ASSIP, Attempted Suicide Short Intervention Program. Two Year Follow-Up Study (ASSIP)

January 13, 2016 updated by: University of Bern

A Novel Brief Therapy for Attempted Suicide: Two Year Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP)

Objective

Attempted suicide is the main risk factor for repeated suicidal behavior. However, evidence of the effectiveness of follow-up treatments for these patients is limited. The authors evaluated the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP), a novel brief therapy based on a patient-oriented model of suicidal behavior. The ASSIP consists of three sessions followed by regular letters for 24 months.

Method

In this treatment study, 120 patients were randomly assigned to either the ASSIP intervention or a control group that received a one-session clinical assessment. Both groups received in- and outpatient treatment as usual. Study participants also completed a set of psychosocial and clinical questionnaires every 6 months during a 24-month follow-up period.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Background

In the prevention and treatment of suicidality the main emphasis according to the traditional medical model has been on diagnosis and treatment of mental disorders, first and foremost depression. However, it is debatable how far this approach toward the suicidal patient can actually affect suicide rates. It has been argued that the mechanisms of suicidal behavior should be studied independently of any associated psychiatric disorder.

Follow-up studies strongly suggest that when a person has attempted suicide, the risk of future suicidal behavior, including death by suicide, cannot be "cured". Once a person has tried to solve an emotional crisis with a suicide attempt, this behavioral pattern will quickly re-emerge in similar situations in the future, not only because a suicide attempt provides a - temporary - solution, but also because very often it associated with an immediate sense of relief. The prevailing view emerging from recent developments in suicide research is that, following attempted suicide, it is crucial to establish individual safety strategies with patients for coping differently in future emotional crises. For as many patients as possible to benefit, treatments targeting suicidality should be brief and focused, and, of course, effective.

ASSIP combines aspects of action theory, cognitive behavior therapy, and attachment theory. A fundamental assumption is that an action theoretical approach toward the suicidal patient will establish a therapeutic alliance in the sense of a "secure base", which will enhance the effect of the regular letters following the four treatment sessions. ASSIP is not a stand-alone therapy but should be offered to suicidal patients in addition to the usual clinical management and follow-up treatment.

Objective

  1. How effective is ASSIP, compared to a control group in preventing suicidal behaviour after a suicide attempt?

    1. Primary outcome measures: Suicidal behaviour, suicidal ideation
    2. Secondary outcome measures: Depression, coping skills, contact to health care system

  2. Which parameters have a moderating influence on outcome measures?

    1. Therapeutic alliance
    2. Diagnosis
    3. Previous suicide attempts

Methods

In this treatment study, 120 patients were randomly assigned to either the ASSIP intervention or a control group that received a one-session clinical assessment. Both groups received in- and outpatient treatment as usual. The quality of the therapeutic alliance as a moderating factor for outcome was measured at the therapy sessions 1 (both groups) and 3 (ASSIP group only) using the Helping Alliance Questionnaire (HAq). Regarding outcome measures the study participants completed a set of psychosocial and clinical questionnaires every 6 months during a 24-months follow-up period.

Study Type

Interventional

Enrollment (Actual)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Switzerland
      • Bern, Switzerland, 3008
        • University Hospital of Psychiatry and Psychotherapy, University of Bern

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Male/female
  • Inpatient/outpatient, day care treatment
  • German language
  • All diagnosis (except: psychosis)
  • Written informed consent

Exclusion Criteria

  • Psychosis
  • Imprisonment
  • Foreign languages

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Group ASSIP
Intervention Group ASSIP (Brief Therapy)
Behavioral: Attempted Suicide Short Intervention Program (ASSIP)

The brief therapy ASSIP consists of three to four sessions, which are ideally administered within a period of 2 to 4 weeks. Therapy sessions are scheduled for 60 to 90 minutes.

Session 1: A narrative interview is conducted, in which the patient is asked to tell his or her personal story which led to the suicidal crisis. The narrative is video-recorded.

Session 2: Using video-playback of the recorded narrative, patient and therapist explore further details of the suicidal process.

Session 3: A case conceptualization focusing on the patient's vulnerability and the trigger of the suicidal crisis is formulated in writing. A list of safety strategies for the prevention of future suicidal behaviour is developed jointly with the patient.

Regular letters are sent to patients over a period of 2 years.
Active Comparator: Control Group CG
Control Group CG (structured interview)
Behavioral: Control Group (CG)
Participants assigned to the control group underwent a single clinical interview that included a structured assessment of suicide using the SSF (Jobes, 2006).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Suicidal behaviour
Time Frame: 2-year follow-up
Measured by socio-demographic & clinical questionnaire
2-year follow-up
Suicidal behaviour
Time Frame: 1-year follow-up
Measured by socio-demographic & clinical questionnaire
1-year follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Contact to health care system
Time Frame: At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Measured by questionnaire
At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Suicidal ideation
Time Frame: At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Measured by Beck Scale for Suicidal Ideation (BSS)
At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Depression
Time Frame: At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Measured by Beck Depression Inventory (BDI)
At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Coping
Time Frame: At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Measured by Brief COPE
At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Global distress
Time Frame: At baseline, after 6 months, after 12 months, after 18 months, after 24 months
Measured by SCL-9
At baseline, after 6 months, after 12 months, after 18 months, after 24 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Bern

Investigators

  • Principal Investigator: Konrad Michel, Prof., Hospital of Psychiatry and Psychotherapy, University of Bern
  • Principal Investigator: Anja C Gysin-Maillart, Ph.D., Hospital of Psychiatry and Psychotherapy, University of Bern

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2009

Primary Completion (Actual)

June 1, 2014

Study Completion (Actual)

June 1, 2014

Study Registration Dates

First Submitted

July 16, 2015

First Submitted That Met QC Criteria

July 21, 2015

First Posted (Estimate)

July 22, 2015

Study Record Updates

Last Update Posted (Estimate)

January 14, 2016

Last Update Submitted That Met QC Criteria

January 13, 2016

Last Verified

January 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 144/08

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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