Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T12:38:33.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive–behavioural suicide prevention for male prisoners: a pilot randomized controlled trial

Published online by Cambridge University Press:  13 July 2015

D. Pratt ,
N. Tarrier ,
G. Dunn ,
Y. Awenat ,
J. Shaw ,
F. Ulph  and
P. Gooding
D. Pratt*
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK Manchester Mental Health and Social Care NHS Trust, Manchester, UK
N. Tarrier
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
G. Dunn
Affiliation:
Institute of Population Health, University of Manchester, Manchester, UK
Y. Awenat
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
J. Shaw
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
F. Ulph
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
P. Gooding
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
*
* Address for correspondence: D. Pratt, Ph.D., School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: daniel.pratt@manchester.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Prisoners have an exceptional risk of suicide. Cognitive–behavioural therapy for suicidal behaviour has been shown to offer considerable potential, but has yet to be formally evaluated within prisons. This study investigated the feasibility of delivering and evaluating a novel, manualized cognitive–behavioural suicide prevention (CBSP) therapy for suicidal male prisoners.

Method.

A pilot randomized controlled trial of CBSP in addition to treatment as usual (CBSP; n = 31) compared with treatment as usual (TAU; n = 31) alone was conducted in a male prison in England. The primary outcome was self-injurious behaviour occurring within the past 6 months. Secondary outcomes were dimensions of suicidal ideation, psychiatric symptomatology, personality dysfunction and psychological determinants of suicide, including depression and hopelessness. The trial was prospectively registered (number ISRCTN59909209).

Results.

Relative to TAU, participants receiving CBSP therapy achieved a significantly greater reduction in suicidal behaviours with a moderate treatment effect [Cohen's d = −0.72, 95% confidence interval −1.71 to 0.09; baseline mean TAU: 1.39 (s.d. = 3.28) v. CBSP: 1.06 (s.d. = 2.10), 6 months mean TAU: 1.48 (s.d. = 3.23) v. CBSP: 0.58 (s.d. = 1.52)]. Significant improvements were achieved on measures of psychiatric symptomatology and personality dysfunction. Improvements on psychological determinants of suicide were non-significant. More than half of the participants in the CBSP group achieved a clinically significant recovery by the end of therapy, compared with a quarter of the TAU group.

Conclusions.

The delivery and evaluation of CBSP therapy within a prison is feasible. CBSP therapy offers significant promise in the prevention of prison suicide and an adequately powered randomized controlled trial is warranted.

Keywords

Cognitive therapyprisonrandomized controlled trialssuicide prevention
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 16 , December 2015 , pp. 3441 - 3451
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.Google Scholar
Beck, AT, Steer, RA (1988). Manual for the Beck Hopelessness Scale. The Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA (1991). Manual for the Beck Scale for Suicide Ideation. The Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory-II. The Psychological Corporation: San Antonio, TX.Google Scholar
Birmingham, L (2003). The mental health of prisoners. Advances in Psychiatric Treatment 9, 191–199.CrossRefGoogle Scholar
Black, G, Forrester, A, Wilks, M, Riaz, M, Maguire, H, Carlin, P (2011). Using initiative to provide clinical intervention groups in prison: a process evaluation. International Review of Psychiatry 23, 70–76.CrossRefGoogle ScholarPubMed
Bowcott, O, Taylor, M, Laville, S (2014). England and Wales prisons chief warns of ‘terrible toll’ of inmate suicides. In The Guardian. http://www.theguardian.com/society/2014/oct/21/prisons-uk-chief-hardwick-suicide-prisoners-safety (accessed April 2015).Google Scholar
Brown, GK, Ten Have, T, Henriques, GR, Xie, SX, Hollander, JE, Beck, AT (2005). Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. Journal of the American Medical Association 294, 563–570.Google Scholar
Cull, J, Gill, W (1982). Manual for the Suicide Probability Scale. Western Psychological Services: Los Angeles, CA.Google Scholar
Dalton, R, Majoy, S, Sharkey, M (1998) Nonattenders and attrition from a forensic psychology outpatient service. International Journal of Offender Therapy and Comparative Criminology 42, 174–180.CrossRefGoogle Scholar
Davidson, K, Norrie, J, Tyrer, P, Gumley, A, Tata, P, Murray, H, Palmer, S (2006). The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the Borderline Personality Disorder Study of Cognitive Therapy (BOSCOT) trial. Journal of Personality Disorders 20, 450–465.CrossRefGoogle ScholarPubMed
Department of Health (2002). National Suicide Prevention Strategy for England. Department of Health: London.Google Scholar
Department of Health (2007). Improving Health, Supporting Justice: A Consultation Document. A Strategy for Improving Health and Social Care Services for People Subject to the Criminal Justice System. Department of Health: London.Google Scholar
Department of Health (2012). Preventing Suicide in England: A Cross-government Outcomes Strategy to Save Lives. Department of Health: London.Google Scholar
Efron, B, Tibshirani, RJ (1993). An Introduction to the Bootstrap. Chapman and Hall: London.Google Scholar
Ehlers, A, Hackmann, A, Grey, N, Wild, J, Liness, S, Albert, I, Deale, A, Stott, R, Clark, DM (2014). A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. American Journal of Psychiatry 171, 294–304.Google Scholar
Fazel, S, Benning, R, Danesh, J (2005). Suicides in male prisoners in England and Wales, 1978–2003. Lancet 366, 1301–1302.Google Scholar
Fazel, S, Grann, M, Kling, B, Hawton, K (2011). Prison suicide in 12 countries: an ecological study of 861 suicides during 2003–2007. Social Psychiatry and Psychiatric Epidemiology 46, 191–195.Google Scholar
Gendreau, P (1996). Offender rehabilitation what we know and what needs to be done. Criminal Justice and Behavior 23, 144–161.CrossRefGoogle Scholar
Gondolf, EW, Foster, RA (1991). Pre-program attrition in batterer programs. Journal of Family Violence 6, 337–349.Google Scholar
Hawton, K, Linsell, L, Adeniji, T, Sariaslan, A, Fazel, S (2014). Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide. Lancet 383, 1147–1154.Google Scholar
Hollin, CR, Palmer, EJ (2006). Offending Behaviour Programmes: Development, Application and Controversies. Wiley: Chichester.CrossRefGoogle Scholar
Humber, N, Hayes, A, Senior, J, Fahy, T, Shaw, J (2010). Identifying, monitoring and managing prisoners at risk of self-harm/suicide in England and Wales. Journal of Forensic Psychiatry and Psychology 22, 22–51.Google Scholar
Jacobson, NS, Roberts, LJ, Berns, SB, McGlinchey, JB (1999). Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. Journal of Consulting and Clinical Psychology 67, 300–307.CrossRefGoogle ScholarPubMed
Johnson, J, Gooding, P, Tarrier, N (2008). Suicide risk in schizophrenia: explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychology and Psychotherapy: Theory, Research and Practice 81, 55–77.Google Scholar
Konrad, N, Daigle, MS, Daniel, AE, Dear, GE, Frottier, P, Hayes, LM, Kerkhof, A, Liebling, A, Sarchiapone, M (2007). Preventing suicide in prisons, Part I: recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons. Crisis: The Journal of Crisis Intervention and Suicide Prevention 28, 113–121.Google Scholar
Lancaster, GA, Dodd, S, Williamson, PR (2004). Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice 10, 307–312.Google Scholar
Landenberger, NA, Lipsey, MW (2005). The positive effects of cognitive–behavioral programs for offenders: a meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology 1, 451–476.CrossRefGoogle Scholar
Liebling, A, Maruna, S (eds.) (2005). The Effects of Imprisonment. Willan: Cullompton.Google Scholar
Little, RJ, Rubin, DB (2002). Statistical Analysis with Missing Data, 2nd edn. Wiley: New York.Google Scholar
McGuire, J (2002). Offender Rehabilitation and Treatment: Effective Programmes and Policies to Reduce Re-Offending. Wiley: Chichester.Google Scholar
Medical Research Council (2008). Developing and Evaluating Complex Interventions: New Guidance. Medical Research Council: London.Google Scholar
Ministry of Justice (2013). PSI 64/2011: Management of Prisoners at Risk of Harm to Self, to Others and from Others. Ministry of Justice: London. http://www.justice.gov.uk/downloads/offenders/psipso/psi-2011/psi-64-2011-safer-custody.doc (accessed April 2015).Google Scholar
Ministry of Justice (2014). Offender Management Statistics Prison Population 2014. Ministry of Justice: London.Google Scholar
Moran, P, Leese, M, Lee, T, Walters, P, Thornicroft, G, Mann, A (2003). Standardised Assessment of Personality – Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry 183, 228–232.Google Scholar
Morley, KC, Sitharthan, G, Haber, PS, Tucker, P, Sitharthan, T (2014). The efficacy of an opportunistic cognitive behavioral intervention package (OCB) on substance use and comorbid suicide risk: a multisite randomized controlled trial. Journal of Consulting and Clinical Psychology 82, 130–140.Google Scholar
National Institute for Health and Clinical Excellence (2011). Self-Harm: Longer-Term Management (Clinical Guideline CG133) . National Institute for Health and Clinical Excellence: London.Google Scholar
Naud, H, Daigle, MS (2010). Predictive validity of the suicide probability scale in a male inmate population. Journal of Psychopathology and Behavioral Assessment 32, 333–342.Google Scholar
Oldfield, VB, Salkovskis, PM, Taylor, T (2011). Time-intensive cognitive behaviour therapy for obsessive compulsive disorder: a case series and matched comparison group. British Journal of Clinical Psychology 50, 7–18.Google Scholar
Olver, ME, Stockdale, KC, Wormith, JS (2011). A meta-analysis of predictors of offender treatment attrition and its relationship to recidivism. Journal of Consulting and Clinical Psychology 79, 6–21.Google Scholar
Perry, AE, Marandos, R, Coulton, S, Johnson, M (2010). Screening tools assessing risk of suicide and self-harm in adult offenders: a systematic review. International Journal of Offender Therapy and Comparative Criminology 54, 803–828.Google Scholar
Rivlin, A, Hawton, K, Marzano, L, Fazel, S (2010). Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case–control study. British Journal of Psychiatry 197, 313–319.Google Scholar
Robson, P (1989). Development of a new self-report questionnaire to measure self-esteem. Psychological Medicine 19, 513–518.CrossRefGoogle ScholarPubMed
Senior, J, Hayes, AJ, Pratt, D, Thomas, SD, Fahy, T, Leese, M, Bowen, A, Taylor, G, Lever-Green, G, Graham, T, Pearson, A, Ahmed, M, Shaw, JJ (2007). The identification and management of suicide risk in local prisons. Journal of Forensic Psychiatry and Psychology 18, 368–380.Google Scholar
Slee, N, Garnefski, N, van der Leeden, R, Arensman, E, Spinhoven, P (2008). Cognitive–behavioural intervention for self-harm: randomised controlled trial. British Journal of Psychiatry 192, 202–211.Google Scholar
Social Exclusion Unit (2002). Reducing Re-offending by Ex-prisoners. Social Exclusion Unit: London.Google Scholar
StataCorp (2009). Stata Release 11. StataCorp: College Station, TX.Google Scholar
Stone, A, Wheeler, C, Barge, A (2007). Improving the design of phase II trials of cytostatic anticancer agents. Contemporary Clinical Trials 28, 138–145.Google Scholar
Tarrier, N, Gooding, P, Pratt, D, Kelly, J, Maxwell, J, Awenet, Y (2013). Cognitive Behavioural Prevention of Suicide in Psychosis: A Treatment Manual. Routledge: London.CrossRefGoogle Scholar
Tarrier, N, Kelly, J, Maqsood, S, Snelson, N, Maxwell, J, Law, H, Dunn, G, Gooding, P (2014). The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophrenia Research 156, 204–210.Google Scholar
Tarrier, N, Taylor, K, Gooding, P (2008). Cognitive–behavioral interventions to reduce suicide behaviour: a systematic review and meta-analysis. Behavior Modification 32, 77–108.Google Scholar
Ventura, J, Lukoff, D, Nuechterlein, K, Liberman, R, Green, M, Shaner, A (1993). Manual for the expanded brief psychiatric rating scale. International Journal of Methods in Psychiatric Research 3, 221–224.Google Scholar
Wormith, JS, Olver, ME (2002). Offender treatment attrition and its relationship with risk, responsivity, and recidivism. Criminal Justice and Behaviour 29, 447–471.Google Scholar