deliberate self poisoning compared with usual treatment. To compare the impact of the active intervention and usual treatment on patients' satisfaction with care.
Design: Randomised controlled trial.
Participants: 119 adults who had deliberately poisoned themselves and presented to the emergency department of a teaching hospital.
Setting: Community based study.
Intervention: Four sessions of therapy delivered in the patient's home. Control patients received "treatment as usual," which in most cases consisted of referral back to their general practitioner.
Outcome measures: Severity of suicidal ideation six months after treatment as assessed by the Beck scale for suicidal ideation. Secondary outcome measures at six month follow up included depressive symptoms as measured by the Beck depression inventory, patient satisfaction with treatment, and self reported subsequent attempts at self harm.
Results: Participants randomised to the intervention had a significantly greater reduction in suicidal ideation at six month follow up compared with those in the control group (reduction in the mean (SD) Beck scale 8.0 v 1.5). They were more satisfied with their treatment and were less likely to report repeated attempts to harm themselves at follow up (proportion repeating 9% v 28% in control group; difference 19%, 95% confidence interval 9% to 30 %, P=0.009).
Conclusion: Brief psychodynamic interpersonal therapy may be a valuable treatment after people have deliberately tried to poison themselves.


What is already known on this topic
Deliberate self poisoning is one of the commonest reasons for admission to hospital in the United Kingdom and up to 15% of patients who poison themselves eventually kill themselves

There are no interventions of proved efficacy for these patients

Most episodes of self poisoning are precipitated by some form of interpersonal problem

What this study adds
Compared with usual treatment four sessions of psychodynamic interpersonal therapy reduced suicidal ideation and self reported attempts at self harm

The intervention also improved patients' satisfaction with care


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