LONDON (Reuters Health) Jul 20 - Among patients who have attempted suicide, a brief course of psychodynamic therapy reduces suicidal ideation and attempts at self-harm to a greater degree than usual care, report British researchers.

Dr. Elspeth Guthrie, of the University of Manchester, and associates enrolled adult patients presenting to an emergency department after an episode of deliberate self-poisoning. The investigators randomly assigned 58 patients to the intervention group and 61 to the usual-care group.

As described in the British Medical Journal for July 21, the intervention group had four sessions of psychodynamic interpersonal therapy, provided by nurse therapists once a week in the patient's home. Usual care involved referral to a psychiatry outpatient clinic for about a third of patients, referral to addiction services for a few, and advice to consult a general practitioner for the rest of the patients.

Eighty percent of subjects attended a 6-month followup evaluation. Compared with the usual-care group, those who received the intervention scored significantly better on the Beck scale for suicidal ideation, 7.9 versus 12.8 (p = 0.005). Similarly, the intervention group scored better on the Beck depression inventory, 18.8 versus 23.7 (p = 0.037).

During the followup period, 9% of those in the intervention group and 28% in the control group harmed themselves again (p = 0.009).

In his commentary, Dr. George C. Patton, of the University of Melbourne, Australia, suggests that focal psychodynamic approaches may be effective and feasible in terms of cost. "The hope is that the debate moves from whether psychotherapy works to questions of how well do specific psychotherapies work in the range of clinical problems and contexts in which they might be indicated," he concludes.

BMJ 2001;323:135-138.

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