Abstract
BackgroundSuicide prevention after a recent suicide attempt remains a major issue for clinicians. Indeed, these patients are at risk of new attempts and also less prone to interact with mental health services. As psychoeducation-based interventions are strongly recommended for patients with severe or chronic disorders and poor adherence, we developed the first French program of suicide psychoeducation (PEPSUI).MethodsWe started a large multicenter randomized controlled trial in outpatients who attempted suicide in the last year (i.e., current suicidal behavior disorder) to assess the feasibility, acceptability, and effectiveness of a 10-week psychoeducational program (PEPSUI group: scientific information on suicidal behavior, and third-wave cognitive behavioral therapies) compared with a 10-week relaxation program (control condition), in a naturalistic setting. Here, we present the qualitative part of this study. Participants in both groups completed a narrative interview with questions on their general impressions about the therapy process and outcomes, specific areas of change in their life since inclusion, and knowledge and perceptions about suicide and mental health services. Interviews were audiotaped, transcribed, and coded using inductive and deductive thematic analysis with a constant comparative approach. Participants were consecutively included until data saturation.ResultsThe interviews of 18 patients (n=10 in the PEPSUI group, and n=8 in the relaxation group) were analyzed. Qualitative analyses revealed some common points, and many differences between groups that are relevant for suicide prevention. Patients in both groups were satisfied with the programs. Group modality and therapeutic alliance with the instructors were considered useful in both groups. Participation was related to improved perception of mental health units (particularly in the PEPSUI group). Both groups reported the acquisition of stress management skills and distress tolerance. Relaxation was an easy way to survive stress. Conversely, the PEPSUI program had deeper implications for daily life through effective positioning towards internal events (thoughts and emotions) as a consequence of mindfulness-derived practices, enhancement of value-based commitments, improvement of the meaning in life and internal locus of control, increased contact with the present moment, use of a matrix (a decision-making tool), and acquisition of scientific knowledge on suicidal behavior.ConclusionThrough specific processes for targeting suicidal risk and reducing the stigma, the PEPSUI program may represent a promising intervention for suicide prevention.
Highlights
Every year 800,000 people die by suicide worldwide and nearly 20 times more attempt suicide [1]
Five main themes were identified: 1. emotional, cognitive and behavioral processes that overlapped with the following categories: a) mindfulness and openness to inner experience in an acceptance way, b) stress and distress tolerance c) defusion, d) Self as context, e) values and meaning in life, f) positive affective and cognitive states, g) projection into the future, h) matrix use for effective decision making, i) new patterns of behaviors, j) improved self-awareness, and k) improved global functioning; 2. relationship-based processes that overlapped with the following categories: a) interpersonal skills in daily life, b) group format of the intervention, and c) therapeutic alliance with the instructors; 3. intervention framework; 4. suicidal behavior perception and management; 5. mental health care services’ perception
I could do it more if something unpleasant were arising for me that I couldn’t cope with”. This is the first qualitative study assessing psychological changes and the underlying processes reported by outpatients at high-risk of suicide enrolled in a psychoeducational (PEPSUI) or relaxation program
Summary
Every year 800,000 people die by suicide worldwide and nearly 20 times more attempt suicide [1]. Despite the increased effectiveness of pharmacological treatments for psychiatric diseases associated with high risk of suicide, the rates of suicidal ideation, suicide attempts, and completed suicide have not significantly decreased in recent years. Suicidal behaviors may be understood as experiential avoidance strategies to reduce suffering in an increasingly addictive way [4, 5] These data highlight the need to target subjects who attempted suicide in the last year (i.e., according to the DSM5 [6], individuals with current suicidal behavior disorder that might be considered a severe and debilitating disorder). Suicide prevention after a recent suicide attempt remains a major issue for clinicians These patients are at risk of new attempts and less prone to interact with mental health services. As psychoeducation-based interventions are strongly recommended for patients with severe or chronic disorders and poor adherence, we developed the first French program of suicide psychoeducation (PEPSUI)
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