Gratitude diary for the management of suicidal inpatients: A randomized controlled trial
Open accessAbstract
Background The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies. Methods We conducted a randomized controlled trial based on a 7-day add-on positive psychology program: gratitude diary (intervention) versus food diary (control) in adults hospitalized for current suicidal ideation or a suicide attempt. The primary effectiveness outcome was between-group differences for mean change of current psychological pain, between the beginning and the end of the 7-day intervention. We measured between-group differences for mean change of suicidal ideation, hopelessness and optimism, and depression and anxiety between inclusion and after the completion of the 7-day intervention. We compared mean change of current psychological pain, suicidal ideation, and hopelessness and optimism between immediate pre and post daily journal completion. Results Two hundred and one participants were enrolled and randomized. Between pretherapy and posttherapy: There were no significant between-group differences for mean change of severity and intensity of suicidal ideation and current hopelessness. Between-group difference for mean change of current psychological pain was trending (P = 0.05). Mean change of depression, anxiety, and optimism was significantly higher in the intervention than in the control group. Between immediate pre and post daily journal completion: Between-group differences favored gratitude (vs. food) diary for all outcomes (psychological pain, suicidal ideation, and hopelessness and optimism; P < 10−3). Participants found the intervention to be more useful than the food diary. Conclusions Through gratitude diary appears a very straightforward intervention that could be developed as an adjunctive strategy for suicidal patients.
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Mindfulness-based gratitude diaries significantly decreased, immediately but transiently, psychological pain and suicidal ideation among inpatients.
“Subsequent studies by Ducasse et al. [39] showed that mindfulness-based gratitude diaries significantly decreased, immediately but transiently, psychological pain (t = 6.65, p < 0.001) and suicidal ideation (t = 4.34, p < 0.001) among inpatients.”
From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [39]
Table 3 reports significant immediate pre-to-post diary differences favoring gratitude over the food diary for psychological pain (t = 6.65) and suicidal ideation (t = 4.34), both p < 0.001, among hospitalized patients. The Methods describe a gratitude journal, not a mindfulness-based intervention. The paper does not establish that the immediate effects were transient; its seven-day comparison found no significant between-group difference in suicidal ideation and only a borderline difference in psychological pain. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOther studies using third-generation psychotherapies showed the reduction in psychological pain with a large effect size, although not targeting it specifically.
“Other studies using third-generation psychotherapies [38,39,40] showed the reduction in psychological pain with a large effect size, although not targeting it specifically.”
From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [39]
The Results (section 3.4, Table 3) report a large immediate reduction in psychological pain after gratitude-diary completion relative to the food diary (d = −0.94). But the seven-day between-group effect was smaller (d = 0.29; section 3.3, Table 2), and the Introduction explicitly names reducing psychological pain as an aim of the study. The claim is therefore supported for the immediate effect, but not as an unqualified large effect or as an outcome the study did not specifically target. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe reviewed studies show that both psychological pain and suicidal ideation were reduced after intervention.
“The reviewed studies show that both psychological pain and suicidal ideation were reduced after intervention [38,39,40,43,50,52].”
From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [39]
The few studies conducted with suicidal populations have utilized gratitude exercises and have yielded mixed findings, with one study showing favorable effects on suicidal ideation compared to a food diary in inpatient adults.
“The few studies conducted with suicidal populations (not included in the meta-analyses) have utilized gratitude exercises and have yielded mixed findings with one study showing favorable effects on suicidal ideation, compared to a food diary, in inpatient adults [36].”
From Skills to Enhance Positivity in adolescents at risk for suicide: Protocol for a randomized controlled trial (2023) · cites this paper as [36]
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- Authors
- Ducasse, D., Dassa, D., Courtet, P., Brand‐Arpon, V., Walter, A., Guillaume, S., Jaussent, I., & Olié, E.
- Affiliations
- Inserm (FR)
- Hôpital Lapeyronie (FR)
- CHU MontpellierLapeyronie HospitalDepartment of Emergency Psychiatry and Post Acute CareCHRU Montpellier Montpellier France
- Corresponding author
- Ducasse, Déborah
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2019-01-18
- Volume
- 36
- Issue
- 5
- Pages
- 400-411
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2908717510
- Cited by
- 44
- References
- 53
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 8 · 2020: 5 · 2019: 2
- FWCI
- 7.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Keywords
- suicidal ideation, suicide attempts, hospitalized patients, positive psychology interventions, psychological suffering, hopelessness, optimism, depression, anxiety, food diary, adjunctive therapy
- MeSH terms
- Optimism, Diaries as Topic, Suicide Prevention, Adult, Female, Humans, Inpatients, Male, Psychotherapy, Suicidal Ideation, Hope
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