Study: Patients can recover from suicidal thinking

Study: Patients can recover from suicidal thinking
(March 2009 Issue)

By Pamela Berard

A follow-along study by a Massachusetts center shows that patients with multiple diagnoses can recover from suicidal thinking and treatment resistant mental illness.

Austen Riggs Center in Stockbridge, Mass., a not-for-profit psychiatric hospital and residential treatment center in western Massachusetts, began to follow 226 admitted patients in 1992 in a multidimensional study. The participants had a variety of diagnoses (some as many as five or six), including major affective disorders, schizophrenia, posttraumatic stress disorder (PTSD), personality disorders, substance abuse and eating disorders. The study sought to answer: Can these patients recover?

Analysis of the data shows that the answer was yes for a majority of participants. Over time - 73 percent ceased to mutilate themselves and 77 percent ceased making suicidal attempts, according to the first main paper released from the study, "Improvement and Recovery from Suicidal and Self-Destructive Phenomena in Treatment-Refractory Disorders." Thoughts of suicide disappeared in more than half.

The progress was not immediate. The median period for recovery was 7.2 years for self-mutilation; 7.3 years for other forms of self-harm (including suicide attempts); and 8.7 years for "suicidal ideation" ruminations on or thoughts about killing oneself.

But researchers were encouraged. The study demonstrated there was a point at which these individuals fundamentally stop thinking about dying and start thinking about living, explains J. Christopher Fowler, Ph.D., director of research at the Austen Riggs Center.

Fowler says clinicians who treat patients who are suicidal or suffering severe mental illness may become pessimistic because "it can seem like a very long time before we see any signs of improvement."

But the results of the study showed that, "There was not just a decrease in attempts, but an actual degree of recovery in those patients who seemed to be on a chronic course at the beginning of the study," he says. "I would also hope this would be good news for those who are suffering from these kinds of self-destructive impulses and desires and for their families as well, because they too can lose hope."

Fowler says he found the results particularly heartening because patients at Austen Riggs are often referred to as treatment-resistant or treatment-refractory individuals. In fact, 40 percent of incoming patients in 2007 had made a serious suicide attempt before admission.

"The patients who volunteered demonstrate that over the length of the follows, really a vast majority are improving in all these areas and becoming treatment responders," he says. "At what point they become treatment responders is a question we have to continue to estimate. But nearly 89 percent of those in the study were improving in terms of the frequency of suicidal acts, 93 percent for cutting and 86 percent in terms of suicidal ideation, so we were seeing a clear decrease in all of those behaviors over time."

Participants in the study averaged a stay of 170 days at Austen Riggs, says Fowler.

Fowler adds that they are wrapping up the data collection phase of the study and plan to finish by 2011. They will look at whether participants returned to work and were able to be productive and examine what factors contribute to the participants' recovery, for example whether it's a decrease in depressed mood and levels of anxiety or a change in underlying personality functioning and gains in ego strength and resiliency.