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

Pratt, D., Tarrier, N., Dunn, G., Awenat, Y., Shaw, J., Ulph, F., & Gooding, P. (2015). Cognitive–behavioural suicide prevention for male prisoners: a pilot randomized controlled trial. Psychological medicine, 45(16), 3441-3451.

Summary by: Valeriia Radchenko

Previous studies have demonstrated that male prisoners are likely to commit suicide or experience suicide ideations due to fears, loss of control over their lives and hopelessness. They may perceive suicide as a way out of current situation (Fazel et al; 2011, Birmingham, 2003).

In the meantime, Cognitive Behavioral Therapy (CBT) program, proven successful in cases of depression and other psychological problems, was developed further and adjusted as a suicide prevention program for schizophrenic patients. In fact, Cognitive-behavioral Suicide Prevention (CBSP) program was validated and demonstrated positive outcome on the respective patients (Tarrier et al. 2014).

In the current study, the research team aimed to assess the effectiveness of CBSP on male prisoners in the United Kingdom (Pratt et al., 2015). The team proposed that CBSP would decrease suicidal behaviors in the treatment group. Moreover, they suggested that CBSP treatment would lead to the decrease in psychiatric symptoms, suicidal ideations, depression and hopelessness.

The participants of the current study were 62 male prisoners (Mage = 35.2 y.) from the United Kingdom. From this sample, 52 participants have shown suicidal behaviors prior to the study. Participants were randomly assigned to the treatment and control groups (each consisting of 31 participants). The experiment took place for six months in the male prison in England.  The CBSP was provided to the treatment group in 20 individual 1-hour sessions by two clinical psychologists. The CBSP consisted of 5 key components: “Attention broadening, Cognitive restructuring, Mood management and behavioural activation, Problem-solving training, Improving self-esteem and positive schema" (Pratt et al., 2015). No medication (e.g. anti-depressants) were provided to any group within the study.

The assessment was conducted via questionnaires and standardized depression scale, suicidal ideation scale such as Beck Scale for Suicidal Ideation (1991) and Beck Depression Inventory (1996). In particular, the reseach team documented the number of suicidal attempts and self-harm behaviors among participants pre- and post-treatment.

This pilot-trial experiment demonstrated that CBSP can be an effective treatment option to decrease suicide rates in the male prisons. The results showed the decrease in self-harm behaviors (by 50%) in the treatment group. The self-reported scales also demonstrated a decrease in psychiatric symptoms (treatment effect = -4.60, p = 0.04).

Although the effect size of this  research is moderate, it cannot fall under generalization to the population. More studies are needed to further investigate the effectiveness of the CBSP program on the prison population. Nevertheless, this pilot experiment gives a solid basis for future research.