Table 2.
Interventions for Self-injurious Thoughts and Behaviors in Youth.
| Authors | Sample Size |
Sample Characteristics |
Setting | Inclusion (In) and Exclusion (Ex) Criteria |
Major Diagnoses |
Outcomes/ Measures |
Treatment Conditions, Dose, and Assessments |
Study Type |
Study Attrition Rate (and Treatment Completion) |
Main Results |
|---|---|---|---|---|---|---|---|---|---|---|
| Cognitive-Behavioral Therapy (CBT): | ||||||||||
| CBT-Individual1 | ||||||||||
| Donaldson, Spirito, & Esposito-Smythers (2005) | 39 | 12-17 year- olds; 82% female; 85% Caucasian, 10% Hispanic, 5% African American | Outpatient | In: Presented to ED or inpatient with SA; Ex: Psychosis, severe intellectual impairment |
CUD (45%), DBD (45%), MDD (29%), AUD (19%) | SA (structured follow-up interview; Spirito et al., 1992), SI (SIQ) | T: Skills-Based Treatment (n = 21), C: Supportive Relationship Treatment (n = 18), Dose: Six acute individual sessions and one adjunct family problem-solving session over 3 months + three monthly individual sessions; Assessments: Pre-treatment, F/u 3 and 6 months |
RCT | T: 29%; C: 11%; F/u Total sample: 20% Treatment completion: ≥ 6 sessions: 77%; full treatment: 60% |
Reduced SI for both groups over treatment, but NS between groups; NS for SA |
| Taylor et al. (2011)2 | 25 | 12-18 year-olds; gender and ethnicity NR | Outpatient | In: ≥ 1 episode of DSH; Ex: ASD, psychosis, global learning disability, unwillingness to address DSH |
NR | DSH (SHI) | T: Individual Manualized CBT (MCBT) for DSH (n = 25), Dose: 8-12 individual sessions + optional 3-session parent psychoeducation group (M = 6 months); C: None; Assessments: Pre- and post-treatment, F/u 3 months |
Pilot | T: 36% Treatment completion: 64% |
Reduced DSH over treatment and maintained at F/u |
| CBT-Individual + CBT-Family | ||||||||||
| Brent et al. (2009) | 124 | 12-18 year-olds; 77% female; 67% Caucasian, 19% Hispanic, 13% African American | Outpatient | In: SA within past 90 days, UMD, moderate depressive symptoms; Ex: BP, PDD, SUD, psychosis |
UMD (100%) | SE (SSRS) | T1: CBT for Suicide Prevention (CBT-SP), Dose: acute 12-16 weekly individual sessions and up to 6 family sessions + continuation 6 individual sessions and up to 3 family sessions (n = 17); T2: Medication algorithm (n = 14); T3: Combined CBT-SP + medication (n = 93); Length for all Ts: 6 months; Assessments: Pre-treatment and at 6, 12, 18, and 24 weeks | Non-randomized controlled trial | Total sample Week 12: 23%, Week 18: 30%, Week 24: 33% Treatment completion: T1: 65%, T2: 57%, T3: 71% |
NS for SE |
| Esposito-Smythers, Spirito, Uth, & LaChance (2006)2 | 6 | 14-16 year-olds; 83% female; 100% Caucasian | Outpatient | In: Inpatient hospitalization for SA or SI and comorbid AUD or CUD; Ex: SUD other than AUD or CUD, IQ < 70 | 100% AUD/CUD and MDD | SA (NR), SI (SIQ-Sn) | T: CBT for suicide and AUD/CUD (n = 6); Dose: weekly individual sessions for 6 months + biweekly individual sessions for 3 months + monthly individual sessions 3 months + conjoint family sessions as needed; C: None; Assessments: Pre-treatment, 6 and 12 months | Pilot | T: 17% Treatment completion: 83% |
Reduced SI; NS for SA |
| CBT-Individual + CBT-Family + Parent Training | ||||||||||
| Esposito-Smythers, Spirito, Kahler, Hunt, & Monti (2011)2 | 40 | 13-17 year-olds; 67% female; 89% Caucasian, 14% Hispanic | Outpatient | In: SA in past 3 months or significant SI (≥ 41 on SIQ) and AUD or CUD; Ex: BP, psychosis, current homicidal ideation, SUD other than AUD or CUD, IQ < 70 |
UMD (94%), CUD (83%), AUD (64%), ANX (56%), DBD (50%) | SA (K-SADS-PL), SI (SIQ-Sn) | T: Integrated CBT for AUD/SUD and suicide (n = 20); Dose: Weekly individual and weekly-biweekly parent sessions for 6 months + biweekly individual and biweekly-monthly parent sessions for 3 months + monthly individual and parent monthly as needed for 3 months + conjoint family sessions as needed; C: Enhanced TAU – diagnostic evaluation + community-based TAU (n = 20); Dose: Varied for 12 months; Assessments: Pre-treatment, 3, 6, 12, and 18 months |
RCT | T: 25%, C: 15%; Total sample 3 months: 10%; 6 months: 15%; 12 months: 18%; 18 months: 20%; Treatment completion (24 sessions w/ adolescent and 12 sessions w/ parent): T: 74% adolescents, 74% families, and 90% parents, C: 44% adolescents, 19% families, and 25% parents |
Reduced SA in T compared to C over 18 months; NS for SI |
| CBT skills-Group | ||||||||||
| Rudd et al. (1996) | 264 | 15-24 year-olds; 18% female; 61% Caucasian, 26% African American, 11% Hispanic |
Partial outpatient | In: Presented with SA, UMD with SI, alcohol abuse with SI; Ex: SUD or chronic abuse, psychosis or thought disorder, severe PD |
MD (72%), AUD (44%) |
SA (measure NR), SI (MSSI) | T: Time-limited CBT group therapy (n = 143), Dose: 9 hours daily for 2 weeks; C: Inpatient and outpatient TAU (n = 121), Dose: Varied combination of individual and group therapy; Assessments: Pre-treatment, F/u 1, 6, 12, 18, and 24 months | RCT | F/u: 1 month: T: 16%, C: 25%, 6 months: T: 47%, C: 54%, 12 months: T: 68%, C: 79% Treatment completion: T: 79% |
Reduced SI for both groups, but NS between groups; not enough SAs to examine group differences |
| Dialectical Behavior Therapy (DBT): | ||||||||||
| DBT3 | ||||||||||
| Fleischhaker et al. (2011)4 | 12 | 13-19 year-olds; 100% female; ethnicity NR | Outpatient | In: NSSI or SA past 4 months, and BPD or ≥ 3 BPD criteria; Ex: AN/BN, SUD, psychosis, severe mood episode requiring inpatient treatment, IQ < 70, illiteracy |
BPD (83%) | NSSI and SA (LPC) | T: DBT (n = 12), Dose: Weekly individual sessions + weekly multifamily skills group (+ regular phone contact as needed) for 16-24 weeks; C: None; Assessments: Pre-treatment, F/u 4 weeks and 1 year post-treatment |
Pilot | F/u T: 0% Treatment completion: 75% |
Reduced NSSI from pre-treatment to F/u 4 weeks post-treatment, F/u 1 year over half still engaging in NSSI; No SAs reported during trial |
| James et al. (2008) | 16 | 15-18 year- olds; 100% female; ethnicity NR | Outpatient | In: DSH > 6 months; Ex: ASD, BP, SZ, moderate to severe mental impairment |
BPD (100%) | DSH (unspecified clinical interview) | T: DBT (n = 16), Dose: Weekly individual sessions + weekly skills group + telephone consultation for two 6-month blocks; C: None; Assessment: Pre- and post-treatment, F/u 8 months |
Pilot | T: 13% Treatment completion: (78% of sessions completed, on average) |
Reduced DSH from pre- to post-treatment and F/u |
| James, et al. (2011) | 25 | 13-17 year- olds; 88% female; ethnicity NR | Outpatient | In: DSH > 6 months; Ex: ASD, BP, SZ, moderate to severe mental impairment |
BPD (100%) | DSH (unspecified clinical interview) | T: DBT (n = 25), Dose: Weekly individual sessions + weekly skills group + telephone consultation for two 6-month blocks; C: None; Assessments: Pre- and post-treatment |
Pilot | T: 28% Treatment completion: 72% |
Reduced DSH from pre- to post-treatment |
| Katz et al. (2004) | 62 | 14-17 year- olds; 84% female; 73% Caucasian | Inpatient | In: Hospitalization for SA or SI; Ex: BP, mental disability, psychosis, severe learning difficulties |
NR |
DSH during treatment (incident reports from nursing staff), DSH at F/u (LPC), SI (SIQ) | T: DBT (n = 32), Dose: 10 daily skills group + twice weekly individual sessions + DBT milieu for 2 weeks; C: Psychodynamic psychotherapy (n = 30), Dose: Daily group sessions + weekly individual sessions + psychodynamic milieu; Assessments: Pre- and post-treatment, F/u 1 year |
Non-randomized controlled trial (treatment assigned by unit) | F/u T: 17%, C: 10% Treatment completion: 100% |
Fewer behavioral incidents (e.g., violence toward self or others-DSH not specified) in T group; Reduced DSH and SI in both groups at F/u, NS differences between groups |
| Rathus, & Miller (2002)4 | 111 | 16.1 years old ± 1.2 (T), 15.0 years old ± 1.7 (C); 93% female (T), 73% female (C); 68% Hispanic, 17% African American, 8% Caucasian | Outpatient | In: SA in past 16 weeks or current SI, and BPD or ≥ 3 BPD features; Ex: NR |
UMD (T: 92%, C: 73%), BPD (T: 88%, C: 16%), ANX (T: 40%, C: 21%), SUD (T: 48%, C: 5%) | SA (patient self-report to therapist), SI (HASS and SSI) | T: DBT (n = 29), Dose: Twice weekly individual sessions + multifamily skills group for 12 weeks; C: Psychodynamic or supportive therapy (n = 82), Dose: Twice weekly individual + family sessions for 12 weeks; Assessments: Pre- and post-treatment |
Non-randomized controlled trial (more severe patients assigned to DBT) | Varies for analyses (e.g., 90% T and 50% C completed baseline SSI; 34% T completed pre- and post-treatment measures) Treatment completion (12 weeks): T: 62%, C: 40% |
Reduced SI in T group pre- to post-treatment (not measured in C group; therefore not able to compare between groups); NS for SA |
| DBT-Group only | ||||||||||
| Perepletchikova et al. (2011) | 11 | 8-11 year- olds; 55% female; 73% Caucasian | School | In: 2nd-6th graders; Ex: NR |
MDD symptoms (55%), ANX symptoms (45%) | SI (MFQ) |
T: DBT group skills (n = 11), Dose: Twice weekly for 6 weeks; C: None; Assessments: Pre- and post-treatment |
Pilot | NR |
Reduced SI from pre- to post- treatment |
| Family-Based Therapy (FBT): | ||||||||||
| FBT-Attachment | ||||||||||
| Diamond et al. (2010) | 66 | 12-17 year-olds; 83% female; 74% African American | Outpatient | In: SI (> 31 on SIQ-Jr) and moderate depression; Ex: Needed psychiatric hospitalization, recent discharge from psychiatric hospital, psychosis, mental retardation or borderline intellectual functioning |
ANX – not specified (67%), ADHD or DBD (58%), MDD (39%) | SI (SIQ-Jr and SSI) | T: Attachment-Based Family Therapy (n = 35), Dose: Weekly sessions for 3 months; C: Enhanced TAU (n = 31); Dose: Varied outpatient treatment with clinical monitoring; Assessments: Pre-treatment, 6 weeks, 12 weeks (post-treatment), and 24 weeks |
RCT | 6 weeks T: 6%, C: 13%; 12 weeks (post-treatment) T: 11%, C: 6%; 24 weeks T: 11%, C: 16%; Treatment completion: ≥ 1 session: T: 91%, C: 68%; ≥ 6 sessions: T: 69%, C: 19%; ≥ 10 sessions: T: 63%, C: 6% |
Reduced SI in T compared to C and maintained at F/u |
| FBT-Ecological | ||||||||||
| Huey et al. (2004) | 160 | 10-17 year-olds; 35% female; 65% African American, 33% Caucasian | Home (T); Inpatient (C) | In: Hospitalization for SA, SI or SP, homicidal ideation or behavior, psychosis, threat to harm self or others; Medicaid-funded or without health insurance, residing in non-institutional environment; Ex: ASD |
NR | DSH or SA (CBCL); SA (YRBS); SI (BSI and YRBS) | T: Multisystemic Therapy (n = 80), Dose: Daily contact if needed for 3-6 months; C: Inpatient hospitalization (n = 80), Dose: Daily behaviorally-based milieu program; Assessments: Pre-treatment, 4 months, F/u 1 year post-treatment |
RCT | Total sample: 2% Treatment completion: T: 94%; C: 100% |
Reduced SAs from pre- to post-treatment in T compared to C (YRBS only); NS for SI |
| FBT-Emergency | ||||||||||
| Asarnow et al. (2011) | 181 | 10-18 year-olds; 69% female; 45% Hispanic, 33% Caucasian, 13% African American | ED | In: Presented to ED with SA and/or SI; Ex: Psychosis; symptoms or other factors that interfered with ability to consent |
UMD (40%) | SA (DISC-IV and HASS), SI (HASS) | T: Family Intervention for Suicide Prevention (n = 89), Dose: One family-based CBT session in ED + phone contact 48 hours post-charge and several other times over 1 month; C: Enhanced ED TAU (n = 92), Dose: ED usual care + specialized staff training; Assessments: Pre-treatment, F/u 2 months |
RCT | F/u T: 15%; C: 9% Treatment completion: 100% |
NS between groups for all SITBs outcomes |
| Ougrin, Boege, Stahl, Banarsee, & Taylor. (2013)2 | 70 | 12-18 year-olds; 80% female; 53% Caucasian, 20% African American, 11% Asian | ED | In: Recent DSH or DSP but not currently receiving psychiatric services; Ex: gross reality distortion, severe intellectual disability; imminent violence or suicide risk | EMD (60%); DBD (13%) | DSH (Accident and Emergency department reports and patient records) | T: Therapeutic Assessment (n = 35); Dose: 30-minute session using cognitive analytic therapy paradigm with family + assessment as usual (AAU); C: AAU (n = 35); Dose Psychosocial history and risk assessment over 1 hour; Assessments: F/u 2 years | RCT | F/u T: 6%, C: 9% Treatment completion: 100% |
NS between groups for DSH over F/u |
| Rotheram-Borus et al. (1996; 2000) | 140 | 12-18 year-olds; 100% female; 88% Hispanic | ED | In: Presented to ED with SA, female gender; Ex: > 1 week psychiatric hospitalization |
UMD (44%), ANX (38%), DBD (24%) | SA (ED records), SI (HASS) | T: Specialized ED Care, Dose: Psychoeducation + family session + staff training (n = 65); C: Standard ED Care (n = 75); Dose: ED evaluation and referral to outpatient therapy; Assessments: Pre- and post-treatment, F/u 3, 6, 12, and 18 months |
Non-randomized controlled trial | F/u Total sample: 8% Treatment completion: 100% |
Greater reduction in SI in T compared to C post-intervention; however, NS between groups for all SITBs outcomes at F/u |
| FBT-Parent training only | ||||||||||
| Pineda & Dadds (2013) | 48 | 12-17 year-olds; female: 73% (T); 78% (C); Caucasian: 64% (T), 50% (C); Mixed ethnicity: 27% (T) 44% (C) | Outpatient | In: ≥ 1 SITBs past two months; primary ANX or MDD; Ex: PDD or psychosis |
MDD (100%); ANX (38%) | SITBs (combines all DSH and SRB) (ASQ-R) | T: Resourceful Adolescent Parent Program (RAP-P) (n = 24); Dose: Four 2-hour sessions, weekly or biweekly + crisis management and safety planning; C: Routine care (n = 24); Dose: Varied outpatient treatment; Assessments: Pre- and post-treatment, F/u 6 months |
RCT | F/u T: 8%, C: 25% Treatment completion (all four sessions): T and C: 100% |
Reduced SITBs in T compared to C from pre- to post-treatment; reductions maintained at F/u |
| FBT-Problem-Focused | ||||||||||
| Harrington et al. (1998) | 162 | 10-16 year-olds; 90% female; ethnicity NR | Home (T); Outpatient (C) | In: DSP; Ex: DSH (other than DSP), inability to engage in family intervention, psychiatrist decided participation was contraindicated (e.g., psychosis) |
MDD (67%), CD (10%) | SI (SIQ) | T: Family-based problem solving (n = 85), Dose: Five home sessions + TAU; C: TAU (n = 77), Dose: Varied outpatient treatment; Assessments: Pre-treatment, 2 and 6 months | RCT | Total sample F/u 2 months: 4%, F/u 6 months: 8% Treatment completion: 74% of T intervention sessions attended |
Reduced SI in T compared to C in subset of adolescents without MDD |
| Interpersonal Psychotherapy (IPT): | ||||||||||
| IPT-Individual | ||||||||||
| Tang, Jou, Ko, Huang, & Yen (2009)5 | 73 | 12-18 year-olds; 66% female; ethnicity NR (study conducted in Taiwan) | School | In: Moderate to severe depression, SI, or previous SA, moderate to severe anxiety, or significant hopelessness in the past 2 weeks; Ex: Psychosis, drug abuse, serious medication condition, or severe (e.g., high-lethality) suicidal behaviors |
MDD (100%) | SI (BSS) | T: Intensive Interpersonal Psychotherapy for depressed adolescents with suicide risk (IPT-A-IN) (n = 35), Dose: Two sessions weekly + 30 min. phone follow-up for 6 weeks; C: Psychoeducation + supportive counseling (parent included if needed) (n = 38), Dose: One to two sessions weekly for 6 weeks; Assessments: Pre- and post-treatment | RCT | T: 0%, C: 8% Treatment completion (full 6-week program): T: 100%; C: 92% |
Reduced SI in T compared to C |
| Psychodynamic Therapy: | ||||||||||
| Psychodynamic therapy-Individual + Family | ||||||||||
|
Rossouw, & Fonagy (2012) |
80 | 12-17 years old; 85% female; 75% Caucasian, 10% Asian, 7.5% mixed race, 5% African American | Outpatient | In: ≥ 1 DSH episode past month; Ex: AN or BN, PDD, psychosis, severe learning disability (IQ < 65), chemical dependence |
Depressive symptoms (97%), BPD (73%) | DSH (CI-BPD and RTSHI) | T: Mentalization-Based Treatment (MBT-A) for self-harm (n = 40), Dose: Weekly individual + monthly family therapy for 1 year; C: Community-based TAU-varied (n = 40), Dose: 1 year; Assessments: Pre-treatment, 3, 6, and 9 months after randomization, and post-treatment |
RCT | 3 months T: 13%, C: 8%; 6 months T: 3%, C: 10%; 9 months T: 13%, C: 15%; 12 months T: 10%, C: 13% Treatment completion: T: 50%, C: 43% |
Reduced DSH in T compared to C post-treatment (12-month) assessment only |
| Combined Skills Group Intervention: | ||||||||||
| CBT skills + DBT skills + Psychodynamic therapy skills-Group | ||||||||||
| Green et al. (2011) | 366 | 12-17 year-olds; 89% female; 94% Caucasian | Outpatient | In: ≥ 2 DSH episodes past year; Ex: AN, acute psychosis, substantial learning difficulties |
Depressive disorder symptoms (62%), behavioral problems (33%) | DSH (interview validated in Harrington et al., 1998), SI (SIQ) | T: Developmental group psychotherapy (n = 183), Dose: (see Wood et al.) + routine care; C: Routine care only (n = 183), Dose: Varied, but no group therapy; Assessments: Pre-treatment, F/u 6 months and 1 year | RCT | F/u T: 2%, C 2% Treatment completion (≥ 4 sessions): T: 79%, C: 63% |
DSH and SI improvement for both groups, NS differences between groups |
| Hazell et al. (2009) | 72 | 12-16 year-olds; 90% female; ethnicity NR | Outpatient | In: ≥ 2 DSH episodes past year, ≥ 1 DSH episode past 3 months; Ex: More intensive treatment required, inability to attend groups, acute psychosis, or intellectual disability |
MDD (57%), DBD (7%), alcohol problems (4%) | DSH (PHI), SI (SIQ) | T: Developmental group psychotherapy (n = 35), Dose: (see Wood et al.) for up to 1 year; C: Routine care (n = 37), Dose: Varied for 1 year; Assessments: Pre-treatment, 8 weeks, 6 months, and 1 year |
RCT | T: 3%, C: 8% Treatment completion (≥ 4 sessions): T: 71%, C: 62% |
Increased DSH in T compared to C at 6 months and 1 year (however, group differences were nonsignificant after controlling for history of medication overdose); NS for SI |
| Wood, Trainor, Rothwell, Moore, & Harrington (2001) | 63 | 12-16 year-olds; 78% female; ethnicity NR | Outpatient | In: ≥ 1 DSH episode past year; Ex: Suicide risk too severe for ambulatory care, inability to attend groups, psychosis, significant learning problems |
MDD (84%), DBD (69%) | DSH (interview—see Kerfoot, 1984), SI (SIQ) | T: Developmental group psychotherapy (DGT) + Routine care (n = 32), Dose: Six acute sessions + weekly long-term group as needed for 6 months (Mdn = 8 sessions, Range 0-19) + Routine care as needed; C: Routine care (n = 31), Dose: Family sessions + non-specific counseling as needed (Mdn = 4 sessions, Range 0-30); Assessments: Pre-treatment, 6 weeks, and 7 months |
RCT | F/u 7 months: T: 3%, C: 0% Treatment completion (≥ 4 sessions): T: 72%, C: 61% |
Fewer DSH repeaters (i.e., multiple DSH episodes) in T compared to C and longer time to repeat DSH in T compared to C; NS for SI |
| Other intervention techniques: | ||||||||||
| Resource interventions-Individual | ||||||||||
| Cotgrove, Zirinsky, Black, & Weston (1995) | 105 | 12-16 year-olds; 85% female; ethnicity NR | ED | In: Admitted for DSH, DSP, or SA; Ex: NR |
NR | SA (unspecified psychiatrist questionnaire) | T: Green card for re-admission to the hospital (n = 47); C: Clinic or child psychiatry department TAU (n = 58); Assessments: Pre-treatment and F/u 1 year |
RCT | Total sample: 0% Treatment completion: T: 11% used green card |
NS between group differences in SA |
| Deykin, Hsieh, Joshi, & McNamarra (1986)6 | 319 | 13-17 year-olds; female: 68% (Boston), 55% (Brockton); Caucasian: 28% (Boston), 68% (Brockton), African American: 57% (Boston), 4% (Brockton) | Community | In: ED presentation with DSH, SA, or SI; Ex: NR | NR | DSH, SI, SA (physicians' reports and medical chart review) | T: Direct service (advocacy, financial needs, social support) + educational training for providers (n = 172), Dose: NR; C: Hospital TAU (n = 147), Dose: NR; Assessments: Pre-treatment, Continuous F/u 2 years | Non-randomized controlled trial | N/A (incidence of ED visits examined; specific adolescents were not followed over time) | NS for all SITBs outcomes |
| Robinson et al. (2012) | 164 | 15-24 year-olds, 65% female; ethnicity NR | Community | In: History DSH or SRB; Ex: Known organic cause for DSH/SRB, intellectual disability |
ANX (63%), MD (67%) |
DSH (SBQ-14), SI (BSS) | T: Post cards promoting well-being and evidence-based skills use + Community-based TAU (n = 81), Dose: Monthly for 12 months; C: Community-based TAU only (n = 83), Dose: 12 months; Assessments: Pre-treatment, F/u 12 and 18 months |
RCT | F/u: 12 months: T: 26% C: 37%; 18 months: T: 38%, C: 55% |
Reduced DSH and SI in both groups, but NS between groups |
| Support-based interventions | ||||||||||
| King et al. (2006) | 289 | 12-17 year- olds; 68% female; 82% Caucasian | Community | In: Recent psychiatric hospitalization, SI or SA past month, and score of 20 or 30 on CAFAS self-harm subscale; Ex: Psychosis, severe mental disability |
NR | SA (SSBS), SI (SIQ-Jr and SSBS) |
T: Youth-nominated Support Team-I + TAU-varied (n = 151), Dose: Psychoeducation for supports + weekly contact between supports and adolescents + supports contacted by intervention specialists for 6 months; C: TAU-varied (n = 138), Dose: 6 months; Assessments: Pre- and post-treatment |
RCT | T: 24%, C: 13% Treatment completion: T: 76%, C: 87% |
Reduced SI in T compared to C in females only; NS for SA |
| King et al. (2009) | 448 | 13-17 year- olds; 71% female; 84% Caucasian | Community | In: Recent psychiatric hospitalization, SI or SA past month; Ex: Severe cognitive impairment, psychosis, medical instability, residential placement, no legal guardian available |
UMD (88%); DBD (42%); ANX (29%); PTSD or acute stress disorder (25%); AUD or SUD (21%) |
SA (DISC-IV), SI (SIQ-Jr) | T: Youth-nominated Support Team-II + TAU-varied (n = 223), Dose: Psychoeducation for supports + weekly contact between supports and adolescents for 3 months; C: TAU-varied (n = 225); Dose: 3 months; Assessments: Pre-treatment, 6 weeks, 3, 6, and 12 months |
RCT | F/u: 6 weeks: 25%, 3 months: 24%, 6 months: 30%, 12 months: 23% Treatment completion (full intervention-two support people for 12 weeks): T: 74% |
Reduced SI in T compared to C in multiple attempters only and at 6-week f/u only; NS for SA |
ED = emergency department; NR = not reported; NS = non-significant; RCT = randomized controlled trial
Major Diagnoses: ADHD = attention deficit disorder; AN = anorexia nervosa; ANX = anxiety disorder–type not specified; ASD = autism spectrum disorder; AUD = alcohol use disorder; BN = bulimia nervosa; BP = bipolar disorder; BPD = borderline personality disorder; CD = conduct disorder; CUD = cannabis use disorder; DBD = disruptive behavior disorder; EMD = emotional disorder; MD = mood disorder (bipolar or unipolar); MDD = major depressive disorder; PD = personality disorder; PDD = pervasive developmental disorder; PTSD = post-traumatic stress disorder; SUD = substance use disorder; SZ = schizophrenia; UMD = unipolar mood disorder
Measures: ASQ-R = Adolescent Suicide Questionnaire Revised; BSI = Brief Symptom Inventory; BSS = Beck Scale for Suicide Ideation; CAFAS = Child and Adolescent Functional Assessment Scale; CBCL = Children Behavior Checklist; CI-BPD= Child Interview for DSM-IV Personality Disorder; DISC-IV = Diagnostic Interview Schedule for Children Version IV; HASS = Harkavy-Asnis Suicide Scale; K-SADS-PL = Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version; LPC = Lifetime Parasuicide Count; MFQ = Mood and Feeling Questionnaire; MSSI = Modified Scale for Suicide Ideation; PHI = Parasuicide History Interview; RTSHI = Risk Taking and Self Harm Inventory; SBQ-14 = Suicide Behavior Questionnaire; SHI = Self Harm Inventory; SIQ (Jr or Sn) = Suicide Ideation Questionnaire (for junior high and senior high school students); SSBS = Spectrum of Suicide Behavior Scale; SSI = Scale for Suicidal Ideation; SSRS = Suicide Severity Rating Scale; YRBS = Youth Risk Behavior Survey
Outcomes: DSH = deliberate self-harm; DSP = deliberate self-poisoning; NSSI = nonsuicidal self-injury; SA = suicide attempt; SE = suicide event (defined by Columbia Classification Algorithm of Suicide Assessment as one or more of the following: completed suicide, attempted suicide, preparatory acts towards imminent suicidal behavior, suicidal behavior, or suicidal ideation); SI = suicide ideation; SITB = self-injurious thought or behavior (suicidal and nonsuicidal); SP = suicide planning or preparation; SRB = suicide-related behavior (suicide thoughts, plans, attempts)
Treatment Conditions: C = control or comparison group; CBT = Cognitive-Behavioral Therapy; DBT = Dialectic Behavior Therapy; F/u = follow-up; T = experimental treatment group; TAU = treatment as usual
1
The CBT-Individual interventions included optional family components (see each study for the specific dose of optional family therapy offered). However, the authors report these components were infrequently utilized during treatment.
2
Motivational interviewing (MI) or motivational enhancement techniques incorporated in treatment package.
3
Although motivational enhancement techniques were not explicitly discussed in these DBT studies, increasing motivation to change is a core component of the DBT package.
4
DBT group skills delivered in a multifamily group format.
5
IPT-A-IN was primarily an individual-based intervention. However, one parent of a participant in the IPT group received three family therapy sessions. In addition, parents were included in the TAU supportive counseling sessions if needed.
6
Deykin et al. (1986) assessed incidence of ED visits over two years at the two sites where the intervention (Boston) and control (Brockton) treatments were employed; that is, specific participants were not followed over time.