Differential Treatment Outcomes of an Intervention Targeting Suicide Ideation: How Patient Typology Moderates the Effectiveness of CAMS-PFT vs. TAU
Suicide related behaviors remain a major public health concern, as 1.1 million adults in the United States attempted suicide in 2008. Along with developing more effective treatments targeting suicidality, there remains a need to better differentiate among suicidal persons in order to maximize limited mental health resources. It may be possible to treat select subgroups with routine care, whereas others with greater perceived risk of suicide may require additional services. The current study investigated the moderating effect that suicidal ambivalence and level of chronicity have on treatment outcomes in an adult sample (n = 50) receiving either the Collaborative Assessment and Management of Suicidality-Problem Focused Treatment (CAMS-PFT) or treatment as usual (TAU) at an outpatient mental health clinic in the Pacific Northwest. Research staff administered the Scale for Suicide Ideation (SSI), Outcome Questionnaire-45.2, and Reasons for Living Inventory, at the pre-treatment, post-treatment, and 6-months time points. Additionally, the Suicide Status Form (SSF) was administered at the pre-treatment assessment. Suicidal ambivalence was determined by creating specific cut points with the wish to live and wish to die scales on the SSI, and chronicity of suicidality was determined by history of previous suicide attempts. Results from a factor analysis of the SSF suggest that the participants experienced greater persistent levels of elevated stress as compared with participants in previous research. Using both hierarchical linear modeling (HLM) and multivariate analysis of covariance (MANCOVA), the study measured differences in rates of change on the three outcomes of interest. The analysis of the interaction between Time and Typology suggests that regardless of treatment condition, patients with two or more previous suicide attempts experienced a greater reduction in suicidal ideation as compared to those with less than two previous suicide attempts. A trend towards significance was observed for the interaction between Chronicity and Treatment, with greater reductions in suicidality for patients that received CAMS-PFT. These findings suggest that outpatient treatment may be effective at reducing suicidality and that a more intensive course of psychotherapy may reduce suicidal ideation at a greater rate than treatment as usual.
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