Thursday, February 7, 2019

Intervention for Suicidal Adolescents May Reduce Long-Term Mortality

Suicidal adolescents who took part in a program for which they chose several “caring adults” who stayed in regular contact with them and were supportive of their treatment were nearly seven times less likely to die during the follow-up of 11 years to 14 years, according to a study published Wednesday in JAMA Psychiatry.

The intervention is believed to be among the first aimed at suicidal adolescents that has shown a reduction in mortality, according to lead author Cheryl A. King, Ph.D., of the University of Michigan and colleagues.

The study was a secondary analysis of a trial involving more than 400 adolescents, aged 13 to 17, who were hospitalized on a psychiatric unit for serious, frequent thoughts about killing themselves or a suicide attempt. The original study comparing adolescents who received Youth-Nominated Support Team–Version II (YST)—a psychoeducational, social support intervention—with those in a control group found that YST was associated with a significant reduction in suicidal ideation.

With YST, the adolescents nominated three or four “caring adults,” such as parents, grandparents, coaches, teachers, parents of friends, and youth group leaders who attended a one-hour psychoeducational session. During the session, the adults learned about the youth’s treatment plan, suicide warning signs, how best to communicate with the adolescents, and ways to increase the likelihood of youth’s adherence to their treatment plan. The adults received weekly supportive calls from YST staff for three months and engaged in regular contact with the youth.

For the current study, King and colleagues examined the National Death Index and found there were 13 deaths among participants in the control group, compared with two deaths in the YST group, meaning that those in the control group had a nearly sevenfold higher risk of dying within the 11 years to 14 years of follow-up. The authors noted that although the confidence interval was wide (1.5-29.3), reflecting the relatively small number of deaths, even the lower end of the confidence interval indicated a 50% higher mortality in the control group. All deaths occurred when participants were between the ages of 18 years and 28 years.

When the authors looked only at suicide, there was not a significant difference between the groups (three suicides in the control group versus one suicide in the YST group). Most of the deaths in the control group (nine) were drug related or caused by drug overdose.

“Although YST was not associated with fewer deaths coded as suicides…, this secondary analysis of mortality outcomes indicates that YST may be associated with positive youth trajectories and reduced mortality. Future studies are needed to replicate our study findings and examine YST’s mechanisms of action, which are suggested by its psychoeducational component, its underlying social support conceptual model, and the study results indicating that YST was associated with more outpatient psychotherapy, medication follow-up, and drug treatment,” King and colleagues wrote.

For related information, please see the American Journal of Psychiatry article “Suicide Attempt Prevention: A Technology-Enhanced Intervention for Treating Suicidal Adolescents After Hospitalization.”

(Image: iStock/kali9)


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