O’Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. The Lancet Psychiatry, 1, 73–85. http://dx.doi.org/10.1016/S2215-0366(14)70222-6
以下說明 暗夜行路 歸鄉猶遙
我們以為知道 我們在做甚麼
但其實我們不知道 做了會有甚麼差別
恐怕我們唯一知道的是 不能不做點甚麼
不管結果如何
Psychological
treatment
Most people struggling with suicidal thoughts and behaviours (roughly 60%) do not receive treatment.148 The main reasons for not seeking help are low perceived need and the desire to handle the problem personally.148
Future research is needed to develop effective ways to connect people with suicidal thoughts and behaviours with effective treatments.
Unfortunately, few well-established evidence-based treatments for suicidal behaviour are available, such as prevention pro grammes,149 pharmacological interventions,150 and psycho logical treatments.151
Treatments targeting depression have not been shown to reduce suicidal thoughts or behaviours.152
Some evidence suggests that specific forms of cognitive and behavioural therapy that target suicidal thoughts and behaviours directly can decrease the risk of suicide reattempt among people who have made a previous attempt.
For example, clinical trials testing dialectical behaviour therapy (in patients with borderline personality disorder)153 and cognitive therapy (in recent suicide attempters)154 have lent support to the effectiveness of these treatments to reduce the rate of suicide reattempt compared with other interventions.
However, few replications have been done by independent research groups, and studies have yet to establish interventions that prevent people at risk from making an initial suicide attempt.
Findings from a metaanalysis155 of cognitive behaviour therapies for suicidal behaviour showed a statistically significant effect of cognitive behavioural therapy to reduce the rate of suicide attempt; however, the investigators noted a publication bias in this topic, with a funnel plot of published studies centring close to zero, smaller studies reporting more positive effect sizes, and no published study findings showing negative effects for any intervention.
Several new interventions also offer promise.
The collaborative assessment and management of suicidality is a clinical intervention designed to enhance the therapeutic alliance and decrease the risk of suicidal behaviour.156
Safety-planning interventions, which include the identification of warning signs, coping strategies, and sources of support in addition to restriction of access to lethal means, are also receiving welcome attention.157
Treatment based on mentalisation has shown some promise to reduce self-harm in adolescents.158
The fact that most suicidal people do not receive treatment, and that little evidence is available for the effectiveness of the interventions received by those who do, emphasises the tremendous importance of future work to develop psychological treatments for people at risk of suicidal behaviour.
The utility of the internet and smartphones in treatment delivery also requires close examination.
