Suicide Prevention Among Substance Abusing Homeless Youth
Condition: Suicide
MeSH terms: Suicide; Suicide Prevention
Study type: Interventional

Summary: 
      The literature is characterized by a dearth of information on interventions for homeless
      youth, and no suicide prevention intervention has been tested with these youth. Such focus is
      critical as suicide is the leading cause of death among homeless youth. Therefore, this study
      seeks to address this gap in the research literature with the goal to identify an effective
      strategy to intervene in suicide ideation in this population.
    

Detailed description: 
      While research on homeless youth is increasing, there is a dearth of information regarding
      effective interventions for these youth. This is of significant concern because studies
      indicate that 70-95% report problem alcohol or drug use and 66% to 89% of homeless youth have
      a mental health disorder. Suicide is the leading cause of death with up to 68% of youth
      reporting a lifetime suicide attempt. Among those who have attempted, an average of 6.2
      attempts is reported. In addition, lifetime suicide ideation rates have ranged from 14% to
      66.5%. Some predictors of suicide among homeless youth have been identified. These include
      substance use, childhood physical and sexual abuse, victimization experiences while living on
      the streets, and psychological functioning, including depression, hopelessness, distress
      tolerance, impulse control, social support, and problem solving. This study uses general
      cognitive theory, complemented with concepts from two suicide specific theoretical models, to
      guide our intervention and conceptual change model. Consonant with the pilot R34
      announcement, this study's goal is to pilot test an intervention that has previously
      demonstrated feasibility and promise with adolescent suicide attempters and efficacy with a
      low-income sample of adults, "The Cognitive Therapy Intervention for Suicide Attempters."
      One-hundred fifty homeless youth with recent severe suicide ideation will be randomly
      assigned to the experimental cognitive therapy for suicide prevention (CTSP) + services as
      usual (SAU) (n=75) or to SAU alone (n=75). SAU includes those services normally offered
      through a local drop-in center. Follow-up assessments will be conducted at 3, 6, and 9-months
      post-baseline. It is hypothesized that youth receiving CTSP+SAU will show greater reductions
      in suicide ideation (primary outcome), substance use and depressive symptoms (secondary
      outcomes) over time compared to SAU alone. Furthermore, theoretically-derived mediators will
      be tested to shed light on mechanisms associated with change. The data from this study will
      be used to determine the initial efficacy of this promising intervention, and determine
      whether findings warrant a broader scale effectiveness trial. Ultimately, attention towards
      reducing suicide risk among these youth has the potential to reduce premature mortality,
      hospitalization and loss of human capital in a very high risk population of youth.
    

Intervention name(s): Cognitive Therapy for Suicide Prevention; Services as Usual
Intervention type(s): Behavioral; Other
Intervention description(s): 10 sessions of cognitive therapy for suicide prevention provided, along with optional 9 booster sessions + SAU; Services as usually provided in the community
Other intervention name(s): CTSP; SAU
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment