Incidental treatment effects of CBT on suicidal ideation and hopelessness

Tonelle E Handley; Frances J Kay-Lambkin; Amanda L Baker; Terry J Lewin; Brian J Kelly; Kerry J Inder; John R Attia; David J Kavanagh

doi:10.1016/j.jad.2013.06.005

Incidental treatment effects of CBT on suicidal ideation and hopelessness

J Affect Disord. 2013 Oct;151(1):275-83. doi: 10.1016/j.jad.2013.06.005. Epub 2013 Jun 29.

Authors

Tonelle E Handley¹, Frances J Kay-Lambkin, Amanda L Baker, Terry J Lewin, Brian J Kelly, Kerry J Inder, John R Attia, David J Kavanagh

Affiliation

¹ Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW 2308, Australia. tonelle.handley@newcastle.edu.au

PMID: 23820094
DOI: 10.1016/j.jad.2013.06.005

Abstract

Background: Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities. The risk posed by these disorders is exacerbated when they co-occur. Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity.

Methods: Participants with depressive symptoms and hazardous alcohol use were selected from two randomised controlled trials. They had received either a brief (1 session) intervention, or depression-focused cognitive behaviour therapy (CBT), alcohol-focused CBT, therapist-delivered integrated CBT, computer-delivered integrated CBT or person-centred therapy (PCT) over a 10-week period. Suicidal ideation, hopelessness, depression severity and alcohol consumption were assessed at baseline and 12-month follow-up.

Results: Three hundred three participants were assessed at baseline and 12 months. Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms, but not with alcohol consumption. Suicidal ideation did not improve significantly at follow-up, with no differences between treatment conditions. Improvements in hopelessness differed between treatment conditions; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT.

Limitations: Low retention rates may have impacted on the reliability of our findings. Combining data from two studies may have resulted in heterogeneity of samples between conditions.

Conclusions: CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse, even when it is not the focus of treatment. Less consistent results were observed for suicidal ideation. Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide.

Keywords: Alcohol; Cognitive behaviour therapy; Depression; Hopelessness; Suicidal ideation; Treatment.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alcohol Drinking / epidemiology
Alcoholism / complications
Alcoholism / therapy*
Cognitive Behavioral Therapy* / methods
Depression / complications
Depression / therapy*
Female
Humans
Male
Psychiatric Status Rating Scales
Suicidal Ideation*
Treatment Outcome