The current study aims to determine the efficacy and effectiveness of a brief cognitive therapy intervention for suicide attempters delivered by trained therapists at community mental health centers. The target group of suicide attempters is largely comprised of ethnic minorities and economically disadvantaged individuals who have high rates of mental health and substance use disorders. Our previous study found that a brief cognitive intervention specifically designed for this high-risk population and delivered in a university setting was successful at reducing subsequent suicide attempts. The primary aim of the proposed study is to implement this evidence-based intervention in the community and to evaluate its effectiveness for preventing subsequent suicide attempts and reducing the psychosocial risk factors associated with such attempts (e.g., depression, hopelessness, and suicide ideation). The intervention also focuses on increasing treatment compliance with adjunctive psychiatric, substance abuse, and medical treatment. In the research design, 140 patients evaluated at the emergency, medical, or psychiatric departments of a large urban hospital following a suicide attempt will be randomly assigned to cognitive therapy plus an enriched care condition or to an enriched care condition. To ensure the generalizability of the intervention, all adult suicide attempters will be eligible for study participation. After the pre-treatment evaluation, patients in the intervention condition will receive 10 sessions of cognitive therapy at a community mental health center Subsequent assessments by independent evaluators will be conducted at 1, 3, 6, 12, 18 and 24 months following the pre-treatment evaluation. The primary outcome variable will be the incidence of subsequent suicide attempts. We will also assess changes in hopelessness, depression, suicide ideation, appropriate health care utilization, and overall psychological and social adaptation. Analyses of repeated measures data will be performed for each measure to determine differences in the pattern of change over time between the two treatment conditions. Successful outcomes will be of considerable public health significance and will warrant implementing such treatment in the community in order to reduce suicidal behavior.
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