title: Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial.
abstract: BACKGROUND
  Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior.
  
  
  METHODS
  A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment.
  
  
  RESULTS
  Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = -3.15, 95% confidence interval -6.18 to -0.12, effect size = -0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks.
  
  
  CONCLUSIONS
  Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.
authors.affiliation: Harvard Medical School,Boston, MA,USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Celano
authors.affiliation: Department of Psychiatry,Massachusetts General Hospital,Boston, MA,USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Beale
authors.affiliation: Department of Psychiatry,Massachusetts General Hospital,Boston, MA,USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Mastromauro
authors.affiliation: Harvard Medical School,Boston, MA,USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Stewart
authors.affiliation: Harvard Medical School,Boston, MA,USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Millstein
authors.affiliation: Harvard Medical School,Boston, MA,USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Auerbach
authors.affiliation: Harvard Medical School,Boston, MA,USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Bedoya
authors.affiliation: Harvard Medical School,Boston, MA,USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method; D055815:Young Adult; D000092864:Suicide Prevention
keywords: Cognition; depression; optimism; positive psychology; suicide