TY - JOUR
T1 - Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention
T2 - A Randomized Controlled Trial
AU - Asarnow, Joan Rosenbaum
AU - Hughes, Jennifer L.
AU - Babeva, Kalina N.
AU - Sugar, Catherine A.
N1 - Publisher Copyright:
© 2017 American Academy of Child and Adolescent Psychiatry
PY - 2017/6
Y1 - 2017/6
N2 - 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
AB - 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
KW - nonsuicidal self-injuries
KW - self-harm
KW - suicidal attempts
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85018648506&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85018648506&partnerID=8YFLogxK
U2 - 10.1016/j.jaac.2017.03.015
DO - 10.1016/j.jaac.2017.03.015
M3 - Article
C2 - 28545756
AN - SCOPUS:85018648506
SN - 0890-8567
VL - 56
SP - 506
EP - 514
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 6
ER -