Annual AAS Conference 2011

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Collaborative Assessment and Management of Suicidality significantly helped depressed, hopeless, and suicidal psychiatric inpatients in a small case series at the Menninger Clinic in Houston.

It was an open study with no control group, but also the first study to show the technique – which previously has been proven to help military, college, and other outpatients – helps hospitalized people, too.

Sixteen women and five men aged 18-55 years reported significant drops in suicidality after an average of about 11 sessions of CAMS, as the technique is known, over 6 weeks.

At the heart of CAMS is a strong, trusting bond – or collaboration – between patients and therapists. CAMS also tackles suicidality as a problem in itself, not merely as a symptom of a disorder, said lead investigator Thomas E. Ellis, Psy.D. "So often when you view suicidality as a symptom and you treat the disorder, you anticipate that as the person feels better, the suicide problem is eliminated. Research is not consistent with that model. We view suicidal ideation and behavior as a target," said Dr. Ellis, director of psychology at the Menninger Clinic. "We address the disorder, but at the same time, we don’t assume suicidality will be eliminated just because the disorder’s been treated."

At the outset, CAMS patients are assured that they will not be judged, and the therapist empathizes with their suicidal wish. The basic assumption is that the patient "is doing the best they can under the circumstances, and that the suicidality is there simply for lack of better coping behavior," Dr. Ellis said.

The therapeutic bond leads to accurate risk assessment plus identification and treatment of suicide drivers, such as emotional pain, stress, agitation, hopelessness, and self-hate. Patients were asked to rate their levels of those things – plus suicidal intent – throughout the study.

All were admitted with significant suicidal ideation and past attempts. Mood disorders were the primary diagnoses, often comorbid with anxiety disorders, substance abuse, and personality disorders. Patients often had been to an acute care facility first. It took a week or two to enroll them in the study once they got to Menninger, "so they had some time to stabilize a bit," said Dr. Ellis, also professor of psychiatry in the Menninger department of psychiatry and behavioral sciences at the Baylor College of Medicine.

At the outset, the patients’ mean Beck Depression Inventory-II score was 38.8, indicating severe depression. At the end of the study, it was 11.9, indicating minimal depression. Beck Hopelessness Scale scores dropped from a mean of 9.4 to 5.8, an improvement from moderate to mild hopelessness. Beck Scale for Suicide Ideation scores dropped from a mean of 10.8 to 3.9. The findings were statistically significant, with robust effects sizes of at least 0.68.

Patients also reported steady improvements in various suicide drivers, with effect sizes greater than 1. The average length of hospitalization in the trial was 52 days.

During treatment, patients were taught problem solving skills, distraction techniques, emotion regulation skills, self-compassion, or whatever else was appropriate. Future trigger events also were anticipated and addressed.

Perfectionism "is often a major issue" with self-hate. Also, "many times we review relationships in the past where a person may have been emotionally or verbally abused, and they picked up those attitudes and continue to beat up on themselves," Dr. Ellis said.

It’s up to the therapist to determine which approach to take with such issues, be it cognitive-behavioral therapy, psychodynamic therapy, or some other method. The process might or might not include pharmacotherapy and group therapy.

CAMS does not advocate any one way. "It’s not specific to a single theoretical orientation. We think of it as a platform a little bit like how Windows runs a variety of different [computer] programs," Dr. Ellis said.

The next step is to analyze the data to figure out whether patients got better because their particular drivers were addressed, or because of the bond they developed with their therapists.

But Dr. Ellis does not expect a randomized trial. "We would have a difficult time randomizing [patients] to the non-CAMS condition, because the hospital is a small world and the word gets around we have this exciting new thing," he said.

Dr. Ellis reported no disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE.  – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.

The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.

"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.

Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.

Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.

Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.

The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.

There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.

However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.

"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.

For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.

The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.

The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.

He said he had no relevant financial disclosures.

PORTLAND, ORE. – People who kill themselves by freight train are similar to others who commit suicide in other ways, but perhaps suffer more severe mental illness, social isolation, and poverty, according to psychological autopsies conducted on 62 recent freight train suicides.

But they have a handful of unique features, too, according to the autopsies, which were conducted by the American Association of Suicidology (AAS) for the Railroad Research Foundation, an industry group that supplied data from eight major freight lines that was gathered from June 2007 through September 2010. The foundation is using the findings to develop prevention measures.

Not uncommonly, the subjects were spotted wandering the tracks or looking up train schedules before their suicides, and they often lived near the tracks – 47 (76%) within 1 mile, 53 (86%) within 2 miles.

Many had spent time around railroads during their lives, and some had known friends or relatives who had committed suicide by train, or at least had heard of others doing so. There were some copycat suicides among the 62.

"Some had a very significant focus on trains as kids," but it’s impossible to say if that focus was more common than in other children, said principle investigator and clinical psychologist Alan L. Berman, Ph.D., executive director of the AAS.

Perhaps about 350 people kill themselves by railroad in the United States each year, three-quarters of them using freight lines, the rest passenger lines. The exact number is unknown, because rail companies are not required to report suicides, said the project’s research director Dr. Ramya Sundararaman, a public health physician with the association.

Even after adjustment for population and amount of track, California, New York, Florida, and Illinois had the most rail suicides, according to an analysis of recent cases. Most of those who commit suicide were aged 35-55 years. Men accounted for about three-quarters, a proportion that is similar to suicide in general.

Most of the 62 autopsied deaths happened on the fringes of cities or suburbs, where fences did not block track access. Just two people drove their cars onto the tracks. The rest were on foot. Suicides occurred in both day and night.

Rail companies "want [the problem] to go away," Dr. Sundararaman said. Each hour of delay costs up to $10,000, and people sometimes opt not to come back to work on a train that has killed someone, she said.

Already, the findings are being used in a pilot project where suicide hotline numbers are posted on signs along three rail lines.

Phones have been installed nearby, too, because only two of the 62 people autopsied had cell phones with them when they died, probably because of financial hardship. Researchers want to be sure that those who are in despair have a way to call the number.

There are other ideas, too. The urban-suburban location of most of these incidents suggests that "you could probably [fence off] a certain miles-of-track, maybe 5 miles" one way and the other, said Dr. Berman, but doing so would be expensive.

Railroad personnel could be trained to intervene when they spot despondent people scoping out the tracks; trains also could slow down in densely populated areas to discourage attempts.

Putting cow catchers on the front of trains to scoop people off tracks and into airbags also might be a possibility but probably prohibitively expensive, Dr. Berman said.

At the very least, he said, a public education campaign is likely in order to raise awareness of suicide warning signs and where to get help, especially because he and his colleagues found that such signs were perhaps even more prevalent in people who decide to commit suicide by train than they are in other types of suicide.

Among the autopsied cases, 52 people (84%) had shown at least three acute risk factors, and more than half exhibited five or more, including withdrawal, anger, anxiety, and statements of hopelessness, according to interviews with kin, friends, and acquaintances.

Comorbid mental illness also proved common. "Many had two or more mental illnesses and/or substance abuse disorders," Dr. Sundararaman said; 38 (62%) had depression and 19 (30%) schizophrenia, the two most common diagnoses.

If they had been in treatment, most were not adherent. Past suicide attempts also were common.

A large number were transient, as well, and had legal and financial problems. Unemployment was high, and many were unmarried and otherwise socially isolated. Often, they were drunk when they killed themselves.

Acute psychiatric symptoms or upcoming court appearances were among the factors that ultimately appeared to push people over the edge, Dr. Berman said.

Most did not have access to guns. "This becomes the substitute firearm," he said.

The study was funded by a federal grant from the Federal Railroad Administration to the Railroad Research Foundation, an industry group that that contracted the AAS to do the research. Neither Dr. Berman and nor Dr. Sundararaman reported disclosures.

PORTLAND, ORE. – People who kill themselves by freight train are similar to others who commit suicide in other ways, but perhaps suffer more severe mental illness, social isolation, and poverty, according to psychological autopsies conducted on 62 recent freight train suicides.

But they have a handful of unique features, too, according to the autopsies, which were conducted by the American Association of Suicidology (AAS) for the Railroad Research Foundation, an industry group that supplied data from eight major freight lines that was gathered from June 2007 through September 2010. The foundation is using the findings to develop prevention measures.

Not uncommonly, the subjects were spotted wandering the tracks or looking up train schedules before their suicides, and they often lived near the tracks – 47 (76%) within 1 mile, 53 (86%) within 2 miles.

Many had spent time around railroads during their lives, and some had known friends or relatives who had committed suicide by train, or at least had heard of others doing so. There were some copycat suicides among the 62.

"Some had a very significant focus on trains as kids," but it’s impossible to say if that focus was more common than in other children, said principle investigator and clinical psychologist Alan L. Berman, Ph.D., executive director of the AAS.

Perhaps about 350 people kill themselves by railroad in the United States each year, three-quarters of them using freight lines, the rest passenger lines. The exact number is unknown, because rail companies are not required to report suicides, said the project’s research director Dr. Ramya Sundararaman, a public health physician with the association.

Even after adjustment for population and amount of track, California, New York, Florida, and Illinois had the most rail suicides, according to an analysis of recent cases. Most of those who commit suicide were aged 35-55 years. Men accounted for about three-quarters, a proportion that is similar to suicide in general.

Most of the 62 autopsied deaths happened on the fringes of cities or suburbs, where fences did not block track access. Just two people drove their cars onto the tracks. The rest were on foot. Suicides occurred in both day and night.

Rail companies "want [the problem] to go away," Dr. Sundararaman said. Each hour of delay costs up to $10,000, and people sometimes opt not to come back to work on a train that has killed someone, she said.

Already, the findings are being used in a pilot project where suicide hotline numbers are posted on signs along three rail lines.

Phones have been installed nearby, too, because only two of the 62 people autopsied had cell phones with them when they died, probably because of financial hardship. Researchers want to be sure that those who are in despair have a way to call the number.

There are other ideas, too. The urban-suburban location of most of these incidents suggests that "you could probably [fence off] a certain miles-of-track, maybe 5 miles" one way and the other, said Dr. Berman, but doing so would be expensive.

Railroad personnel could be trained to intervene when they spot despondent people scoping out the tracks; trains also could slow down in densely populated areas to discourage attempts.

Putting cow catchers on the front of trains to scoop people off tracks and into airbags also might be a possibility but probably prohibitively expensive, Dr. Berman said.

At the very least, he said, a public education campaign is likely in order to raise awareness of suicide warning signs and where to get help, especially because he and his colleagues found that such signs were perhaps even more prevalent in people who decide to commit suicide by train than they are in other types of suicide.

Among the autopsied cases, 52 people (84%) had shown at least three acute risk factors, and more than half exhibited five or more, including withdrawal, anger, anxiety, and statements of hopelessness, according to interviews with kin, friends, and acquaintances.

Comorbid mental illness also proved common. "Many had two or more mental illnesses and/or substance abuse disorders," Dr. Sundararaman said; 38 (62%) had depression and 19 (30%) schizophrenia, the two most common diagnoses.

If they had been in treatment, most were not adherent. Past suicide attempts also were common.

A large number were transient, as well, and had legal and financial problems. Unemployment was high, and many were unmarried and otherwise socially isolated. Often, they were drunk when they killed themselves.

Acute psychiatric symptoms or upcoming court appearances were among the factors that ultimately appeared to push people over the edge, Dr. Berman said.

Most did not have access to guns. "This becomes the substitute firearm," he said.

The study was funded by a federal grant from the Federal Railroad Administration to the Railroad Research Foundation, an industry group that that contracted the AAS to do the research. Neither Dr. Berman and nor Dr. Sundararaman reported disclosures.

PORTLAND, ORE. – People who kill themselves by freight train are similar to others who commit suicide in other ways, but perhaps suffer more severe mental illness, social isolation, and poverty, according to psychological autopsies conducted on 62 recent freight train suicides.

But they have a handful of unique features, too, according to the autopsies, which were conducted by the American Association of Suicidology (AAS) for the Railroad Research Foundation, an industry group that supplied data from eight major freight lines that was gathered from June 2007 through September 2010. The foundation is using the findings to develop prevention measures.

Not uncommonly, the subjects were spotted wandering the tracks or looking up train schedules before their suicides, and they often lived near the tracks – 47 (76%) within 1 mile, 53 (86%) within 2 miles.

Many had spent time around railroads during their lives, and some had known friends or relatives who had committed suicide by train, or at least had heard of others doing so. There were some copycat suicides among the 62.

"Some had a very significant focus on trains as kids," but it’s impossible to say if that focus was more common than in other children, said principle investigator and clinical psychologist Alan L. Berman, Ph.D., executive director of the AAS.

Perhaps about 350 people kill themselves by railroad in the United States each year, three-quarters of them using freight lines, the rest passenger lines. The exact number is unknown, because rail companies are not required to report suicides, said the project’s research director Dr. Ramya Sundararaman, a public health physician with the association.

Even after adjustment for population and amount of track, California, New York, Florida, and Illinois had the most rail suicides, according to an analysis of recent cases. Most of those who commit suicide were aged 35-55 years. Men accounted for about three-quarters, a proportion that is similar to suicide in general.

Most of the 62 autopsied deaths happened on the fringes of cities or suburbs, where fences did not block track access. Just two people drove their cars onto the tracks. The rest were on foot. Suicides occurred in both day and night.

Rail companies "want [the problem] to go away," Dr. Sundararaman said. Each hour of delay costs up to $10,000, and people sometimes opt not to come back to work on a train that has killed someone, she said.

Already, the findings are being used in a pilot project where suicide hotline numbers are posted on signs along three rail lines.

Phones have been installed nearby, too, because only two of the 62 people autopsied had cell phones with them when they died, probably because of financial hardship. Researchers want to be sure that those who are in despair have a way to call the number.

There are other ideas, too. The urban-suburban location of most of these incidents suggests that "you could probably [fence off] a certain miles-of-track, maybe 5 miles" one way and the other, said Dr. Berman, but doing so would be expensive.

Railroad personnel could be trained to intervene when they spot despondent people scoping out the tracks; trains also could slow down in densely populated areas to discourage attempts.

Putting cow catchers on the front of trains to scoop people off tracks and into airbags also might be a possibility but probably prohibitively expensive, Dr. Berman said.

At the very least, he said, a public education campaign is likely in order to raise awareness of suicide warning signs and where to get help, especially because he and his colleagues found that such signs were perhaps even more prevalent in people who decide to commit suicide by train than they are in other types of suicide.

Among the autopsied cases, 52 people (84%) had shown at least three acute risk factors, and more than half exhibited five or more, including withdrawal, anger, anxiety, and statements of hopelessness, according to interviews with kin, friends, and acquaintances.

Comorbid mental illness also proved common. "Many had two or more mental illnesses and/or substance abuse disorders," Dr. Sundararaman said; 38 (62%) had depression and 19 (30%) schizophrenia, the two most common diagnoses.

If they had been in treatment, most were not adherent. Past suicide attempts also were common.

A large number were transient, as well, and had legal and financial problems. Unemployment was high, and many were unmarried and otherwise socially isolated. Often, they were drunk when they killed themselves.

Acute psychiatric symptoms or upcoming court appearances were among the factors that ultimately appeared to push people over the edge, Dr. Berman said.

Most did not have access to guns. "This becomes the substitute firearm," he said.

The study was funded by a federal grant from the Federal Railroad Administration to the Railroad Research Foundation, an industry group that that contracted the AAS to do the research. Neither Dr. Berman and nor Dr. Sundararaman reported disclosures.

PORTLAND, ORE. – People who kill themselves by freight train are similar to others who commit suicide in other ways, but perhaps suffer more severe mental illness, social isolation, and poverty, according to psychological autopsies conducted on 62 recent freight train suicides.

But they have a handful of unique features, too, according to the autopsies, which were conducted by the American Association of Suicidology (AAS) for the Railroad Research Foundation, an industry group that supplied data from eight major freight lines that was gathered from June 2007 through September 2010. The foundation is using the findings to develop prevention measures.

Not uncommonly, the subjects were spotted wandering the tracks or looking up train schedules before their suicides, and they often lived near the tracks – 47 (76%) within 1 mile, 53 (86%) within 2 miles.

Many had spent time around railroads during their lives, and some had known friends or relatives who had committed suicide by train, or at least had heard of others doing so. There were some copycat suicides among the 62.

"Some had a very significant focus on trains as kids," but it’s impossible to say if that focus was more common than in other children, said principle investigator and clinical psychologist Alan L. Berman, Ph.D., executive director of the AAS.

Perhaps about 350 people kill themselves by railroad in the United States each year, three-quarters of them using freight lines, the rest passenger lines. The exact number is unknown, because rail companies are not required to report suicides, said the project’s research director Dr. Ramya Sundararaman, a public health physician with the association.

Even after adjustment for population and amount of track, California, New York, Florida, and Illinois had the most rail suicides, according to an analysis of recent cases. Most of those who commit suicide were aged 35-55 years. Men accounted for about three-quarters, a proportion that is similar to suicide in general.

Most of the 62 autopsied deaths happened on the fringes of cities or suburbs, where fences did not block track access. Just two people drove their cars onto the tracks. The rest were on foot. Suicides occurred in both day and night.

Rail companies "want [the problem] to go away," Dr. Sundararaman said. Each hour of delay costs up to $10,000, and people sometimes opt not to come back to work on a train that has killed someone, she said.

Already, the findings are being used in a pilot project where suicide hotline numbers are posted on signs along three rail lines.

Phones have been installed nearby, too, because only two of the 62 people autopsied had cell phones with them when they died, probably because of financial hardship. Researchers want to be sure that those who are in despair have a way to call the number.

There are other ideas, too. The urban-suburban location of most of these incidents suggests that "you could probably [fence off] a certain miles-of-track, maybe 5 miles" one way and the other, said Dr. Berman, but doing so would be expensive.

Railroad personnel could be trained to intervene when they spot despondent people scoping out the tracks; trains also could slow down in densely populated areas to discourage attempts.

Putting cow catchers on the front of trains to scoop people off tracks and into airbags also might be a possibility but probably prohibitively expensive, Dr. Berman said.

At the very least, he said, a public education campaign is likely in order to raise awareness of suicide warning signs and where to get help, especially because he and his colleagues found that such signs were perhaps even more prevalent in people who decide to commit suicide by train than they are in other types of suicide.

Among the autopsied cases, 52 people (84%) had shown at least three acute risk factors, and more than half exhibited five or more, including withdrawal, anger, anxiety, and statements of hopelessness, according to interviews with kin, friends, and acquaintances.

Comorbid mental illness also proved common. "Many had two or more mental illnesses and/or substance abuse disorders," Dr. Sundararaman said; 38 (62%) had depression and 19 (30%) schizophrenia, the two most common diagnoses.

If they had been in treatment, most were not adherent. Past suicide attempts also were common.

A large number were transient, as well, and had legal and financial problems. Unemployment was high, and many were unmarried and otherwise socially isolated. Often, they were drunk when they killed themselves.

Acute psychiatric symptoms or upcoming court appearances were among the factors that ultimately appeared to push people over the edge, Dr. Berman said.

Most did not have access to guns. "This becomes the substitute firearm," he said.

The study was funded by a federal grant from the Federal Railroad Administration to the Railroad Research Foundation, an industry group that that contracted the AAS to do the research. Neither Dr. Berman and nor Dr. Sundararaman reported disclosures.

PORTLAND, ORE. – People who kill themselves by freight train are similar to others who commit suicide in other ways, but perhaps suffer more severe mental illness, social isolation, and poverty, according to psychological autopsies conducted on 62 recent freight train suicides.

But they have a handful of unique features, too, according to the autopsies, which were conducted by the American Association of Suicidology (AAS) for the Railroad Research Foundation, an industry group that supplied data from eight major freight lines that was gathered from June 2007 through September 2010. The foundation is using the findings to develop prevention measures.

Not uncommonly, the subjects were spotted wandering the tracks or looking up train schedules before their suicides, and they often lived near the tracks – 47 (76%) within 1 mile, 53 (86%) within 2 miles.

Many had spent time around railroads during their lives, and some had known friends or relatives who had committed suicide by train, or at least had heard of others doing so. There were some copycat suicides among the 62.

"Some had a very significant focus on trains as kids," but it’s impossible to say if that focus was more common than in other children, said principle investigator and clinical psychologist Alan L. Berman, Ph.D., executive director of the AAS.

Perhaps about 350 people kill themselves by railroad in the United States each year, three-quarters of them using freight lines, the rest passenger lines. The exact number is unknown, because rail companies are not required to report suicides, said the project’s research director Dr. Ramya Sundararaman, a public health physician with the association.

Even after adjustment for population and amount of track, California, New York, Florida, and Illinois had the most rail suicides, according to an analysis of recent cases. Most of those who commit suicide were aged 35-55 years. Men accounted for about three-quarters, a proportion that is similar to suicide in general.

Most of the 62 autopsied deaths happened on the fringes of cities or suburbs, where fences did not block track access. Just two people drove their cars onto the tracks. The rest were on foot. Suicides occurred in both day and night.

Rail companies "want [the problem] to go away," Dr. Sundararaman said. Each hour of delay costs up to $10,000, and people sometimes opt not to come back to work on a train that has killed someone, she said.

Already, the findings are being used in a pilot project where suicide hotline numbers are posted on signs along three rail lines.

Phones have been installed nearby, too, because only two of the 62 people autopsied had cell phones with them when they died, probably because of financial hardship. Researchers want to be sure that those who are in despair have a way to call the number.

There are other ideas, too. The urban-suburban location of most of these incidents suggests that "you could probably [fence off] a certain miles-of-track, maybe 5 miles" one way and the other, said Dr. Berman, but doing so would be expensive.

Railroad personnel could be trained to intervene when they spot despondent people scoping out the tracks; trains also could slow down in densely populated areas to discourage attempts.

Putting cow catchers on the front of trains to scoop people off tracks and into airbags also might be a possibility but probably prohibitively expensive, Dr. Berman said.

At the very least, he said, a public education campaign is likely in order to raise awareness of suicide warning signs and where to get help, especially because he and his colleagues found that such signs were perhaps even more prevalent in people who decide to commit suicide by train than they are in other types of suicide.

Among the autopsied cases, 52 people (84%) had shown at least three acute risk factors, and more than half exhibited five or more, including withdrawal, anger, anxiety, and statements of hopelessness, according to interviews with kin, friends, and acquaintances.

Comorbid mental illness also proved common. "Many had two or more mental illnesses and/or substance abuse disorders," Dr. Sundararaman said; 38 (62%) had depression and 19 (30%) schizophrenia, the two most common diagnoses.

If they had been in treatment, most were not adherent. Past suicide attempts also were common.

A large number were transient, as well, and had legal and financial problems. Unemployment was high, and many were unmarried and otherwise socially isolated. Often, they were drunk when they killed themselves.

Acute psychiatric symptoms or upcoming court appearances were among the factors that ultimately appeared to push people over the edge, Dr. Berman said.

Most did not have access to guns. "This becomes the substitute firearm," he said.

The study was funded by a federal grant from the Federal Railroad Administration to the Railroad Research Foundation, an industry group that that contracted the AAS to do the research. Neither Dr. Berman and nor Dr. Sundararaman reported disclosures.

PORTLAND, ORE. – People who kill themselves by freight train are similar to others who commit suicide in other ways, but perhaps suffer more severe mental illness, social isolation, and poverty, according to psychological autopsies conducted on 62 recent freight train suicides.

But they have a handful of unique features, too, according to the autopsies, which were conducted by the American Association of Suicidology (AAS) for the Railroad Research Foundation, an industry group that supplied data from eight major freight lines that was gathered from June 2007 through September 2010. The foundation is using the findings to develop prevention measures.

Not uncommonly, the subjects were spotted wandering the tracks or looking up train schedules before their suicides, and they often lived near the tracks – 47 (76%) within 1 mile, 53 (86%) within 2 miles.

Many had spent time around railroads during their lives, and some had known friends or relatives who had committed suicide by train, or at least had heard of others doing so. There were some copycat suicides among the 62.

"Some had a very significant focus on trains as kids," but it’s impossible to say if that focus was more common than in other children, said principle investigator and clinical psychologist Alan L. Berman, Ph.D., executive director of the AAS.

Perhaps about 350 people kill themselves by railroad in the United States each year, three-quarters of them using freight lines, the rest passenger lines. The exact number is unknown, because rail companies are not required to report suicides, said the project’s research director Dr. Ramya Sundararaman, a public health physician with the association.

Even after adjustment for population and amount of track, California, New York, Florida, and Illinois had the most rail suicides, according to an analysis of recent cases. Most of those who commit suicide were aged 35-55 years. Men accounted for about three-quarters, a proportion that is similar to suicide in general.

Most of the 62 autopsied deaths happened on the fringes of cities or suburbs, where fences did not block track access. Just two people drove their cars onto the tracks. The rest were on foot. Suicides occurred in both day and night.

Rail companies "want [the problem] to go away," Dr. Sundararaman said. Each hour of delay costs up to $10,000, and people sometimes opt not to come back to work on a train that has killed someone, she said.

Already, the findings are being used in a pilot project where suicide hotline numbers are posted on signs along three rail lines.

Phones have been installed nearby, too, because only two of the 62 people autopsied had cell phones with them when they died, probably because of financial hardship. Researchers want to be sure that those who are in despair have a way to call the number.

There are other ideas, too. The urban-suburban location of most of these incidents suggests that "you could probably [fence off] a certain miles-of-track, maybe 5 miles" one way and the other, said Dr. Berman, but doing so would be expensive.

Railroad personnel could be trained to intervene when they spot despondent people scoping out the tracks; trains also could slow down in densely populated areas to discourage attempts.

Putting cow catchers on the front of trains to scoop people off tracks and into airbags also might be a possibility but probably prohibitively expensive, Dr. Berman said.

At the very least, he said, a public education campaign is likely in order to raise awareness of suicide warning signs and where to get help, especially because he and his colleagues found that such signs were perhaps even more prevalent in people who decide to commit suicide by train than they are in other types of suicide.

Among the autopsied cases, 52 people (84%) had shown at least three acute risk factors, and more than half exhibited five or more, including withdrawal, anger, anxiety, and statements of hopelessness, according to interviews with kin, friends, and acquaintances.

Comorbid mental illness also proved common. "Many had two or more mental illnesses and/or substance abuse disorders," Dr. Sundararaman said; 38 (62%) had depression and 19 (30%) schizophrenia, the two most common diagnoses.

If they had been in treatment, most were not adherent. Past suicide attempts also were common.

A large number were transient, as well, and had legal and financial problems. Unemployment was high, and many were unmarried and otherwise socially isolated. Often, they were drunk when they killed themselves.

Acute psychiatric symptoms or upcoming court appearances were among the factors that ultimately appeared to push people over the edge, Dr. Berman said.

Most did not have access to guns. "This becomes the substitute firearm," he said.

The study was funded by a federal grant from the Federal Railroad Administration to the Railroad Research Foundation, an industry group that that contracted the AAS to do the research. Neither Dr. Berman and nor Dr. Sundararaman reported disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.