Preventing Youth Suicide in Primary Care: A Family Model

Study Overview
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Brief Summary
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The purpose of the study is to test the efficacy of a brief family therapy (Attachment-Based Family Therapy) for youth presenting in primary care with suicidal ideation and depressed mood.

Detailed Description
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Youth suicide is a serious public health problem and clinical challenge for medical and behavioral health providers, yet few preventive interventions have been tested for this population. This project addresses this deficit by testing the efficacy of a brief family therapy for adolescents presenting with serious risk for suicide in a primary care setting. Several innovations characterize the study. First, patients will be identified and treated directly in the primary care setting. Integrating behavioral health services into primary care may a) reduce burden on physicians by promoting parents as safety monitors, b) increase behavioral health treatment adherence, and c) address many underlying family problems associated with suicide. Second, to identify seriously at risk adolescents, we will assess for severe and persistent suicidal ideation and co-occurring depression. Patients will need to score above clinical cutoffs on both ideation (SIQ-JR > 31) and depression (BDI-II >20) at two consecutive appointments (generally within 3 days of each other). Third, treatment will target two of the most critical suicide risk factors: depression and family conflict. Depression is the most consistently associated risk factor for suicide and family conflict is the most common precipitant of completed suicide (20%) and non-fatal suicidal episodes (50%). Fourth, we will use Attachment Based Family Therapy (ABFT; Diamond et al., 2002) as the intervention approach, an efficacious and manualized family therapy model specifically designed for adolescent depression. ABFT has been successful in reducing suicidal ideation, hopelessness, depression, anxiety, and family conflict. Participants will be recruited from the primary care centers at The Children's Hospital of Philadelphia. Eighty-seven percent of patients are African American and 60% are girls. One hundred adolescents will be randomized to 6 to 10 weeks of either ABFT or Enhanced Usual Care (EUC). Patients will be evaluated at baseline 6, 12, 24, and 52 weeks.

Official Title
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Preventing Youth Suicide in Primary Care: A Family Model

Conditions
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Suicide

Intervention / Treatment
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* Behavioral: Attachment-Based Family Therapy
* Behavioral: Enhanced Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Suicidal ideation (SIQ-JR > 30) Moderate depressed mood (BDI-II > 19) At least one parent/caregiver willing to participate Exclusion Criteria: Psychosis Mental retardation or other significant cognitive impairment

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Attachment-Based Family Therapy | Behavioral: Attachment-Based Family Therapy<br>* 12-16 week family-based therapy<br>|
| Active Comparator: 2<br>Enhanced Usual Care | Behavioral: Enhanced Usual Care<br>* Rapid referral to community outpatient care with weekly monitoring of symptoms by study team<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Suicidal Ideation Questionnaire - JR (SIQ-JR) |  | Baseline, 6 weeks, 12 weels, 24 weeks | 
| Beck Depression Inventory - II (BDI-II) |  | Baseline, 6 weeks, 12 weeks, 24 weeks | 
| Scale for Suicidal Ideation (SSI) |  | baseline, 6 weeks, 12 weeks, 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment retention | Number of treatment sessions attended. | 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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youth suicide, family therapy, primary care, intervention