***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Concerns have been expressed about the impact that screening for risk of suicide may have on a person 's mental health . AIMS To examine whether screening for suicidal ideation among people who attend primary care services and have signs of depression increases the short-term incidence of feeling that life is not worth living . METHOD In a multicentre , single-blind , r and omised controlled trial , 443 patients in four general practice s were r and omised to screening for suicidal ideation or control questions on health and lifestyle ( trial registration : IS RCT N84692657 ) . The primary outcome was thinking that life is not worth living measured 10 - 14 days after r and omisation . Secondary outcome measures comprised other aspects of suicidal ideation and behaviour . RESULTS A total of 443 participants were r and omised to early ( n = 230 ) or delayed screening ( n = 213 ) . Their mean age was 48.5 years ( s.d . = 18.4 , range 16 - 92 ) and 137 ( 30.9 % ) were male . The adjusted odds of experiencing thoughts that life was not worth living at follow-up among those r and omised to early compared with delayed screening was 0.88 ( 95 % CI 0.66 - 1.18 ) . Differences in secondary outcomes between the two groups were not seen . Among those r and omised to early screening , 37 people ( 22.3 % ) reported thinking about taking their life at baseline and 24 ( 14.6 % ) that they had this thought 2 weeks later . CONCLUSIONS Screening for suicidal ideation in primary care among people who have signs of depression does not appear to induce feelings that life is not worth living A total of 480 patients were treated in a large , multicenter r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behavior therapy ( MACT ) versus treatment as usual ( TAU ) for recurrent deliberate self-harm . Each patient was r and omized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year . The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year . A total of 60 % of those allocated to MACT had face-to-face treatment and 430 ( 90 % ) of all patients had self-harm data recorded after 1 year . Although the results showed no significant difference between those repeating self-harm in the MACT group ( 39 % ) compared with the TAU group ( 46 % ) ( P = 0.20 ) , the treatment was cost effective ( 10 % cheaper than TAU ) and the frequency of self-harm episodes was fewer ( 50 % ) in the MACT group . A total of nine of 10 patients had some personality disturbance ( 42 % of these with disorder ) , and for those where information on parasuicide events was collected , the proportion having a repeat episode ranged from 33 % to 63 % for different personality disorders . Those with BPD were most likely to repeat episodes quickly ( mean 89 days for 25 % to repeat ) with dissocial personality disorder ( equivalent mean 384 days ) the slowest to repeat . Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT ; this saving was reversed in those with borderline disorder . On average , MACT appeared to increase the cost of those patients with BPD ( BPD ) and reduce the cost of those with other personality disorders . It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD AIM The aim of the present study was to examine the intervention effects of intensive interpersonal psychotherapy for depressed adolescents with suicidal risk ( IPT-A-IN ) by comparison with treatment as usual ( TAU ) at schools . METHODS A total of 347 students from one-fifth of the classes of a high school in southern Taiwan completed the Beck Depression Inventory-II , the Beck Scale for Suicide Ideation , the Beck Anxiety Inventory and the Beck Hopelessness Scale for screening for suicidal risk . Of them , 73 depressed students who had suicidal risk on screening were r and omly assigned to the IPT-A-IN or TAU group . Analysis of covariance ( ANCOVA ) was performed to examine the effect of IPT-A-IN on reducing the severity of depression , suicidal ideation , anxiety and hopelessness . RESULTS Using the pre-intervention scores as covariates , the IPT-A-IN group had lower post-intervention severity of depression , suicidal ideation , anxiety and hopelessness than the TAU group . CONCLUSION Intensive school-based IPT-A-IN is effective in reducing the severity of depression , suicidal ideation , anxiety and hopelessness in depressed adolescents with suicidal risk PURPOSE We wanted to determine whether an educational intervention targeting general practitioners reduces the 2-year prevalence of depression and self-harm behavior among their older patients . METHODS Our study was a cluster r and omized controlled trial conducted between July 2005 and June 2008 . We recruited 373 Australian general practitioners and 21,762 of their patients aged 60 years or older . The intervention consisted of a practice audit with personalized automated audit feedback , printed educational material , and 6 monthly educational newsletters delivered over a period of 2 years .  Control physicians completed a practice audit but did not receive individualized feedback . They also received 6 monthly newsletters describing the progress of the study , but they were not offered access to the educational material about screening , diagnosis and management of depression , and suicide behavior in later life . The primary outcome was a composite measure of clinical ly significant depression ( Patient Health Question naire score ≥10 ) or self-harm behavior ( suicide thoughts or attempt during the previous 12 months ) . Information about the outcomes of interest was collected at the baseline assessment and again after 12 and 24 months . We used logistic regression models to estimate the effect of the intervention in a complete case analysis and intention-to-treat analysis by imputed chain equations ( primary analysis ) . RESULTS Older adults treated by general practitioners assigned to the intervention experienced a 10 % ( 95 % CI , 3%–17 % ) reduction in the odds of depression or self-harm behavior during follow-up compared with older adults treated by control physicians . Post hoc analyses showed that the relative effect of the intervention on depression was not significant ( OR = 0.93 ; 95 % CI , 0.83–1.03 ) , but its impact on self-harm behavior over 24 months was ( OR = 0.80 ; 95 % CI , 0.68–0.94 ) . The beneficial effect of the intervention was primarily due to the relative reduction of self-harm behavior among older adults who did not report symptoms at baseline . The intervention had no obvious effect in reducing the 24-month prevalence of depression or self-harm behavior in older adults who had symptoms at baseline . CONCLUSIONS Practice audit and targeted education of general practitioners reduced the 2-year prevalence of depression and self-harm behavior by 10 % compared with control physicians . The intervention had no effect on recovery from depression or self-harm behavior , but it prevented the onset of new cases of self-harm behavior during follow-up . Replication of these results is required before we can confidently recommend the roll-out of such a program into normal clinical practice CONTEXT Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention , yet no study has directly addressed the potential harm of suicide screening . OBJECTIVE To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms , substance use problems , or suicide attempts . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled study conducted within the context of a 2-day screening strategy . Participants were 2342 students in 6 high schools in New York State in 2002 - 2004 . Classes were r and omized to an experimental group ( n = 1172 ) , which received the first survey with suicide questions , or to a control group ( n = 1170 ) , which did not receive suicide questions . MAIN OUTCOME MEASURES Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version ( POMS-A ) instrument . Suicidal ideation assessed in the second survey . RESULTS Experimental and control groups did not differ on distress levels immediately after the first survey ( mean [ SD ] POMS-A score , 5.5 [ 9.7 ] in the experimental group and 5.1 [ 10.0 ] in the control group ; P = .66 ) or 2 days later ( mean [ SD ] POMS-A score , 4.3 [ 9.0 ] in the experimental group and 3.9 [ 9.4 ] in the control group ; P = .41 ) , nor did rates of depressive feelings differ ( 13.3 % and 11.0 % , respectively ; P = .19 ) . Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students ( 4.7 % and 3.9 % , respectively ; P = .49 ) . High-risk students ( defined as those with depression symptoms , substance use problems , or any previous suicide attempt ) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group ; on the contrary , depressed students and previous suicide attempters in the experimental group appeared less distressed ( P = .01 ) and suicidal ( P = .02 ) , respectively , than high-risk control students . CONCLUSIONS No evidence of iatrogenic effects of suicide screening emerged . Screening in high schools is a safe component of youth suicide prevention efforts The purpose of this study was to examine the efficacy of the Youth-Nominated Support Team-Version II ( YST-II ) for suicidal adolescents , an intervention based on social support and health behavior models , which was design ed to supplement st and ard treatments . Psychiatrically hospitalized and suicidal adolescents , 13 - 17 years of age , were r and omly assigned to treatment-as-usual ( TAU ) + YST-II ( n = 223 ) or TAU only ( n = 225 ) . YST-II provided tailored psychoeducation to youth-nominated adults in addition to weekly check-ins for 3 months following hospitalization . In turn , these adults had regular supportive contact with adolescents . Adolescents assigned to TAU + YST-II had an average of 3.43 ( SD = 0.83 ) nominated adults . Measures included the Suicidal Ideation Question naire-Junior ( SIQ-JR ; W. M. Reynolds , 1988 ) , Children 's Depression Rating Scale-Revised ( E. O. Poznanski & H. B. Mokros , 1996 ) , Beck Hopelessness Scale ( A. T. Beck & R. A. Steer , 1993 ) , and Child and Adolescent Functional Assessment Scale ( CAFAS ; K. Hodges , 1996 ) . YST-II had very limited positive effects , which were moderated by history of multiple suicide attempts , and no negative effects . It result ed in more rapid decreases in suicidal ideation ( SIQ-JR ) for multiple suicide attempters during the initial 6 weeks after hospitalization ( small-to-moderate effect size ) . For nonmultiple attempters , it was associated with greater declines in functional impairment ( CAFAS ) at 3 and 12 months ( small effect sizes ) . YST-II had no effects on suicide attempts and no enduring effects on SIQ-JR scores AIM Suicide attempt , ideation and deliberate self-harm are common among adolescents . Limited evidence exists regarding interventions that can reduce risk ; however , research indicates that maintaining contact with at-risk adults following discharge from services via letter or postcard can reduce risk . The aim of the study was to test a postcard intervention among people aged 15 - 24 who presented to mental health services but were not accepted , yet were at risk of suicide . METHODS A r and omized controlled trial of 3 years in duration was used . The intervention consisted of 12 postcards sent once a month for 12 months following presentation to the service . Key outcomes of interest were reduced rates of suicide attempt , suicidal ideation and deliberate self-harm , assessed at 12 and 18 months . RESULTS Participants reported that they liked receiving the postcard and that they used the strategies recommended . However , no significant effect of the postcard intervention was found on suicide risk , although participants in both groups improved on measures of mental health over the course of the study . CONCLUSIONS There remains a need for further research into youth-friendly interventions for young people at risk of suicide BACKGROUND Repetition of self-poisoning is common . AIMS To report the 24-month outcomes of a non-obligatory postcard intervention ( plus treatment as usual ) compared with treatment as usual . METHOD In a r and omised-controlled trial ( Zelen design ) conducted in Newcastle , Australia , eight postcards were sent to participants over a 12-month period . The principal outcomes were the proportion of participants with one or more repeat episodes of self-poisoning and the number of repeat episodes per person . RESULTS No significant reduction was observed in the proportion of people repeating self-poisoning in the intervention group ( 21.2 % , 95 % CI 17.0 - 25.3 ) compared with the control group ( 22.8 % , 95 % CI 18.7 - 27.0 ; chi(2)=0.32 , d.f.=1 , P=0.57 ) ; the difference between groups was -1.7 % ( 95 % CI - 
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DATA SYNTHESIS Evidence was insufficient to determine the benefits of screening in primary care population s ; very limited evidence identified no serious harms .
Minimal evidence suggested that screening tools can identify some adults at increased risk for suicide in primary care , but accuracy was lower in studies of older adults .
Minimal evidence limited to high-risk population s suggested poor performance of screening instruments in adolescents .
Trial evidence showed that psychotherapy reduced suicide attempts in high-risk adults but not adolescents .
Primary care-feasible screening tools might help to identify some adults at increased risk for suicide but have limited ability to detect suicide risk in adolescents .
Psychotherapy may reduce suicide attempts in some high-risk adults , but effective interventions for high-risk adolescents are not yet proven .