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Cognitive–behavioural suicide prevention for male prisoners: a pilot randomized controlled trial

Published online by Cambridge University Press:  13 July 2015

D. Pratt ,
N. Tarrier ,
G. Dunn ,
Y. Awenat ,
J. Shaw ,
F. Ulph  and
P. Gooding
D. Pratt*
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK Manchester Mental Health and Social Care NHS Trust, Manchester, UK
N. Tarrier
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
G. Dunn
Affiliation:
Institute of Population Health, University of Manchester, Manchester, UK
Y. Awenat
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
J. Shaw
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
F. Ulph
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
P. Gooding
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
*
* Address for correspondence: D. Pratt, Ph.D., School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: daniel.pratt@manchester.ac.uk)
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Abstract

Background.

Prisoners have an exceptional risk of suicide. Cognitive–behavioural therapy for suicidal behaviour has been shown to offer considerable potential, but has yet to be formally evaluated within prisons. This study investigated the feasibility of delivering and evaluating a novel, manualized cognitive–behavioural suicide prevention (CBSP) therapy for suicidal male prisoners.

Method.

A pilot randomized controlled trial of CBSP in addition to treatment as usual (CBSP; n = 31) compared with treatment as usual (TAU; n = 31) alone was conducted in a male prison in England. The primary outcome was self-injurious behaviour occurring within the past 6 months. Secondary outcomes were dimensions of suicidal ideation, psychiatric symptomatology, personality dysfunction and psychological determinants of suicide, including depression and hopelessness. The trial was prospectively registered (number ISRCTN59909209).

Results.

Relative to TAU, participants receiving CBSP therapy achieved a significantly greater reduction in suicidal behaviours with a moderate treatment effect [Cohen's d = −0.72, 95% confidence interval −1.71 to 0.09; baseline mean TAU: 1.39 (s.d. = 3.28) v. CBSP: 1.06 (s.d. = 2.10), 6 months mean TAU: 1.48 (s.d. = 3.23) v. CBSP: 0.58 (s.d. = 1.52)]. Significant improvements were achieved on measures of psychiatric symptomatology and personality dysfunction. Improvements on psychological determinants of suicide were non-significant. More than half of the participants in the CBSP group achieved a clinically significant recovery by the end of therapy, compared with a quarter of the TAU group.

Conclusions.

The delivery and evaluation of CBSP therapy within a prison is feasible. CBSP therapy offers significant promise in the prevention of prison suicide and an adequately powered randomized controlled trial is warranted.

Keywords

Cognitive therapyprisonrandomized controlled trialssuicide prevention
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 16 , December 2015 , pp. 3441 - 3451
Copyright
Copyright © Cambridge University Press 2015 

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