Evidence-Based Psychotherapies for Suicide Prevention

Future Directions
      Psychotherapeutic interventions targeting suicidal thoughts and behaviors are essential for reducing suicide attempts and deaths by suicide. To determine whether specific psychotherapies are efficacious in preventing suicide and suicide-related behaviors, it is necessary to rigorously evaluate therapies using RCTs. To date, a number of RCTs have demonstrated efficacy for several interventions focused on preventing suicide attempts and reducing suicidal ideation. Although these studies have contributed greatly to the understanding of treatment for suicidal thoughts and behaviors, the extant literature is hampered by a number of gaps and methodologic limitations. Thus, further research employing increased methodologic rigor is needed to improve psychotherapeutic suicide prevention efforts. The aims of this paper are to briefly review the state of the science for psychotherapeutic interventions for suicide prevention, discuss gaps and methodologic limitations of the extant literature, and suggest next steps for improving future studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • USDHHS Office of the Surgeon General and National Action Alliance for Suicide Prevention
        2012 National Strategy for Suicide Prevention: Goals and Objectives for Action.
        HHS, Washington, DCSeptember 2012 (
        • O’Neil M.
        • Peterson K.
        • Low A.
        • et al.
        Suicide prevention interventions and referral/follow-up services: a systematic review.
        Department of Veterans Affairs, Washington, DC2012
        • Mann J.
        • Apter A.
        • Bertolote J.
        • et al.
        Suicide prevention strategies: a systematic review.
        JAMA. 2005; 294: 2064-2074
      1. National Institute for Health and Clinical Excellence. Self-harm: longer-term management. (Clinical Guideline CG133).

        • O’Connor E.
        • Gaynes B.N.
        • Burda B.U.
        • et al.
        Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2013; 158: 741-754
        • Brown G.K.
        • Ten Have T.
        • Henriques G.R.
        • et al.
        Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial.
        JAMA. 2005; 294: 563-570
        • Slee N.
        • Garnefski N.
        • van der Leeden R.
        • et al.
        Cognitive-behavioural intervention for self-harm: randomized controlled trial.
        Br J Psychiatry. 2008; 192: 202-211
        • Linehan M.M.
        • Comtois K.A.
        • Murray A.M.
        • et al.
        Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder.
        Arch Gen Psychiatry. 2006; 63: 757-766
        • Hatcher S.
        • Sharon C.
        • Parag V.
        • Collins N.
        Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial.
        Br J Psychiatry. 2011; 199: 310-316
        • Bateman A.
        • Fonagy P.
        Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.
        Am J Psychiatry. 1999; 156: 1563-1569
        • Guthrie E.
        • Kapur N.
        • Mackway-Jones K.
        • et al.
        Randomised controlled trial of brief psychological intervention after deliberate self-poisoning.
        BMJ. 2001; 323: 135-138
        • McMain S.F.
        • Links P.S.
        • Gnam W.H.
        • et al.
        A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder.
        Am J Psychiatry. 2009; 166: 136-174
        • Blum St, N.
        • John D.
        • Pfohl B.
        • et al.
        Systems training for emotional predictability and problem solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up.
        Am J Psychiatry. 2008; 165: 468-478
        • Davidson K.
        • Norrie J.
        • Tyrer P.
        • et al.
        The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the Borderline Personality Disorder Study of Cognitive Therapy (BOSCOT) trial.
        J Pers Disord. 2006; 20: 450-465
        • Wood A.
        • Trainor G.
        • Rothwell J.
        • et al.
        Randomized trial of a group therapy for repeated deliberate self-harm in adolescents.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 1246-1253
        • Huey S.
        • Henggeler S.
        • Rowland M.
        • et al.
        Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies.
        J Am Acad Child Adolesc Psychiatry. 2004; 43: 183-190
        • Comtois K.
        • Jones D.
        • O’Connor S.
        • et al.
        Collaborative assessment and management of suicidality (CAMS): feasibility trial for next-day appointment services.
        Depress Anxiety. 2011; 28: 963-972
        • Stewart C.
        • Quinn A.
        • Plever S.
        • Emmerson B.
        Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high-risk population.
        Suicide Life Threat Behav. 2009; 39: 538-547
        • Diamond G.
        • Wintersteen M.
        • Brown G.K.
        • et al.
        Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial.
        J Am Acad Child Adolesc Psychiatry. 2010; 49: 122-131
        • Unützer J.
        • Tang L.
        • Oishi S.
        • et al.
        Reducing suicidal ideation in depressed older primary care patients.
        J Am Geriatr Soc. 2006; 54: 1550-1556
        • Bruce M.
        • Ten Have T.
        • Reynolds Cr
        • et al.
        Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial.
        JAMA. 2004; 291: 1081-1091
        • Pearson J.
        • Stanley B.
        • King C.
        • Fisher C.
        Intervention research with persons at high risk for suicidality: safety and ethical considerations.
        J Clin Psychiatry. 2001; 62: S17-S26
        • Moher D.
        • Schulz K.F.
        • Altman D.G.
        • CONSORT Group
        Consolidated standards of reporting trials.
        Ann Intern Med. 2001; 134: 657-662
        • Crosby A.E.
        • Ortega L.
        • Melanson C.
        Self-directed violence surveillance: uniform definitions and recommended data elements, version 1.0. CDC, Atlanta GA2011 (
        • Posner K.
        • Brown G.K.
        • Stanley B.
        • et al.
        The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults.
        Am J Psychiatry. 2011; 168: 1266-1277
        • Meltzer H.Y.
        • Alphs L.
        • Green A.I.
        • et al.
        Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).
        Arch Gen Psychiatry. 2003; 60: 82-91
        • Hoyert S.
        • Smith B.
        • Murphy S.
        • Kochanek M.
        Deaths: final data for 1999.
        Natl Vital Stat Rep. 2001; 49: 1-113
      2. CDC, National Center for Injury and Prevention Control. Web-Based Injury Statistics Query and Reporting System (WISQARS).