Effects of the Collaborative Assessment and Management of Suicidality (CAMS) Model: A Secondary Analysis of Moderation and Influencing Factors

Abstract

In a randomized controlled trial, we found that suicidal patients who received Collaborative Assessment and Management of Suicidality (CAMS) reported greater improvements in suicidal ideation and mental health distress compared to participants who received treatment as usual (TAU). Here, we explored moderators and mediators of the effectiveness of CAMS. Compared to TAU, CAMS was more effective in reducing suicidal ideation when the working alliance, in particular its bond subcomponent, was low. In terms of reducing mental health distress, CAMS was superior to TAU only for participants who did not use illicit drugs and, more tentatively, only for patients without borderline personality traits. We suggest that CAMS may repair a difficult vantage point in terms of poor working alliance in patients with suicide ideation. To obtain superior benefits of CAMS upon more general mental health distress in patients with drug abuse or borderline traits, these problems may need to be more explicitly targeted in parallel.

Keywords:

• Collaborative Assessment and Management of Suicidality (CAMS)
• randomized controlled trial
• moderator effects
• working alliance
• suicidality

ACKNOWLEDGMENTS

The authors thank all patients and personnel who participated in the trial. Thanks to Inge W. Brorson and Paul Møller for contributions to study logistics, to Merete Kvalsvik Carlsson, Marit Dullum, Christine Soot Sandli, and Rita Cecilie Skinstad-Bermingrud for performing patient interviews, and to Suzanne Moore for data preparation.

DISCLOSURE STATEMENT

None. This trial was an independent investigation.

Additional information

Funding

This work was supported by the South-Eastern Norway Regional Health Authority under Grant 2014/110 and the Vestre Viken internal research fund.

Notes on contributors

Wenche Ryberg

Wenche Ryberg, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.

Lien My Diep

Lien My Diep, Oslo Centre for Biostatistics & Epidemiology (OCBE), Oslo University Research Hospital, Oslo, Norway.

Nils Inge Landrø

Nils Inge Landrø, Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway.

Roar Fosse

Roar Fosse, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.