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Randomized Controlled Trial
. 2019 Jul;58(7):721-731.
doi: 10.1016/j.jaac.2018.10.006. Epub 2018 Oct 30.

A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal

Guy S Diamond  1 , R Roger Kobak  2 , E Stephanie Krauthamer Ewing  3 , Suzanne A Levy  3 , Joanna L Herres  4 , Jody M Russon  5 , Robert J Gallop  6
Affiliations
Randomized Controlled Trial

A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal

Guy S Diamond et al. J Am Acad Child Adolesc Psychiatry. 2019 Jul.

Abstract

Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents' suicide ideation and depressive symptoms.

Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms.

Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, ≥50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST.

Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators.

Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.

Keywords: attachment; depression; suicide; treatment.

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Figures

Figure 1:
Figure 1:
CONSORT Table Note: ABFT = Attachment-based Family Therapy; FE-NST = Family Enhanced Non-Directive Supportive Therapy.
Figure 2:
Figure 2:
Suicide Ideation by Treatment Condition at Weeks 0, 4, 8, 12 and 16 Note: ABFT = Attachment-based Family Therapy; NST = Non-Directive Supportive Therapy; SID-JR = Suicidal Ideation Questionnaire-Jr
Figure 3:
Figure 3:
Depressive Symptoms by at Weeks 0, 4, 8, 12, and 16 Note: ABFT = Attachment-based Family Therapy; BDI = Beck Depression Inventory II; NST = Non-Directive Supportive Therapy.
See this image and copyright information in PMC

Comment in

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