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Randomized Controlled Trial
. 2017 Jun;56(6):506-514.
doi: 10.1016/j.jaac.2017.03.015. Epub 2017 Apr 5.

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial

Joan Rosenbaum Asarnow  1 , Jennifer L Hughes  2 , Kalina N Babeva  3 , Catherine A Sugar  3
Affiliations
Randomized Controlled Trial

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial

Joan Rosenbaum Asarnow et al. J Am Acad Child Adolesc Psychiatry. 2017 Jun.

Abstract

Objective: Suicide is a leading cause of death. New data indicate alarming increases in suicide death rates, yet no treatments with replicated efficacy or effectiveness exist for youths with self-harm presentations, a high-risk group for both fatal and nonfatal suicide attempts. We addressed this gap by evaluating Safe Alternatives for Teens and Youths (SAFETY), a cognitive-behavioral, dialectical behavior therapy-informed family treatment designed to promote safety.

Method: Randomized controlled trial for adolescents (12-18 years of age) with recent (past 3 months) suicide attempts or other self-harm. Youth were randomized either to SAFETY or to treatment as usual enhanced by parent education and support accessing community treatment (E-TAU). Outcomes were evaluated at baseline, 3 months, or end of treatment period, and were followed up through 6 to 12 months. The primary outcome was youth-reported incident suicide attempts through the 3-month follow-up.

Results: Survival analyses indicated a significantly higher probability of survival without a suicide attempt by the 3-month follow-up point among SAFETY youths (cumulative estimated probability of survival without suicide attempt = 1.00, standard error = 0), compared to E-TAU youths (cumulative estimated probability of survival without suicide attempt = 0.67, standard error = 0.14; z = 2.45, p = .02, number needed to treat = 3) and for the overall survival curves (Wilcoxon χ21 = 5.81, p = .02). Sensitivity analyses using parent report when youth report was unavailable and conservative assumptions regarding missing data yielded similar results for 3-month outcomes.

Conclusion: Results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm. This is the second randomized trial to demonstrate that treatment including cognitive-behavioral and family components can provide some protection from suicide attempt risk in these high-risk youths. Clinical trial registration information-Effectiveness of a Family-Based Intervention for Adolescent Suicide Attempters (The SAFETY Study); http://clinicaltrials.gov/; NCT00692302.

Keywords: nonsuicidal self-injuries; self-harm; suicidal attempts; treatment.

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Figures

Figure 1
Figure 1
Participant flow. Note: NSSI = non-suicidal self-injury; SA = suicide attempt; SAFETY = Safe Alternatives for Teens and Youths. aUnstable living situation, n = 13; psychosis, n = 3; substance abuse, n = 2; language, n = 2; age, n = 5; medical condition, n = 1; left emergency department/unit, n = 11; unknown/not reachable, n = 11. b n = 6 based on early report, within first 30 days.
Figure 2
Figure 2
Probability of survival without a suicide attempt. Note: E-TAU = enhanced treatment as usual; SAFETY = Safe Alternatives for Teens and Youths.
See this image and copyright information in PMC

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