62 Outcomes from a randomized controlled trial of a brief virtual group intervention for adolescents with mild to moderate suicidal ideation and their caregivers: The BRAVA study
Authors: Gray Clare , Cloutier Paula , Kennedy Allison , Sheridan Nicole 
Published: October 2024

Abstract

Background
Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a brief virtual group intervention designed for adolescents with mild to moderate suicidal ideation (SI) and their caregivers. The goal of BRAVA is to reduce SI in adolescents and increase family connection. The intervention consists of six independent, 90 minute modules that are delivered in a group setting on a weekly basis. Independent modules allow for rolling admission thereby reducing wait time to start the intervention. The modules include components of Dialectical Behaviour Therapy. Attachment Based Family Therapy, Cognitive Behavioral Therapy, Collaborative Problem Solving and psychoeducation. Adolescents and their parents attend separate groups. Adolescents focus on emotional regulation, coping skills, managing crisis situations and caregivers focus on connecting with their teen, validation and crisis management

Objectives
This randomized controlled trial (RCT) assessed the efficacy of BRAVA in reducing symptoms of SI, depression and anxiety in adolescents, and improving life stress and competency in caregivers.

Design/Methods
Ninety-nine eligible youth (13-17.5 years) presenting with mild to moderate SI (rated 1 on the suicide item of HEADS-ED MH screening tool) and their caregivers were recruited from hospital and community services. Families were randomized to BRAVA (n=50) or the control group (n=49). The control group intervention consisted of weekly text messages and the opportunity to join the BRAVA group post-exit assessment). Outcome measures were administered at intake and exit for adolescents (Suicidal Ideation Questionnaire-Junior, SIQ-JR; Revised Children’s Anxiety and Depression Scale, RCADS) and caregivers (Perceived Stress Scale, PSS; Parent Sense of Competency Scale, PSOC). Outcomes were analyzed using repeated measures of multivariable analysis of variance (MANOVA).

Results
Preliminary analyses showed no significant differences between groups at intake for any demographic or clinical variables. Most adolescents and caregivers completed their exit assessment (nBRAVA=37; nControl=39). Adolescents and caregivers attended a median of six and five groups, respectively. Comparing to the control group, BRAVA was superior in reducing SI (p = 0.05) and depression (p = 0.005) in adolescents and caregiver life stress (p = 0.026). Preliminary MANOVA of adolescent outcomes were significant for time [p &lt;0.01, Effect size (ES) = 0.98] and between groups (p = 0.03, ES = 0.11). Caregiver outcomes were significant for time (p=0.051, ES=0.70).

Conclusion
This study demonstrates that a brief virtual group intervention can have a significant impact on adolescent SI and depression compared to an enhanced treatment as usual control group. In addition, BRAVA can reduce caregiver perceived stress, helping them view their lives as less unpredictable, uncontrollable and overloaded.