Abstract
BackgroundSuicide is a leading cause of death among adolescents in North America. Youth who present to the Emergency Department (ED) with acute suicidality are at increased risk for eventual death by suicide, thereby presenting an opportunity for secondary prevention of suicide. The current study evaluates the effectiveness of a standardized individual and family-based suicidal behaviour risk reduction intervention targeting adolescents at high-risk for suicide.MethodsA randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of a manualized youth- and family- based suicide prevention strategy (SPS) as compared with case navigation (NAV) among adolescents aged 12 to 18 years of age who present to the ED with acute suicidal ideation (SI) or suicide risk behaviours (SRB). We will recruit 128 participants and compare psychiatric symptoms including SI/SRB, family communication, and functional impairment at baseline and follow-ups (post-intervention [6 weeks], 24 weeks). The primary outcome is change in suicidal ideation measured with the Suicide Ideation Questionnaire- Junior. SRBs are measured with the Suicide Behaviour Questionnaire. Secondary outcomes are change in depressive and anxious symptoms measured with semi-structured psychiatric interview and Screen for Child Anxiety Related Disorders; acute mental health crises measured by urgent medical (including ED) visits; family communication measured with Conflict Behaviour Questionnaire, functional impairment measured by Columbia Impairment Scale; cost effectiveness, and fidelity of implementation measured by audio recording and fidelity checklist.DiscussionResults of this study will inform a larger multi-centre RCT that will include both community and academic hospitals in urban and rural settings. Study results will be shared at international psychiatry and emergency medicine meetings, in local rounds, and via publication in academic journals and clinician-oriented newsletters. If effective, the intervention may provide a brief, scalable, and transportable treatment program that may be implemented in a variety of settings, including those in which access to children’s mental health care services is challenging.Trial registrationClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.
Highlights
Suicide is a leading cause of death among adolescents in North America
Studies examining trends have identified increasing suicide rates among females between 1980 and 2008 [3], with both males and females experiencing an increase in the medical severity of their emergency department (ED) presentations for suicide-related behaviours since 2004 [10]
A recent overview of systematic reviews concluded that the Emergency Department (ED) is likely the most promising site for the introduction of an effective suicide prevention strategy
Summary
Study design This is a single-blinded, RCT of a SPS + UC (intervention) with NAV + UC (control) in high-risk youth who present to the ED with suicidality using a superiority framework. A research team member will complete the screening and consent with the youth and caregiver for those that are interested in study participation. A research team member that is blinded to treatment allocation and study hypotheses is responsible for administering outcome measures at 6 and 24-week study assessment visits. The study therapist will communicate with the youth’s usual care provider (as identified and permitted by youth participants) at the outset and at completion of the intervention. Intervention sessions will be audio-recorded with youth and the parent(s) or caregiver consent These sessions will be reviewed by the principal investigator and members of the study team in order to ensure fidelity to the treatment model. Probabilistic sensitivity analysis using Monte Carlo simulations will be used to establish a point estimate and the 95% confidence intervals of the ICER
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