Suicide attempts constitute a major risk factor for completed suicide. The current study aims to determine the efficacy and effectiveness of a short-tem cognitive therapy intervention for suicide attempters, implemented as soon as possible after a suicide attempt. The target group of suicide attempters, largely compromised of people from economically disadvantaged and minority groups, has a high rate of substance abuse. Our approach addresses the social as well as the psychological problems that contributes to suicide attempts in this disadvantaged group. The proposed intervention includes: (1) Cognitive and behavioral strategies that focus on the modifiable psychosocial risk factors including depression, hopelessness and suicide ideation, (2) problem-solving strategies, (3) utilization of social support, (4) addressing thoughts and beliefs that lead to substance abuse, and (5) increasing compliance with adjunctive medical, substance abuse, psychiatric and social interventions. In the research design, 120 patients evaluated at the emergency, medical, surgical, or psychiatric departments of a large urban hospital following a suicide attempt will be randomly assigned to cognitive therapy plus treatment-as-usual (CT+TAU) condition or to a treatment-as-usual condition. To test the generalizability of this intervention, all suicide attempters will be eligible for study participation. Patients in the CT+TAU condition will receive therapy immediately after the pre-treatment evaluation. The therapy will continue on a weekly basis post-hospitalization for ten sessions followed by booster sessions at the time of the post-treatment evaluations. All patients will receive in- hospital evaluations and then re-evaluations at 1, 3, 6, 12, 18 and 24 months after the suicide attempt. The primary outcome variable will be the incidence of subsequent suicide attempts. In addition, we will assess changes in hopelessness, depression, suicide ideation, appropriate health care utilization, cost-effectiveness and overall psychological and social adaptation. Analyses of repeated measures data will be performed for each measure to determine and characterize differences in the pattern of change over time between the two treatment conditions.
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