TY - JOUR
T1 - Protecting adolescents from self-harm
T2 - A critical review of intervention studies
AU - Brent, David A.
AU - McMakin, Dana L.
AU - Kennard, Betsy D.
AU - Goldstein, Tina R.
AU - Mayes, Taryn L.
AU - Douaihy, Antoine B.
N1 - Funding Information:
This work was supported by the National Institute of Mental Health (NIMH) grants MH056612, MH61835, MH018951, MH064503, MH065368, MH084916, MH092400, MH039188, DA032505, MH091177, and MH092424.
Funding Information:
Disclosure: Dr. Brent has received research support from NIMH, and royalties from Guilford Press and from the electronic self-rated version of the Columbia Suicide Severity Rating Scale (C-SSRS) from ERT, Inc. He serves as an UpToDate Psychiatry editor. Dr. McMakin has received research support from NIMH. Dr. Goldstein has received research support from NIMH and the National Institute on Drug Abuse; and royalties from Guilford Press. Drs. Kennard and Douaihy, and Ms. Mayes report no biomedical financial interests or potential conflicts of interest.
PY - 2013/12
Y1 - 2013/12
N2 - Objective To review the studies that test treatments targeting adolescent suicidal ideation, suicide attempts, or self-harm, and to make recommendations for future intervention development. Method The extant randomized clinical trials that aim to reduce the intensity of suicidal ideation or the recurrence of suicide attempts or self-harm were reviewed with respect to treatment components, comparison treatments, sample composition, and outcomes. Results The majority of studies that showed any effect on suicidal ideation, attempts, or self-harm had some focus on family interactions or nonfamilial sources of support. Two of the most efficacious interventions also provided the greatest number of sessions. Some other treatment elements associated with positive effects include addressing motivation for treatment and having explicit plans for integrating the experimental treatment with treatment as usual. In many studies, suicidal events tend to occur very early in the course of treatment prior to when an effective "dose" of treatment could be delivered. Important factors that might mitigate suicidal risk, such as sobriety, healthy sleep, and promotion of positive affect, were not addressed in most studies. Conclusion Interventions that can front-load treatment shortly after the suicidal crisis, for example, while adolescent suicide attempters are hospitalized, may avert early suicidal events. Treatments that focus on the augmentation of protective factors, such as parent support and positive affect, as well as the promotion of sobriety and healthy sleep, may be beneficial with regard to the prevention of recurrent suicidal ideation, attempts, or self-harm in adolescents.
AB - Objective To review the studies that test treatments targeting adolescent suicidal ideation, suicide attempts, or self-harm, and to make recommendations for future intervention development. Method The extant randomized clinical trials that aim to reduce the intensity of suicidal ideation or the recurrence of suicide attempts or self-harm were reviewed with respect to treatment components, comparison treatments, sample composition, and outcomes. Results The majority of studies that showed any effect on suicidal ideation, attempts, or self-harm had some focus on family interactions or nonfamilial sources of support. Two of the most efficacious interventions also provided the greatest number of sessions. Some other treatment elements associated with positive effects include addressing motivation for treatment and having explicit plans for integrating the experimental treatment with treatment as usual. In many studies, suicidal events tend to occur very early in the course of treatment prior to when an effective "dose" of treatment could be delivered. Important factors that might mitigate suicidal risk, such as sobriety, healthy sleep, and promotion of positive affect, were not addressed in most studies. Conclusion Interventions that can front-load treatment shortly after the suicidal crisis, for example, while adolescent suicide attempters are hospitalized, may avert early suicidal events. Treatments that focus on the augmentation of protective factors, such as parent support and positive affect, as well as the promotion of sobriety and healthy sleep, may be beneficial with regard to the prevention of recurrent suicidal ideation, attempts, or self-harm in adolescents.
KW - prevention
KW - psychotherapy
KW - suicide
KW - suicide attempt
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U2 - 10.1016/j.jaac.2013.09.009
DO - 10.1016/j.jaac.2013.09.009
M3 - Review article
C2 - 24290459
AN - SCOPUS:84889007186
SN - 0890-8567
VL - 52
SP - 1260
EP - 1271
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 12
ER -