King, C. A., Arango, A., Kramer, A., Busby, D., Czyz, E., Foster, C. E., & Gillespie, B. W. (2019). Association of the youth-nominated support team intervention for suicidal adolescents with 11- to 14-year mortality outcomes.JAMA Psychiatry, 76(5), 492−498. Web.
This study investigated the efficacy of a psychoeducational intervention in reducing mortality among suicidal adolescents.
The proposed article first discusses the high adolescent suicide prevalence in the United States and globally. The authors acknowledge that the current understanding of effective dialectical behavioral or supportive therapy interventions is limited. Therefore, an RCT can provide the evidence base for greater utilization of youth-nominated support team (YST) intervention with high-risk adolescents. Mortality outcomes related to psychoeducation has not been measured previously. As a result, this study evaluated suicide-related deaths after the YST intervention.
The main aspects of the research design include:
- 448 adolescents aged 13-17 years were randomized into YST and control groups (King et al., 2019).
- The study used baseline and follow-up assessments (psychiatric health utilization).
- Specified inclusion criteria were used – suicidal thoughts or attempt within the last month.
- The YST intervention involved teachers or family members but the sessions are not indicated.
- Measures included self-reported suicidal ideation and attempts and deaths analyzed by the t-test and Chi-square test.
The authors covered three key topics, including:
- Common symptoms of youth hospitalized for suicide attempt and mortality risk.
- Therapeutic interventions for high-risk adolescents and those with self-injurious behavior.
- The YST design and potential to improve mortality and suicidal ideation outcomes.
The research established that the YST intervention significantly reduced reported mortality due to suicide compared to usual care (2 vs. 13), at twelve months follow-up (King et al., 2019). The authors attributed this difference to improved problem-solving in YST participants, decreasing suicidal ideation and attempt. As a result, they concluded that implementing YST psychoeducational intervention reduces the mortality risk in high-risk youth.
Hetrick, S. E., Yuen, H. P., Bailey, E., Cox, G. R., Templer, K., Rice, S. M., Bendall, S., & Robinson, J. (2017). Internet-based cognitive behavioural therapy for young people with suicide-related behaviour (Reframe-IT): A randomised controlled trial.Evidence-Based Mental Health, 20(3), 76−82. Web.
The study tested the effectiveness of cognitive-behavioral therapy in decreasing suicidal behaviors in students.
The article begins with a discussion of the prevalence of suicide among young people and associated negative outcomes. It examines the potential use of cognitive-behavioral therapy (CBT) in suicide prevention for adolescents. The study’s premise is that online CBT programs delivered by school staff could reduce suicidal ideation and depression in this group but the evidence is lacking. Consequently, the researchers developed Reframe-IT, which was found to be effective based on pilot study results.
The main components of the research methodology were:
- Participants were 50 students recruited from 18 Australian high schools randomized into control and intervention groups (Hetrick et al., 2017).
- Inclusion criteria were students aged 13-19 years, engaged by school staff, and with suicidal ideation history.
- Reframe-IT (eight modules) was delivered via a personalized web page for 10 weeks.
- Primary measures included suicide attempts, depressive signs, anxiety, and hopelessness.
- Descriptive statistics were used for data analysis of variables at baseline and 10 and 22 weeks post-intervention.
The main topics covered in this study were:
- Suicide-related behaviors, such as distress and suicidal ideation and attempt.
- Standard CBT approaches, including effective internet-based interventions designed for the youth.
- Outcomes of intervention use compared to usual care or controls.
In this study, the Reframe-IT group had better outcomes than the usual care arm. After the eight modules, suicidal ideation decreased significantly in the intervention subjects but distress did not differ substantially between the two groups. The researchers concluded that Reframe-IT engages adolescents optimally, which reduces suicidal thoughts and depression.
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial.JAMA Psychiatry, 75(8), 777−785. Web.
The study compared the outcomes of dialectical behavior therapy (DBT) and supportive therapy when used with suicidal adolescents.
The article is unique, as it evaluated a multicomponent CBT intervention (DBT) that included teaching emotion-regulation skills. The researchers first give statistics on rates of suicide-related deaths and then claim that DBT’s effectiveness has been demonstrated in suicidal adults. Therefore, they sought to compare its efficacy in high-risk adolescents against supportive therapy (ST) offered individually and in groups. They hypothesized that DBT would reduce suicide attempts and self-harming behaviors (SHB).
The design of this randomized control trial was as follows:
- 173 participants aged 12-18 years were recruited in 5 trial sites in the United States (McCauley et al., 2018).
- Adolescents gave informed assent or consent and were randomized into the ST group or DBT that included 7 telephone teaching sessions.
- Inclusion criteria were suicide attempt history, elevated suicidal thoughts, and repeated self-harm (McCauley et al., 2018).
- Measures included suicide attempts, SHB episodes, and mental disorders, and substance use.
- Data were analyzed using t-test, logistic regression, and intention-to-treat analyses.
The main topics covered in the study are:
- The prevalence of suicide and suicide-related behaviors – suicidal attempts and self-harm.
- Therapeutic interventions for decreasing suicide among the youth, including DBT.
- Evidence supporting the efficacy of DBT use with suicidal youth.
In this study, rates of self-harm and suicide attempt were significantly lower in DBT subjects than in ST participants at 12-months follow-up. The authors concluded that DBT delivered through telephone coaching is an empirically supported suicide prevention intervention for the youth.
Ghoncheh, R., Gould, M. S., Twisk, J. W. R., Kerkhof, A. J. M., & Koot, H. M. (2016). Efficacy of adolescent suicide prevention e-learning modules for gatekeepers: A randomized controlled trial.JMIR Mental Health, 3(1), e8. Web.
The study investigated the efficacy of gatekeeper training in preventing suicide among youth.
The article first gives global mortality rates, including suicide-related deaths. The authors note that professional gatekeepers – school staff and police – in contact with high-risk adolescents can help identify risk for suicide and intervene. Therefore, training them on symptom recognition, counseling, and referral can be an effective intervention.
The following research methodology was adopted in this study:
- 211 gatekeepers working with adolescents (12-20 years) were randomized into experimental and control groups (Ghoncheh et al., 2016).
- Inclusion criteria: Dutch speakers working with youth, including school nurses.
- The intervention involved 8 e-learning modules focusing on suicide risk factors.
- Pre-intervention, post-intervention, and follow-up assessments of perceived self-efficacy and self-confidence.
- Data analysis involved hierarchical linear modeling of the study variables.
The main topics covered in this study were:
- Gatekeeper training models and focus areas in adolescent suicide prevention.
- Types of gatekeepers that work with students, including academic staff.
- Effective delivery methods for gatekeeper training: face-to-face and web-based strategies.
The study’s results demonstrated that the gatekeepers’ perceived self-efficacy and self-confidence were significantly elevated in the intervention group at post-test and 3-month follow-up. The authors concluded that online training modules can support gatekeepers to prevent adolescent suicide due to their accessibility and flexibility.
Grupp-Phelan, J., Stevens, J., Boyd, S., Cohen, D. M., Ammerman, R. T., Liddy-Hicks, S., Heck, K., Marcus, S. C., Stone, L., Campo, J. V., & Bridge, J. A. (2019). Effect of a motivational interviewing-based intervention on initiation of mental health treatment and mental health after an emergency department visit among suicidal adolescents: A randomized clinical trial.JAMA Network Open, 2(12), e1917941. Web.
The study tested motivational interviewing (MI) as the basis for a psychoeducational intervention targeting high-risk youth.
The article first highlights the adolescent suicide problem in the United States. As such, prevention of suicide-related deaths is a priority. The authors note that referral to psychoeducational programs or other interventions is limited due to poor screening of suicide risk factors. Consequently, they sought to use MI to improve mental health utilization and outcomes.
The study’s methodology included the following components:
- 168 participants (12-17 years) visiting an Ohio academic emergency department (ED) were enrolled in intervention and control groups (Grupp-Phelan et al., 2019).
- The study was conducted in September 2018 to October 2019 period and included follow-up assessments.
- Outcome measures included suicidal thoughts and attempts and depressive symptoms.
- Data were analyzed by Chi-square tests and logistic regression models.
The main topics covered in this study were:
- Effectiveness of interventions for youth seeking ED care in hospitals.
- Screening for suicide risk factors and outpatient referral of suicidal youth.
The study found that MI can be an effective strategy for screening for suicide risk factors and referral to outpatient care. The authors conclude that youth presenting with nonpsychiatric complaints can be assessed for suicide-related behaviors and referred to mental health interventions, including psychoeducation.