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

Joan Rosenbaum Asarnow, Jennifer L. Hughes, Kalina N. Babeva, Catherine A. Sugar

Research output: Contribution to journalArticle

39 Citations (Scopus)

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 χ2 1 = 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

Original languageEnglish (US)
Pages (from-to)506-514
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume56
Issue number6
DOIs
StatePublished - Jun 1 2017

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Suicide
Randomized Controlled Trials
Therapeutics
Numbers Needed To Treat
Survival Analysis

Keywords

  • nonsuicidal self-injuries
  • self-harm
  • suicidal attempts
  • treatment

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention : A Randomized Controlled Trial. / Asarnow, Joan Rosenbaum; Hughes, Jennifer L.; Babeva, Kalina N.; Sugar, Catherine A.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 56, No. 6, 01.06.2017, p. 506-514.

Research output: Contribution to journalArticle

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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 χ2 1 = 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",
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