Cercle psy > Brèves > Parler avec un patient suicidaire est-il efficace ?
Parler avec un patient suicidaire est-il efficace ?
Héloïse Junier
Article publié le
Erlangsen, A. and al. (2015). « Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm : a register-based, nationwide multicentre study using propensity score matching ». The Lancet Psychiatry. Vol 2, n°1, pp. 49-58.
Published Online November 24, 2014
Auteurs Annette Erlangsen, Bertel Dam Lind, Elizabeth A Stuart, Ping Qin, Elsebeth Stenager, Kim Juul Larsen, August G Wang, Marianne Hvid, Ann Colleen Nielsen, Christian Møller Pedersen, Jan-Henrik Winsløv, Charlotte Langhoff, Charlotte Mühlmann, Merete Nordentoft
Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark (A Erlangsen PhD, Prof M Nordentoft DMSc); Department of Mental Health (A Erlangsen, E A Stuart PhD) and Department of Biostatistics (E A Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Clinic of Suicide Prevention and Treatment for Adults, Department of Psychiatry, Region of Southern Denmark, Denmark (B D Lind MSc); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Prof P Qin PhD); Department of Psychiatry, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark (E Stenager PhD); Department of Child and Adolescent Psychiatry, Clinic of Suicide Prevention and Treatment for Children and Adolescents, Region of Southern Denmark, Denmark (K J Larsen MSc); Competence Centre for Suicide Prevention, Amager, Capital Region of Denmark, Denmark (A G Wang DMSc, M Hvid); Competence Centre for Suicide
Prevention, Copenhagen, Capital Region of Denmark, Denmark (A C Nielsen Cand Psych); Clinic for Suicide Prevention, Aarhus University Hospital Risskov, Aarhus, Central Denmark Region, Denmark (C Møller Pedersen Cand Psych, C Mühlmann Cand Psych); Unitfor Suicide Prevention, Aalborg University Hospital, North Denmark Region, Denmark (J-H Winsløv MSc); and Clinic for Suicide Prevention, Herning, Central Denmark Region, Denmark (C Langhoff Cand Psych)
Correspondence to: Annette Erlangsen, Research Unit, Mental Health Centre Copenhagen, DK-2400 Copenhagen, Denmark annette.Erlangsen@regionh.dk
Auteurs Annette Erlangsen, Bertel Dam Lind, Elizabeth A Stuart, Ping Qin, Elsebeth Stenager, Kim Juul Larsen, August G Wang, Marianne Hvid, Ann Colleen Nielsen, Christian Møller Pedersen, Jan-Henrik Winsløv, Charlotte Langhoff, Charlotte Mühlmann, Merete Nordentoft
Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark (A Erlangsen PhD, Prof M Nordentoft DMSc); Department of Mental Health (A Erlangsen, E A Stuart PhD) and Department of Biostatistics (E A Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Clinic of Suicide Prevention and Treatment for Adults, Department of Psychiatry, Region of Southern Denmark, Denmark (B D Lind MSc); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Prof P Qin PhD); Department of Psychiatry, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark (E Stenager PhD); Department of Child and Adolescent Psychiatry, Clinic of Suicide Prevention and Treatment for Children and Adolescents, Region of Southern Denmark, Denmark (K J Larsen MSc); Competence Centre for Suicide Prevention, Amager, Capital Region of Denmark, Denmark (A G Wang DMSc, M Hvid); Competence Centre for Suicide
Prevention, Copenhagen, Capital Region of Denmark, Denmark (A C Nielsen Cand Psych); Clinic for Suicide Prevention, Aarhus University Hospital Risskov, Aarhus, Central Denmark Region, Denmark (C Møller Pedersen Cand Psych, C Mühlmann Cand Psych); Unitfor Suicide Prevention, Aalborg University Hospital, North Denmark Region, Denmark (J-H Winsløv MSc); and Clinic for Suicide Prevention, Herning, Central Denmark Region, Denmark (C Langhoff Cand Psych)
Correspondence to: Annette Erlangsen, Research Unit, Mental Health Centre Copenhagen, DK-2400 Copenhagen, Denmark annette.Erlangsen@regionh.dk
Summary
Background Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality.
Methods In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992–2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause.
Findings 5678 recipients of psychosocial therapy (followed up for 42·828 person-years) were matched with 17 034 individuals with no psychosocial therapy in a 1:8 ratio. During 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy repeated the act of self-harm, and 391 (6·9%) died, 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm than was no psychosocial therapy (odds ratio [OR] 0·73, 95% CI 0·65–0·82) and death by any cause (0·62, 0·47–0·82) within a year. Long-term effects were identified for repeated self-harm (0·84, 0·77–0·91; absolute risk reduction [ARR] 2·6%, 1·5–3·7; numbers needed to treat [NNT] 39, 95% CI 27–69), deaths by suicide (OR 0·75, 0·60–0·94; ARR 0·5%, 0·1–0·9; NNT 188, 108–725), and death by any cause (OR 0·69, 0·62–0·78; ARR 2·7%, 2·0–3·5; NNT 37, 29–52), implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented.
Interpretation Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm.
Funding Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900083-2/abstract
Accessible en ligne http://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/publicaties/2015/01/13/short-term-and-long-term-effects-of-psychosocial-therapy-for-people-after-deliberate-self-harm-a-register-based-nationwide-multicentre-study-using-propensity-score-matching/acz-130389-b.pdf
Background Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality.
Methods In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992–2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause.
Findings 5678 recipients of psychosocial therapy (followed up for 42·828 person-years) were matched with 17 034 individuals with no psychosocial therapy in a 1:8 ratio. During 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy repeated the act of self-harm, and 391 (6·9%) died, 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm than was no psychosocial therapy (odds ratio [OR] 0·73, 95% CI 0·65–0·82) and death by any cause (0·62, 0·47–0·82) within a year. Long-term effects were identified for repeated self-harm (0·84, 0·77–0·91; absolute risk reduction [ARR] 2·6%, 1·5–3·7; numbers needed to treat [NNT] 39, 95% CI 27–69), deaths by suicide (OR 0·75, 0·60–0·94; ARR 0·5%, 0·1–0·9; NNT 188, 108–725), and death by any cause (OR 0·69, 0·62–0·78; ARR 2·7%, 2·0–3·5; NNT 37, 29–52), implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented.
Interpretation Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm.
Funding Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900083-2/abstract
Accessible en ligne http://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/publicaties/2015/01/13/short-term-and-long-term-effects-of-psychosocial-therapy-for-people-after-deliberate-self-harm-a-register-based-nationwide-multicentre-study-using-propensity-score-matching/acz-130389-b.pdf
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La presse en parle ..
6 à 10 séances suicide : la thérapie verbale réduit le risque de seconde tentative
par Audrey Vaugrente
Avoir recours à une psychothérapie verbale
après une tentative de suicide est efficace. Les personnes qui ont fait 6
à 10 séances sont moins à risque de récidive selon une étude.
Publié le
Des cliniques ouvertes
« Nous savons que les personnes qui ont
fait une tentative de suicide représentent une population à haut risque,
et nous devons les aider. Cependant, nous ne savions pas ce qui est
efficace en termes de traitement », explique le principal auteur de
l’étude, Annette Erlangsen. En effet, au Danemark, plusieurs approches
co-existent. L’une d’entre elle, mise en place sur tout le territoire en
2007, propose aux personnes à risque de suicide une thérapie
psychosociale, sans hospitalisation en structure psychiatrique. L’équipe
de l’université de Copenhague a évalué l’impact de cette prise en
charge.
5 678 Danois qui avaient tenté de mettre
fin à leurs jours et qui se sont rendus dans une de ces cliniques ont
été suivis. 17 304 personnes correspondant aux mêmes critères, mais qui
n’ont pas été traitées, ont servi de contrôle. Pendant 20 ans, leurs
dossiers médicaux ont été soigneusement observés.
- 25 % de risque à 5 ans
Les cliniques de prévention du suicide
sont efficaces, concluent les auteurs de l’étude. Les patients qui s’y
sont rendus ont bénéficié de six à dix séances de psychothérapie
verbale. Un suivi court, mais dont les effets persistent sur le long
terme. Un an après leur thérapie, ces sujets étaient 27 % moins à risque
de refaire une tentative de suicide par rapport à ceux qui n’ont pas
été traités. A 5 ans, cette réduction du risque est de 25 %.
A 10 ans, on observe toujours un bénéfice
: le taux de suicide s’élève à 229 pour 100 000 personnes chez les
personnes traitées par psychothérapie verbale, contre 314 pour 100 000
dans le groupe de contrôle. « Nous avons à présent la preuve que le
traitement psychosocial - qui propose un soutien et non des médicaments -
peut prévenir le suicide dans un groupe à haut risque », conclut
Annette Erlangsen. C’est la première fois que cette efficacité est
démontrée. Et selon les auteurs de l’étude, il y aurait un véritable
intérêt à proposer davantage de programmes de ce type.