A eficácia de psicoterapias na redução de novas tentativas de suicídio: uma revisão sistemática com meta-análises de ensaios clínicos randomizados

Autores

DOI:

https://doi.org/10.22235/cp.v18i2.3667

Palavras-chave:

tentativa de suicídio, psicoterapia, ensaio clínico randomizado, eficácia

Resumo

Há poucas evidências sobre a eficácia das psicoterapias na redução de novas tentativas de suicídio. Este artigo tem como objetivo avaliar a eficácia das intervenções psicoterapêuticas na redução de tentativa de suicídio em pacientes com histórico de tentativas anteriores. Selecionamos 17 artigos de quatro bases de dados: PubMed, Cochrane, APA PsycInfo e LILACS, em 2023. Seis estudos mostraram diferenças estatísticas que favoreceram a intervenção psicoterapêutica em algum momento durante o período de acompanhamento. Essas psicoterapias abordaram: resolução de problemas, indução de esperança, treinamento de habilidades. Ao comparar a psicoterapia com o tratamento usual, uma meta-análise revelou um odds ratio geral de 0,41 (IC 95 %, 0,17 a 0,99, p = 0,05) na análise até 12 meses de acompanhamento, e um odds ratio de 0,48 (IC 95 %, 0,30 a 0,78, p < 0,001) após 12 meses de acompanhamento. Os resultados apontam para a eficácia dessas intervenções na redução de novas tentativas de suicídio, mas devem ser analisadas com cautela, dada a heterogeneidade da amostra, tratamentos e comparadores. Esta revisão oferece suporte para o desenvolvimento de estratégias de prevenção indicada para pacientes que tentaram suicídio.

Downloads

Não há dados estatísticos.

Referências

Almondes, K. M., & Teodoro, M. (2020). Os três Ds: desespero, desamparo e desesperança em profissionais da saúde. Sociedade Brasileira de Psicologia. Tópico 3. https://acortar.link/7O2Es7

Andreasson, K., Krogh, J., Wenneberg, C., Jessen, H. K., Krakauer, K., Gluud, C., Thomsen, R. R., Randers, L., & Nordentoft, M. (2016). Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline personality traits and disorder-a randomized observer-blinded clinical trial. Depression and Anxiety, 33(6), 520-530. https://doi.org/10.1002/da.22472

Arias, S. A, Miller, I., Camargo, C.A., Jr, Sullivan, A. F., Goldstein, A. B., Allen, M. H., Manton, A. P., & Boudreaux, E. D. (2016). Factors associated with suicide outcomes 12 months after screening positive for suicide risk in the emergency department. Psychiatry Serviçes, 67(2), 206-213. https://doi.org/10.1176/appi.ps.201400513

Arvilommi, P., Valkonen, J., Ruishalme, O., Kukkonen, M., Sihvola, H., Lindholm, L., Suominen, K., Gaily-Luoma, S., & Isometsä, E. (2021). A randomized clinical trial of the ASSIP vs. crisis counselling in preventing suicide attempt repetition: a two-year follow-up study. Nordic Journal of Psychiatry, 75(sup1). https://doi.org/10.1080/08039488.2021.2019916

Bertolote, J. M. (2012). O suicídio e sua prevenção. Unesp.

Botega, N. J. (2023). Crise suicida: avaliação e manejo (2nd ed). Artmed.

Brazil. Ministry of Health. (2024). Panorama of suicides and self-inflicted injuries in Brazil from 2010 to 2021. Epidemiological Bulletin, 55(4), 1-18.

Briggs, S., Netuveli, G., Gould, N., Gkaravella, A., Gluckman, N. S., Kangogyere, P., Farr, R., Goldblatt, M. J., & Lindner, R. (2019). The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: systematic review and meta-analysis. The British Journal of Psychiatry, 214(6), 320-328. https://doi.org/10.1192/bjp.2019.33

Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA, 294(5), 563-570. https://doi.org/10.1001/jama.294.5.563

Center for Disease Control and Prevention. (2016). WISQARS: Web-based injury Statistics Query and Reporting System. https://wisqars.cdc.gov/

Cuijpers, P., de Beurs, D. P., Van Spijker, B. A., Berking, M., Andersson, G., & Kerkhof, A. J. (2013). The effects of psychotherapy for adult depression on suicidality and hopelessness: a systematic review and meta-analysis. Journal of Affective Disorders, 144(3), 183-190. https://doi.org/10.1016/j.jad.2012.06.025

Díez-Gómez, A., Sebastián-Enesco, C., Pérez-Albéniz, A., Lucas-Molina, B., Al-Halabí, S., & Fonseca-Pedrero, E. (2024). The PositivaMente Program: universal prevention of suicidal behaviour in educational settings. School Mental Health, 16, 455-466. https://doi.org/10.1007/s12310-024-09650-0

Donaldson, D., Spirito, A., & Esposito-Smythers, C. (2005). Treatment for adolescents following a suicide attempt: results of a pilot trial. Journal of the American Academy of Child & Adolescent Psychiatry, 44(2), 113-120. https://doi.org/10.1097/00004583-200502000-00003

Fonseca-Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., López-Navarro, E. R., Muñiz, J., Lucas-Molina, B., Pérez-Albéniz, A., Rivera, R. B., Cano-Vindel, A., Gimeno-Peón, A., Prado-Abril, J., González-Menéndez, A., Valero, A. V., Priede, A., González-Blanch, C., Ruiz-Rodríguez, P., Moriana, J. A., Gómez, L. E., ...& Montoya-Castilla, I. (2021a). Tratamientos psicológicos empíricamente apoyados para la infancia y adolescencia: Estado de la cuestión. Psicothema, 33(3), 386-398.

Fonseca-Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., Muñiz, J., López-Navarro, E., Pérez de Albéniz, A., Lucas Molina, B., Debbané, M., Bobes-Bascarán, M. T., Gimeno-Peón, A., Prado-Abril, J., Fernández-Álvarez, J., Rodríguez-Testal, J. F., González Pando, D., Díez-Gómez, A., García Montes, J. M., García Cerdán, L., Osma, J., ... & Ma, R. J. (2021b). Tratamientos psicológicos empíricamente apoyados para adultos: Una revisión selectiva. Psicothema, 33(2), 188-197. https://doi.org/10.7334/psicothema2020.426

Grupp-Phelan, J., Stevens, J., Boyd, S., Cohen, D. M., Ammerman, R. T., Liddy-Hicks, S., Heck, K., Marcus, S. C., Stone, L., Campo, J. V., & Bridge, J. A. (2019). Effect of a motivational interviewing-based intervention on initiation of mental health treatment and mental health after an emergency department visit among suicidal adolescents: A randomized clinical trial. JAMA Network Open, 2(12), e1917941. https://doi.org/10.1001/jamanetworkopen.2019.17941

Guthrie, E., Kapur, N., Mackway-Jones, K., Chew-Graham, C., Moorey, J., Mendel, E., Marino-Francis, F., Sanderson, S., Turpin, C., Boddy, G., & Tomenson, B. (2001). Randomised controlled trial of brief psychological intervention after deliberate self-poisoning. BMJ, 323, 135-138. https://doi.org/10.1136/bmj.323.7305.135

Gysin-Maillart, A., Schwab, S., Soravia, L., Megert, M., & Michel, K. (2016). A novel brief therapy for patients who attempt suicide: A 24-months follow-up randomized controlled study of the Attempted Suicide Short Intervention Program (ASSIP). PLoS Medicine, 13(3), e1001968. https://doi.org/10.1371/journal.pmed.1001968

Hassanzadeh M., Khajeddin, N., Nojomi, M., Fleischmann, A., & Eshrati, T. (2010). Brief intervention and contact after deliberate self-harm: an Iranian randomized controlled trial. Iran Journal of Psychiatry and Behavior Sciences, 4(2), 5-12.

Hepp, U., Wittmann, L., Schnyder, U., & Michel, K. (2004). Psychological and psychosocial interventions after attempted suicide: an overview of treatment studies. Crisis, 25(3), 108-117. https://doi.org/10.1027/0227-5910.25.3.108

Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327, 557-560. https://doi.org/10.1136/bmj.327.7414.557

Huggett, C., Gooding, P., Haddock, G., Quigley, J., & Pratt, D. (2022). The relationship between the therapeutic alliance in psychotherapy and suicidal experiences: A systematic review. Clinical Psychology & Psychotherapy, 29(4), 1203-1235. https://doi.org/10.1002/cpp.2726

Hvid, M., Vangborg, K., Sørensen, H. J., Nielsen, I. K., Stenborg, J. M., & Wang, A. G. (2011). Preventing repetition of attempted suicide—II. The Amager Project, a randomized controlled trial. Nordic Journal of Psychiatry, 65(5), 292-298. https://doi.org/10.3109/08039488.2010.544404

Inagaki, M., Kawashima, Y., Yonemoto, N., & Yamada, M. (2019). Active contact and follow-up interventions to prevent repeat suicide attempts during high-risk periods among patients admitted to emergency departments for suicidal behavior: a systematic review and meta-analysis. BMC Psychiatry, 19, 44. https://doi.org/10.1186/s12888-019-2017-7

Jeong, H., Yim, H. W., Lee, S. Y., Potenza, M. N., & Kim, N. J. (2023). Effectiveness of psychotherapy on prevention of suicidal re-attempts in psychiatric emergencies: a systematic review and network meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 92(3), 152-161. https://doi.org/10.1159/000529753

Labelle, R., Pouliot, L., & Janelle, A. (2015). A systematic review and meta-analysis of cognitive behavioural treatments for suicidal and self-harm behaviours in adolescents. Canadian Psychology, 56(4), 368-378. https://doi.org/10.1037/a0039159

LaCroix, J. M., Perera, K. U., Neely, L. L., Grammer, G., Weaver, J., & Ghahramanlou-Holloway, M. (2018). Pilot trial of post-admission cognitive therapy: Inpatient program for suicide prevention. Psychological Services, 15(3), 279-288. https://doi.org/10.1037/ser0000224

Lahoz, T., Hvid, M., & Wang, A. G. (2016). Preventing repetition of attempted suicide-III. The Amager Project, 5-year follow-up of a randomized controlled trial. Nordic Journal of Psychiatry, 70(7), 547-553. https://doi.org/10.1080/08039488.2016.1180711

Leavey, K., & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive Behaviour Therapy, 46(5), 353-374. https://doi.org/10.1080/16506073.2017.1332095

Lin, T-J., Ko, H-C., Wu, J. Y-W, Oei, T. P., Lane, H-Y., & Chen, C-H. (2019). The Effectiveness of Dialectical Behavior Therapy skills training group vs. Cognitive Therapy group on reducing depression and suicide attempts for borderline personality disorder in Taiwan. Archives of Suicide Research, 23(1), 82-99. https://doi.org/10.1080/13811118.2018.1436104

Linehan, M. M. (2018). Skills training in DBT: Dialectical behavior therapy manual for the therapist (2nd ed.). Artmed.

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. https://doi.org/10.1001/jamapsychiatry.2014.3039

Macedo, M. M. K., & Werlang, B. S. G. (2004). Trauma, pain, and act: The psychoanalytic perspective on a suicide attempt. Ágora, 10(1), 86-106. https://doi.org/10.1590/S1516-14982007000100006

Malakouti, S. K., Nojomi, M., Ghanbari, B., Rasouli, N., Khaleghparast, S., & Farahani, I. G. (2022). Aftercare and suicide reattempt prevention in Tehran, Iran. Crisis, 43(1), 18-27. https://doi.org/10.1027/0227-5910/a000754

McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry, 75(8), 777-785. https://doi.org/10.1001/jamapsychiatry.2018.1109

Méndez-Bustos, P., Calati, R., Rubio-Ramírez, F., Olié, E., Courtet, P., & Lopez-Castroman, J. (2019). Effectiveness of psychotherapy on suicidal risk: a systematic review of observational studies. Frontiers in Psychology, 10, 277. https://doi.org/10.3389/fpsyg.2019.00277

Messiah, A., Notredame, C. E., Demarty, A. L., Duhem, S., Vaiva, G., & AlgoS investigators. (2019). Combining green cards, telephone calls and postcards into an intervention algorithm to reduce suicide reattempt (AlgoS): P-hoc analyses of an inconclusive randomized controlled trial. PloS One, 14(2), e0210778. https://doi.org/10.1371/journal.pone.0210778

Morthorst, B., Krogh, J., Erlangsen, A., Alberdi, F., & Nordentoft, M. (2012). Effect of assertive outreach after suicide attempt in the AID (Assertive Intervention for Deliberate Self harm) trial: randomised controlled trial. BMJ, 345, e4972 https://doi.org/10.1136/bmj.e4972

Mousavi, S. G., Amini, M., Mahaki, B., & Bagherian-Sararoudi, R. (2016). Effect of phone call versus face-to-face follow-up on recurrent suicide attempts prevention in individuals with a history of multiple suicide attempts. Advanced Biomedical Research, 5, 184. https://doi.org/10.4103/2277-9175.190990

Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30(1), 133-154. https://doi.org/10.1093/epirev/mxn002

Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54(2), 97-107. https://doi.org/10.1016/j.jaac.2014.10.009

Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews. Systematic Reviews, 5, 210 https://doi.org/10.1186/s13643-016-0384-4

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., & Moher, D. (2021). Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. Journal of Clinical Epidemiology, 134, 103-112. https://doi.org/10.1016/j.jclinepi.2021.02.003

Probert-Lindström, S., Berge, J., Westrin, Å., Öjehagen, A., & Skogman Pavulans, K. (2020). Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32-year follow-up study. BMJ Open, 10(10), e038794. https://doi.org/10.1136/bmjopen-2020-038794

Rodrigues, C. L., & Ziegelmann, P. K. (2010). Metanálise: um guia prático. Clinical & Biomedical Research, 30(4), 436-447.

Roever, L. (2016). Compreendendo os estudos de metanálise na pesquisa clínica. Revista da Sociedade Brasileira de Clínica Médica, 14(4), 245-250.

Rogers, C. R. (1995). On Becoming a Person: A Therapist’s view of psychotherapy. Houghton Mifflin.

Rudd, M. D., Bryan, C. J., Wertenberger, E. G., Peterson, A. L., Young-McCaughan, S., Mintz, J., Williams, S. R., Arne, K. A., Breitbach, J., Delano, K., Wilkinson, E., & Bruce, T. O. (2015). Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. The American Journal of Psychiatry, 172(5), 441-449. https://doi.org/10.1176/appi.ajp.2014.14070843

Salkovskis, P. M., Atha, C., & Storer, D. (1990). Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide a controlled trial. The British Journal of Psychiatry, 157(6), 871-876. https://doi.org/10.1192/bjp.157.6.871

Santos, C. M. C, Pimenta, C. A. M., & Nobre, M. R. C. (2007). The PICO strategy for the research question construction and evidence search, updating articles. Revista Latino-Americana de Enfermagem, 15(3), 1-4. https://doi.org/10.1590/S0104-11692007000300023

Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Jason Aronson.

Silverman, M. M. (2006). The language of suicidology. Suicide and Life-Threatening Behaviour, 36(5), 519-532. https://doi.org/10.1521/suli.2006.36.5.519

Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R.G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng H-Y., Corbett, M. S., Eldridge, S. M., Emberson J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li T., … Higgins, J. P. T. (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 366, l4898. https://doi.org/10.1136/bmj.l4898

Stewart, C. D., Quinn, A., Plever, S., & Emmerson, B. (2009). Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high risk population. Suicide and Life-Threatening Behavior, 39(5), 538-547. https://doi.org/10.1521/suli.2009.39.5.538

Torre-Luque, A., Estupiñá Puig, F. J., Pemauy, A., & Prata, J. (2021). General strategies for suicide behavior prevention. In S. Al-Halabí & E. Fonseca-Pedrero (Eds.), Manual of psychology of suicidal behavior (pp. 173-193). Pirámide.

van der Sande, R., Van Rooijen, L., Buskens, E., Allart, E., Hawton, K., Van der Graaf, Y., & Van Engeland, H. (1997). Intensive in-patient and community intervention versus routine care after attempted suicide. A randomised controlled intervention study. The British Journal of Psychiatry, 171(1), 35-41. https://doi.org/10.1192/bjp.171.1.35

Wang, Y. C., Hsieh, L. Y., Wang, M. Y., Chou, C. H., Huang, M. W., & Ko, H. C. (2016). Coping card usage can further reduce suicide reattempt in suicide attempter case management within 3-month intervention. Suicide and Life-Threatening Behavior, 46(1), 106-120. https://doi.org/10.1111/sltb.12177

Wei, S., Liu, L., Bi, B., Li, H., Hou, J., Tan, S., Chen, X., Chen, W., Jia, X., Dong, G., Qin, X., & Liu, Y. (2013). An intervention and follow-up study following a suicide attempt in the emergency departments of four general hospitals in Shenyang, China. Crisis, 34(2), 107-115. https://doi.org/10.1027/0227-5910/a000181

Wenzel, A., Brown, G. K., & Beck, A. T. (2010). Terapia cognitivo-comportamental para pacientes suicidas. Artmed.

World Health Organization. (2014). Preventing suicide: a global imperative. http://www.who.int/mental_health/suicide-prevention/en/.

World Health Organization. (2019). Suicide in the world: Global health estimatives. https://apps.who.int/iris/bitstream/handle/10665/326948/WHO-MSD-MER-19.3-eng.pdf?sequence=1&isAllowed=y

Publicado

2024-09-16

Como Citar

Santos, L. A., Teodoro, M. L. M., & De Oliveira, F. C. (2024). A eficácia de psicoterapias na redução de novas tentativas de suicídio: uma revisão sistemática com meta-análises de ensaios clínicos randomizados. Ciencias Psicológicas, 18(2), e-3667. https://doi.org/10.22235/cp.v18i2.3667

Edição

Secção

ARTIGOS ORIGINAIS

Artigos Similares

> >> 

Também poderá iniciar uma pesquisa avançada de similaridade para este artigo.