Neuropsychological Patterns of Suicide Ideators and Suicide Attempters

Differences Between Suicide Attempters and Suicide Ideators. Influence of the Brief Therapy ASSIP on Neuropsychological Correlates and Psychological Process Factors (NePsyASSIP HT) - Project 1

The present study consists of 3 projects in total and aims to investigate the (neuro-) psychological patterns from suicidal ideation to suicidal behavior as well as the effects and feasibility of ASSIP Home Treatment.

The overall aim of project 1 is to determine (neuro-) psychological differences between suicide attempters, suicide ideators, a clinical control group, and healthy controls. Study participants in project 1 will participate in a one-time (neuro-) psychological assessment.

Project 1 of this study is an observational cross-sectional study with four groups that will be conducted at the University Hospital of Psychiatry and Psychotherapy Bern (Switzerland): Patients with at least one suicide attempt in their past (SUAT), patients with suicidal ideation (SUID), patients from the same clinical cohort, without neither suicidal behavior or ideation (CLIN) and the healthy group (HLTH). The cohorts to be examined (SUAT & SUID) will be compared to the two control groups (CLIN & HLTH). Only people who have signed the informed consent and meet the eligibility criteria can participate in this study.

Purpose and aims:

The present study consists of 3 projects in total and aims to investigate the (neuro-) psychological patterns from suicidal ideation to suicidal behavior as well as the effects and feasibility of ASSIP Home Treatment.

The aim of this project is to distinguish the (neuro-) psychological patterns of suicide ideators from suicide attempters by investigating four experimental groups. For this purpose, neuropsychological functioning, as well as psychological process factors, are analyzed. Patients with at least one prior suicide attempt are compared to patients with suicidal ideation, to a clinical control group, as well as to healthy controls. For this project, patients who are being treated at the University Hospital of Psychiatry and Psychotherapy Bern (Switzerland) at the time of the project will be requested. Afterwards, participants with a suicide attempt in their history will also be asked to participate in the longitudinal part of the study, which is Project 2.

Background:

In Switzerland, approximately three people die by suicide every day, and suicide attempts exceed this number by far. As a previous suicide attempt is one of the strongest predictors of a completed suicide, it is of utmost importance to identify the people at risk. However, research has shown that traditional risk factors (e.g., depression, psychiatric disorder, etc.) reliably predict suicidal ideation but poorly predict suicidal behavior. Furthermore, while effective suicide-specific interventions exist, up to 50% of the suicide attempters reject the recommended treatment, and around 60% discontinue treatment after one session. Hence, a different approach is required. In this study, three projects will be conducted. In Project 1, (neuro-) psychological patterns of suicide attempters will be identified by comparing the following four different groups:

1. patients with a prior suicide attempt (SUAT),
2. patients with no prior suicide attempt but suicidal ideation (SUID),
3. a general patient group (CLIN), and
4. a healthy control group (HLTH).

Project 2 will investigate how these patterns are modulated by the efficacious brief therapy ASSIP. In Project 3, the feasibility, effects and cost-effectiveness of the ASSIP Home Treatment will be investigated.

Study design of Project 1:

Project 1 of this study is a quantitative cross-sectional and observational study with four groups that will be conducted at the University Hospital of Psychiatry and Psychotherapy Bern (Switzerland): Patients with at least one suicide attempt in their past (SUAT), patients with suicidal ideation (SUID), patients from the same clinical cohort without suicidal behavior or ideation (CLIN), and the healthy group (HLTH). The cohorts to be examined (SUAT & SUID) will be compared to two control groups (CLIN & HLTH). Study participants in Project 1 will participate in a one-time (neuro-) psychological assessment. To account for the heterogeneity in suicide attempters, suicide ideators, generally clinical patients and healthy controls, the samples will be balanced for age, gender and treatment setting by group matching.

Inclusion Criteria:

Subjects fulfilling the following inclusion criteria are eligible for the study:

• Informed consent as documented by signature
• Age ≥ 18 years

Additional inclusion criterion for the SUAT group in project 1:

• At least one previous suicide attempt

Additional inclusion criterion for the SUID group in project 1:

• Suicidal ideation

Additional inclusion criterion for the CLIN group in project 1:

• Current psychiatric disorder treated on an inpatient, day-care or outpatient basis For the HLTH group, no further inclusion criteria are formulated.

Exclusion Criteria:

The presence of any one of the following exclusion criteria leads to exclusion of the subject:

• Serious cognitive impairment
• Any current psychotic disorder
• Any current medication, which substantially impairs the attention span, reaction rate or any other relevant cognitive functions
• Inability to follow the procedures of the study (e.g., insufficient mastery of the German language, previous enrolment into the current study)

Additional exclusion criterion for the SUID group:

• Previous suicidal behavior

Additional exclusion criteria for the CLIN and HLTH groups:

• Previous suicidal behavior
• Suicidal ideation

Additional exclusion criterion for the HLTH group:

• Current psychiatric disorder treated on an inpatient, day-care or outpatient basis