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

Psychol Med. 2015 Dec;45(16):3441-51. doi: 10.1017/S0033291715001348. Epub 2015 Jul 13.


Background: Prisoners have an exceptional risk of suicide. Cognitive-behavioural therapy for suicidal behaviour has been shown to offer considerable potential, but has yet to be formally evaluated within prisons. This study investigated the feasibility of delivering and evaluating a novel, manualized cognitive-behavioural suicide prevention (CBSP) therapy for suicidal male prisoners.

Method: A pilot randomized controlled trial of CBSP in addition to treatment as usual (CBSP; n = 31) compared with treatment as usual (TAU; n = 31) alone was conducted in a male prison in England. The primary outcome was self-injurious behaviour occurring within the past 6 months. Secondary outcomes were dimensions of suicidal ideation, psychiatric symptomatology, personality dysfunction and psychological determinants of suicide, including depression and hopelessness. The trial was prospectively registered (number ISRCTN59909209).

Results: Relative to TAU, participants receiving CBSP therapy achieved a significantly greater reduction in suicidal behaviours with a moderate treatment effect [Cohen's d = -0.72, 95% confidence interval -1.71 to 0.09; baseline mean TAU: 1.39 (S.D. = 3.28) v. CBSP: 1.06 (S.D. = 2.10), 6 months mean TAU: 1.48 (S.D. = 3.23) v. CBSP: 0.58 (S.D. = 1.52)]. Significant improvements were achieved on measures of psychiatric symptomatology and personality dysfunction. Improvements on psychological determinants of suicide were non-significant. More than half of the participants in the CBSP group achieved a clinically significant recovery by the end of therapy, compared with a quarter of the TAU group.

Conclusions: The delivery and evaluation of CBSP therapy within a prison is feasible. CBSP therapy offers significant promise in the prevention of prison suicide and an adequately powered randomized controlled trial is warranted.

Keywords: Cognitive therapy; prison; randomized controlled trials; suicide prevention.

Publication types

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

MeSH terms

  • Adult
  • Affect
  • Attention
  • Cognition
  • Cognitive Behavioral Therapy / methods*
  • Depression / therapy*
  • England
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance*
  • Pilot Projects
  • Prisoners / psychology*
  • Problem Solving
  • Psychiatric Status Rating Scales
  • Self Concept
  • Self Report
  • Suicide / prevention & control*
  • Treatment Outcome
  • Young Adult

Associated data

  • ISRCTN/ISRCTN59909209