Suicide prevention after traumatic brain injury: a randomized controlled trial of a program for the psychological treatment of hopelessness

J Head Trauma Rehabil. 2011 Jul-Aug;26(4):290-300. doi: 10.1097/HTR.0b013e3182225250.


Objective: To evaluate the efficacy of a psychological treatment to reduce moderate to severe hopelessness after severe traumatic brain injury (TBI).

Method: Randomized controlled trial. Participants were aged between 18 and 65 years, experienced posttraumatic amnesia more than 1day and moderate to severe hopelessness (Beck Hopelessness Scale [BHS]) and/or suicide ideation. Intervention comprised a 20-hour manualized group cognitive behavior therapy program. Participants were randomly allocated using concealed allocation (treatment n = 8; wait-list n = 9); all remained in their allocated group. Outcome variables were collected by assessors blind to group allocation.

Results: No between-groups differences were observed on demographic, injury, cognitive, and psychosocial variables at baseline (time 1). A significant group-by-time interaction was found for BHS in the treatment group (F1,15 = 13.20, P = .002), reflecting a reduction in mean BHS scores between time 1 and time 2 (posttreatment) with no main effects for group or time. At 3-month follow-up (time 3), the treatment gains were maintained or improved for 75% (6/8) of participants. Secondary outcome variables (suicide ideation, depression, social problem solving, self-esteem, hopefulness) displayed no significant group-by-time interactions or main effects.

Conclusions: This trial provides initial evidence for the efficacy of a psychological intervention in reducing hopelessness among long-term survivors with severe TBI.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Australia
  • Brain Injuries / epidemiology
  • Brain Injuries / psychology
  • Brain Injuries / rehabilitation*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Depressive Disorder / rehabilitation*
  • Female
  • Glasgow Coma Scale
  • Humans
  • Incidence
  • Injury Severity Score
  • Male
  • Middle Aged
  • Primary Prevention / methods
  • Psychotherapy / organization & administration*
  • Psychotherapy, Group / organization & administration
  • Reference Values
  • Risk Assessment
  • Sick Role
  • Single-Blind Method
  • Suicide / statistics & numerical data
  • Suicide Prevention*
  • Survival Rate
  • Young Adult