Positive Psychology in Suicidal Patients

Study Overview
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Brief Summary
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Suicide is a major health concern. Weeks following psychiatric admission are a highly suicide risk period for those having current suicidal ideation or attempt. Recently, a pilot study suggested the feasibility of positive psychology in patients in suicidal crisis. Notably, gratitude exercises suggested improvement in optimism and hopelessness, two dimensions associated to suicide. Moreover, gratitude has been associated to suicidal ideation and attempt, independently from depression. Thus, investigators want to conduct the first randomized controlled study in order to assess effectiveness of gratitude exercises (vs control task) in suicidal inpatients, on 1) psychological pain reduction 2) suicidal ideation, hopelessness, optimism, depressive symptomatology, and anxiety improvement.

Detailed Description
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Study design: monocentric randomized controlled study Methods: 206 inpatients (Department of Emergency Psychiatry and Post Acute Care), between 18 and 65 years-old, having attempted suicide before hospitalisation or having current active suicidal ideation at the time of the psychiatric hospitalisation. Patients suffering from schizophrenia are excluded. Randomization into two groups: Positive Psychology (i.e., gratitude journal) (n = 103) or Control Task (i.e., food journal) (n = 103), daily exercises during 7 days (in add-on from usual treatment). Clinical assessment: 1) at baseline (the day before the intervention beginning) (V0); 2) short daily self-assessments (immediately before and after the exercise); 3) the day following the last day of the intervention (V1). V0 : socio-demographic data, treatments, psychopathology, suicidal ideation,depressive and anxious symptomatology, psychological pain, optimism, hopelessness. Daily self-assessments: psychological pain, optimism, hopelessness V1 : treatments suicidal ideation,depressive and anxious symptomatology, psychological pain, optimism, hopelessness, intervention satisfaction.

Official Title
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Effectiveness of Positive Psychology in Suicidal Patients: A Randomized Controlled Trial

Conditions
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Suicidal Thoughts, Suicidal Crisis

Intervention / Treatment
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* Behavioral: Positive Psychology
* Behavioral: Placebo (food journal)


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Being hospitalized for suicidal thoughts or suicide attempt (from less than a week) Having signed informed consent Be fluent in French Able to understand nature, aims and methodology of the study Exclusion criteria: Lifetime history of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders - V (DSM-V) criteria Current eating disorder according to DSM-V criteria Patient on protective measures (guardianship or trusteeship) Deprived of liberty subject (judicial or administrative decision)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Positive Psychology (gratitude journal) | Behavioral: Positive Psychology<br>* Gratitude Journal (Emmons and Stern, 2013) Every evening, patients have to write down the things they feel grateful about.<br>|
| Placebo Comparator: Control group<br>Alimentary list | Behavioral: Placebo (food journal)<br>* Food journal (i.e. alimentary list): Patients have to write down the list of foods eaten during the day.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychological pain reduction using a likert scale | Psychological pain reduction, in gratitude vs control group, between the beginning and the end of the intervention, using a likert scale. | At the inclusion and day 8 (the day after the end of the intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychological pain reduction using a likert scale | Psychological pain reduction, in gratitude vs control group, the beginning and the end of each exercise, using a likert scale. | At day 1, 2, 3, 4, 5, 6, 7 | 
| intensity of suicidal ideation | Reduction of suicidal ideation intensity, in gratitude vs control group between the beginning and the end of the intervention using a Likert Scale and the Scale for Suicidal Ideation (SSI). | At the inclusion and day 8 (the day after the end of the intervention) | 
| Intensity of hopelessness | Reduction of hopelessness, in gratitude vs control group between the beginning and the end of the intervention, using a Likert Scale and the Beck Hopelessness Scale (BHS). | At the inclusion and day 8 (the day after the end of the intervention) | 
| Intensity of optimism | Reduction of hopelessness, in gratitude vs control group between the beginning and the end of the intervention, using a Likert Scale and the Life Orientation Test-Revised (LOT-R). | At the inclusion and day 8 (the day after the end of the intervention) | 
| Intensity of depressive symptoms using the Beck Depression Inventory (BDI) | Reduction of depressive symptoms between the beginning and the end of the intervention, using the Beck Depression Inventory (BDI) | Day 8 (the day after the end of the intervention) | 
| Intensity of anxious symptoms using the State Anxiety Inventory- State (SAI-State) | Reduction of anxious symptoms between the beginning and the end of the intervention, using the State Anxiety Inventory- State (SAI-State) | Day 8 (the day after the end of the intervention) | 
| Perceived usefulness of the intervention using a likert scale | Evaluation of the perceived usefulness of each intervention, using a likert scale. | Day 8 (the day after the end of the intervention) | 
| Intensity of suicidal ideation | Reduction of suicidal ideation intensity, in gratitude vs control group between the beginning and the end of each exercise, using a Likert Scale. | At day 1, 2, 3,4 5, 6, 7 | 
| Intensity of hopelessness | Reduction of hopelessness, in gratitude vs control group between the beginning and the end of each exercise, using a Likert Scale. | At day 1, 2, 3, 4, 5, 6, 7 | 
| Intensity of optimism | Reduction of hopelessness, in gratitude vs control group between the beginning and the end of each exercise, using a Likert Scale. | At day 1, 2, 3, 4, 5, 6, 7 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Suicidal inpatients, Positive Psychology, Gratitude, Psychological pain