Abstract
BackgroundSuicide, attempted suicide and suicidal thoughts are major public health problems worldwide. Effective face-to-face treatments are Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT) and Problem Solving Treatment (PST). However, about two-thirds of persons who die by suicide have not been in contact with mental health care services in the preceding year, and many have never been treated. Furthermore, many patients do not disclose their suicidal thoughts to their care provider. This may be out of shame, due to fear of stigma or due to lack of trust in (mental) health care. Since many suicidal individuals seek information online, the internet provides an opportunity to reach suicidal individuals who would not be contacted otherwise. By providing a self-help intervention online, persons can anonymously learn to gain control over their suicidal thoughts. There is convincing evidence that self-help is effective for a number of mental disorders. In this study the effectiveness for suicidal thoughts is examined.Methods/DesignIn this study, a recently developed self-help intervention will be evaluated in a Randomized Controlled Trial. The intervention is based on Cognitive Behavioural Therapy and is aimed at subjects who experience mild to moderate suicidal thoughts. This is defined as a score between 1 and 26 on the Beck Scale for Suicidal Ideation (BSS). Higher and lower scores are excluded. In addition, severely depressed subjects are excluded. In total, 260 subjects will be randomly allocated to the intervention-condition (N = 130) or to the information-control condition (N = 130). Self-report questionnaires will be filled out at baseline, 6 weeks after baseline and 18 weeks after baseline. Primary outcome measure is the reduction in frequency and intensity of suicidal thoughts. Secondary outcome measures are the reduction of hopelessness, anxiety and depression, sleeplessness, worry and quality of life measures.DiscussionThis study is the first to evaluate the effectiveness of a web-based self-help intervention for suicidal thoughts. Several limitations and strengths of the design are discussed.Trial RegistrationNetherlands Trial Register, NTR1689
Highlights
Suicide, attempted suicide and suicidal thoughts are major public health problems worldwide
This study is the first to evaluate the effectiveness of a web-based self-help intervention for suicidal thoughts
A population-based study in the USA showed that 34% of individuals with suicidal thoughts developed specific suicide plans, while 26% directly proceeded to an attempt
Summary
Suicidal behaviour and suicidal thoughts are major public health problems worldwide. Factors that contribute to this ‘help-negation effect’ may be shame, fear of stigma, lack of trust in mental health care, and prejudices about health care providers Bearing this in mind, suicidal individuals could benefit from accessible, anonymous help. The internet could be an effective tool in reaching individuals with suicidal thoughts who would not be reached otherwise, or would come into contact with mental health care in a late phase of their suicidal process. A substantial number of individuals with suicidal thoughts do not seek help, effective treatments exist. A few self-help books are available, but these have not been scientifically evaluated. No Internet self-help treatments for suicidal thoughts are yet available. The effectiveness of a recently developed web-based self-help intervention for suicidal thoughts is evaluated in a randomized controlled trial
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