Dr. Simon Hatcher
An interesting review article this month which is relevant to BEACON from the good folks at the Black Dog Institute. They did a systematic review looking at the different effects of treatment in men and women on suicidal ideas and behavior. The review was published in Archives of Suicide Research (http://dx.doi.org/10.1080/13811118.2016.1162246). The first finding was that only about one in five trials reported the effects of treatment on the different genders. None of the trials that I have done were included for this reason. (From memory I don’t think there were any sex differences but I’m going to go back and have a look. It wasn’t an outcome that we included in our protocol so will be a post hoc analysis). Of the 24 randomized controlled trials that reported effects in men and women the majority found no differences between the sexes. Also despite men making up about 75% of suicides in most countries they found only one study which had a male only sample. This study found no effect on suicidal behaviour of intensive case management compared to treatment as usual (de Leo and Heller 2007 a study of 60 men in Australian psychiatric units with suicidal ideas or behavior). Three out of 11 studies that looked at outcomes in both genders found an effect on suicidal behavior in women and not in men – two postcard studies and one study that looked at an assertive follow-up program.
This is clearly how suicide trials are going to advance in the next decade by tailoring interventions to particular groups rather than offering everyone the same treatment. Tailoring treatment to gender is one way to go. The authors here suggest that treatments with more of a “practical emphasis such as problem solving” as well as a bias towards the social benefits of help-seeking would be more likely to apply to appeal to men. They also suggest that treatments that encourage adherence in men are important. All these of cause are things we’ve tried to build into BEACON. The other important factor that our problem solving studies have demonstrated is the importance of a past history of self-harm. In the ACCESS study from New Zealand we found that problem solving therapy was effective in this group but not in first timers. When looking at treatment effects in different genders this also needs to be taken into account.