Efficacy of a problem-solving intervention for the indicated prevention of suicidal risk in young Brazilians: Randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the efficacy of a problem-solving intervention for the prevention of suicidal risk in Brazilian adolescents with elevated suicidal potential and depressive symptoms. METHODS: A randomized controlled trial was conducted involving 100 participants (mean age 17.2 years, 60% women, 46% mixed race), allocated to the problem-solving intervention (n = 50) or the usual care control group (n = 50). Blinded interviewers conducted assessments at pretreatment, posttreatment, 1, 3, and 6 months of follow-up. The main outcome was suicidal orientation; secondary outcomes were suicidal risk, suicidal plans and attempts, depressive symptoms, and problem-solving skills. RESULTS: At posttreatment and up to 6-month follow-up, there was lower suicidal orientation and suicidal risk in the problem-solving group compared to the control group. There were lower suicidal plans and attempts (0.0% participants vs 2.2% with a suicide plan and 2.2% with both suicide plan and attempt); risk difference was 0.04 (95% CI: 0.01-0.09) and the number needed to treat was 25 (95% CI: 11-70). Significant effects of the intervention on depressive symptoms were found at posttreatment and maintained for 6 months. The change in global and functional problem-solving skills mediated the reduction in suicide orientation. CONCLUSIONS: Thus, suicidal risk can be successfully prevented in adolescents.

Evaluación de la eficacia de un programa preventivo para la depresión en adolescentes de sexo femenino / Evaluation of the efficacy of a prevention program for depression in female adolescents

Se evalúa el efecto de un programa preventivo de depresión aplicado a adolescentes de sexo femenino que cursaban primero medio. Este programa fue implementado en dos modalidades: 1) Indicada, aplicado a participantes con sintomatología depresiva subumbral (grupo experimental n=101; grupo control n=108), y 2) Universal, aplicado a cursos completos sólo de niñas (grupo experimental=119 participantes; grupo control n=118). El programa tuvo 11 sesiones, de 1,5 hora de duración, con 15 a 23 participantes por grupo. Se evaluó el efecto del programa en depresión, en ansiedad, conductas de autodaño y conductas externalizadas. El programa no mostró efectos en ninguna de sus dos modalidades de implementación. La modalidad indicada fue más satisfactoria para las participantes. Se comentan las limitaciones del estudio y sus proyecciones para el desarrollo de programas preventivos.

This study assesses the impact of a preventive program of depression in female adolescents from first grade of secondary school. The program was implemented in two ways: 1) Indicated: Applied to patients with subthreshold depressive symptoms (experimental group N=101; control group N=108) 2) Universal applied to a class comprised only by girls (experimental group=119; control group N=118). The program had 11 sessions, that lasted 1,5 hours each, with 15 to 23 participants per group. The impact of the program was measured in terms of anxiety, self-damage behavior, and externalized behavior. The program did not show effects in any of the two modalities. The Indicated modality obtained more satisfaction in the group of participants. The limitations of the study and implications for preventive programs in mental health are discussed.

Terapias motivacionales breves: diferencias entre la aplicación individual y grupal para la moderación del consumo de alcohol y de las variables psicológicas asociadas al cambio / Brief motivational therapy: differences between individual and group application for the moderation in alcohol consumption and other psychological variables associated with change / Terapias de motivação breves: diferencias entre a aplicação individual e grupal para a moderação do consumo de álcool e das variáveis psicológicas associadas á mudança

Se realizó un estudio de corte empírico-analítico, siguiendo un diseño cuasi experimental, con el fin de someter a prueba y evaluar el impacto de un programa motivacional de terapia breve para el control del consumo de alcohol en bebedores perjudiciales. La variable independiente fue el programa de intervención, estructurado con base en principios de entrevista motivacional y de autocontrol cognitivo. La variable dependiente estuvo constituida por indicadores de consumo (intensidad, frecuencia y riesgo), la etapa motivacional ante el cambio, el estado de los procesos de cambio y las expectativas acerca del consumo. La medición de todas las variables se realizó en tres momentos a través del uso de instrumentos previamente validados: a) preintervención, b) al finalizar la intervención y c) cinco semanas después de terminar el tratamiento. Participaron 180 estudiantes universitarios previamente detectados como bebedores perjudiciales, quienes fueron asignados al azar a uno de tres grupos: a) terapia motivacional individual, b) terapia motivacional grupal y c) ausencia de terapia. Se observó que ambas terapias motivacionales (individual y grupal) condujeron a una disminución significativa en los indicadores de consumo y a una mejoría en el uso de los procesos de cambio responsables del mismo. Sin embargo, la intervención grupal condujo a un impacto superior al de la intervención individual en aspectos como: a) frecuencia de consumo, b) autoeficacia ente situaciones de alto riesgo de consumo, c) percepción de vulnerabilidad y daño y d) uso de procesos conductuales asociados al cambio y al mantenimiento del mismo.

An empirical-analytic study was carried out using a quasi-experimental design with the aim of testing and assessing the impact of a brief intervention motivational program for the control of alcohol consumption in problem drinkers. The independent variable in this study was the intervention program, as structured upon the principles of motivational interviewing and cognitive self-control. Indicators of consumption (intensity, frequency, and risk) were the dependent variable, as were the motivational stage towards change, the state of change processes, and the expectations on consumption. Measurement of all variables was carried out with the use of previously validated instruments in three moments: a) pre-intervention; b) end of intervention and; c) five weeks after treatment. 180 college students, previously detected as heavy drinkers were randomly assigned to one of three groups: (a) Individual motivational interviewing, (b) Group motivational interviewing, and (c) no intervention. Both of the motivational interventions (individual and group) led to a significant decrease in indicators of consumption and to an improvement in the use of those change processes responsible for it. Nevertheless, group intervention led to a more significant impact than individual intervention in aspects such as: (a) consumption frequency and intensity; (b) self-efficacy in situations of a high consumption risk; (c) perception of vulnerability and damage; and (d) use of behavioral processes associated with change and its maintenance.

A fim de provar e avaliar o impacto de um programa motivacional de terapia breve para controlar o consumo de álcool em bebedores prejudiciais levou-se a cabo um estudo empírico-analítico com desenho quase experimental. O programa de intervenção constituiu a variável independente, baseado em princípios de entrevista motivacional e de autocontrole cognitivo. A variável dependente foram os indicadores de consumo (intensidade, freqüência e risco), etapa motivacional ante a mudança, estado dos processos da mudança e expectações acerca do consumo. As variáveis foram medidas em três momentos com instrumentos validados previamente: 1. pré-intervenção, 2. ao finalizar a intervenção e 3. cinco semanas depois de acabado o tratamento. No estudo participaram 180 estudantes universitários detectados previamente como bebedores prejudiciais, designados aleatoriamente a uno de três grupos: 1. terapia motivacional individual, 2. terapia motivacional grupal e 3. ausência de terapia. Ambas as terapias motivacionais (individual e grupal) levaram à redução importante dos indicadores de consumo e a melhorar o uso dos processos de mudança responsáveis do consumo. No entanto, a intervenção grupal conduziu a um impacto maior do que a intervenção individual em aspetos como freqüência de consumo, auto-eficácia em situações de alto risco de consumo, percepção de vulnerabilidade e dano, e uso de processos comportamentais associados à mudança e à conservação desta.