Table 2.
Randomized Trials of Psychosocial Interventions for Self-injurious Thoughts and Behaviors in Youth.
| Treatment Family | Citation | Sample Size (at randomization) | Sample Characteristics | Recruitment Setting | Inclusion (In) and Exclusion (Ex) Criteria | Major Diagnoses | SITB Outcomes (Measures) |
Treatment Conditions, Dose, and Assessments | Treatment Attrition and Completion (if available) | Main Results |
|---|---|---|---|---|---|---|---|---|---|---|
| DBT-A | McCauley et al. (2018) | 173; T=86, C=87 |
12–18 years old; 95% female; 56% Caucasian, 27% Hispanic, 7% African American, 6% Asian American, <1% Native American, 2% other | ED, inpatient, outpatient, community | In: Lifetime SA≥1; elevated past-month SI (SIQ-Jr≥24); DSH lifetime≥3 episodes + at least 1 DSH episode in past 12 weeks; meet at least 3 BPD criteria Ex: IQ<70; psychosis; mania; AN; life-threatening condition; youth not fluent in English; parent not fluent in English or Spanish |
MDD (84%); ANX (54%); BPD (53%); ED (<1%) |
SI (SIQ-Jr); SA (SASII); NSSI (SASII); DSH (SASII) |
T: DBT-A (individual sessions, multifamily group skills training, youth and parent telephone coaching, individual parent session, family sessions [as needed]); Dose: 6 months of weekly individual and group sessions, weekly therapist team consultation C: Individual and Group Supportive Therapy (IGST; individual and group sessions, parent sessions [as needed]); Dose: 6 months of weekly individual and group sessions, weekly therapist team consultation Assessments: Pre-treatment (BL), mid-treatment (3 months), post-treatment (6 months), F/U at 9 and 12 months |
Treatment completion (≥24 adolescent sessions): T: 45.4% C: 16.1% Attrition: Post-treatment: T: 10.5% C: 24.1% 12-month F/U: T: 19.8% C: 26.4% |
Significantly greater decrease in SI and SA, NSSI, and DSH frequency for T as compared to C at post-treatment. NS between group differences in SI, SA, NSSI, or DSH from post-treatment to 12-month F/U. |
| DBT-A | Mehlum et al. (2014; 2016) | 77; T=39, C=38 |
12–18 years old; 88% female; 85% Norwegian | Outpatient | In: Lifetime DSH≥2 episodes + at least 1 DSH episode in past 16 weeks; at least 2 DSM-IV BPD criteria or 1 BPD criterion + 2 sub-threshold-level criteria; fluent in Norwegian Ex: BP; SZ; SCAD; psychotic disorder not otherwise specified; intellectual disability; Asperger syndrome |
ANX (43%); Other depressive disorder (38%); MDD (22%); BPD (21%); PTSD (17%); PD (9%); ED (8%); SUD (3%) |
DSH (LPC); SI (SIQ-Jr) |
T: DBT-A (individual sessions, multifamily skills training, family therapy or telephone coaching [as needed]); Dose: 19 weeks of weekly individual sessions (1 hour), weekly multi-family skills training (1.5 hours) C: EUC (TAU + therapists agreed to minimum dose); Dose: 19 weeks (minimum) of weekly individual sessions Assessments: Pre-treatment (BL), F/U at 9 and 15 weeks (during treatment), post-treatment (19 weeks), F/U at 71 weeks (1-year post-treatment) |
Treatment completion (≥ 50% of sessions): T: 74.4% C: 71% Attrition: Post-treatment: T: 0% C: 0% 71-week F/U: T: 2.6% C: 2.6% |
Significantly fewer DSH episodes and significantly greater decrease in SI for T as compared to C at post-treatment. Significantly fewer DSH episodes in T as compared to C from post-treatment to 71-week F/U. NS between group differences in SI at 71-week F/U. |
| CBT—Individual | Hetrick et al. (2017) | 50; T=26, C=24 |
13–19 years old; high school students; 82% female; race/ethnicity NR | High school | In: High school student; engaged with a well-being staff member (i.e., school counselor); experienced any level of SI in past 4-week period Ex: Intellectual disability; psychotic symptoms; youth not fluent in English |
NR | SI (SIQ); SA (2-item questionnaire) |
T: Reframe-IT (online CBT modules), TAU; Dose: 8 modules of CBT delivered over 10 weeks C: TAU (contact with school well-being staff, outpatient mental health counseling and medication management); Dose: Varied Assessments: Pre-treatment (BL), post-treatment (10 weeks), F/U at 22 weeks |
Attrition: Post-treatment: T: 30.8% C: 12.5% 22-week F/U: T: 50% C: 29.2% |
NS between group differences in SI or SA from BL to post-treatment or BL to 22-week F/U. |
| CBT— Individual + Family | Esposito-Smythers, Spirito, Kahler, Hunt, & Monti (2011)1 | 40; T=20, C=20 |
13–17 years old; 67% female; 89% Caucasian, 14% Hispanic | Inpatient | In: SA in past 3 months or significant SI (SIQ-Sn≥41); AUD or CUD; lived in the home with a parent/guardian willing to participate Ex: Verbal IQ<70; active psychosis; current homicidal ideation; BP; SUD other than AUD or CUD |
UMD (94%); CUD (83%); AUD (64%); ANX (56%); DBD (50%) |
SA (K-SADS-PL; depression module suicide items); SI (SIQ-Sn) |
T: Integrated CBT for AUD/SUD and suicide (CBT skills, family and parent training, [1] MI session), 18 months of free medication management; Dose: 6 months of weekly individual and weekly-biweekly parent sessions, 3 months of biweekly individual and biweekly-monthly parent sessions, 3 months of monthly individual sessions (monthly parent sessions as needed), conjoint family sessions as needed C: Enhanced TAU – diagnostic evaluation, offer for 18 months of free medication management, community-based TAU; Dose: Varied over 12 months Assessments: Pre-treatment (BL), F/U at 3, 6, 12, and 18 months post-enrollment |
Treatment completion (≥24 adolescent sessions, ≥12 parent sessions): T: 74% adolescents + 90% parents C: 44% adolescents + 25% parents Attrition: 18-month F/U: T: 25% C: 15% |
Significantly fewer T participants made a SA as compared to C over 18-month F/U. NS between group difference in SI over 18-month F/U. |
| IPT-A—Individual | Tang, Jou, Ko, Huang, & Yen (2009)1 | 73; T=35, C=38 |
12–18 years old; high school students; 66% female; race/ethnicity NR (study conducted in Taiwan) | High school | In: Moderate to severe MDD (BDI>19); SI or lifetime history of SA (BSS>0); moderate to severe ANX (BAI>16); significant hopelessness (BHS>8) in past 2 weeks Ex: Acute psychosis; drug abuse; PD; serious medical condition; severe (e.g., high-lethality) suicidal behaviors; lack of proper care for suicidal risk by family |
MDD (100%) | SI (BSS) |
T: Intensive Interpersonal Psychotherapy for depressed adolescents with suicide risk (IPT-A-IN; school-based intervention); Dose: 2 sessions weekly, 30-minute phone F/U for 6 weeks C: TAU in schools (psychoeducation, irregular supportive counseling [parent included as needed]); Dose: 30- to 60-minute sessions once or twice weekly for 6 weeks Assessments: Pre-treatment (BL), post-treatment (6 weeks) |
Treatment completion: T: 100% C: 92.1% Attrition: Post-treatment: T: 0% C: 7.9% |
Significantly greater decrease in SI for T as compared to C at post-treatment. |
| Psychodynamic Therapy —Individual + Family | Rossouw & Fonagy (2012)1 | 80; T=40, C=40 |
12–17 years old; 85% female; 75% Caucasian, 10% Asian, 5% African American, 8% mixed race, 3% other | ED, community mental health | In: ≥1 DSH episode in past month Ex: Required inpatient care; ED (in the absence of self-harm); PDD; psychosis; severe learning disability (IQ<65); chemical dependence |
MDD (96%); BPD (73%); Alcohol problems (44%); Substance misuse (28%) |
DSH (RTSHI) |
T: Mentalization-Based Treatment (MBT-A; individual + family therapy) for self-harm; Dose: Weekly individual + monthly family therapy for 12 months C: Community-based TAU (varied, [e.g., individual counseling, family therapy]); Dose: 12 months, varied Assessments: Pre-treatment (BL), 3, 6, and 9 months after randomization, post-treatment (12 months) |
Treatment completion: T: 50% C: 42.5% Attrition: 3-month F/U: T: 13% C: 8% 6-month F/U: T: 3% C: 10% 9-month F/U: T: 13% C: 15% 12-month F/U: T: 10% C: 13% |
Significantly greater decrease in DSH (RTSHI scores) for T as compared to C at post-treatment. Significantly lower odds of reporting ≥ 1 DSH episode in past 3 months for T as compared to C at post-treatment. Significantly greater rate of decline in DSH (RTSHI scores) for T as compared to C over treatment period. |
| Psychodynamic Therapy—Family-Based | Diamond et al. (2010)1 | 66; T=35, C=31 |
12–17 years old; 83% female; 74% African American | ED, primary care | In: SI (SIQ-Jr>31) and moderate depression (BDI-II >20) at 2 pre-BL screenings Ex: Needed psychiatric hospitalization; recent discharge from psychiatric hospital; psychosis; mental retardation or borderline intellectual functioning |
ANX (67%); ADHD or DBD (58%); MDD (39%) |
SI (SIQ-Jr, self-report; SSI, clinician-report) | T: Attachment-Based Family Therapy (ABFT; individual youth and parent sessions, joint parent-youth sessions); Dose: Weekly sessions for 3 months C: Enhanced TAU (E-TAU; referral to care, clinical monitoring); Dose: Varied Assessments: Pre-treatment (BL), mid-treatment (6 weeks), post-treatment (12 weeks), F/U at 24 weeks |
Treatment completion: ≥ 1 session: T: 91.4% C: 67.7% ≥ 6 sessions: T: 68.6% C: 19.4% ≥ 10 sessions: T: 62.9% C: 6.5% Attrition: Mid-treatment: T: 5.7% C: 12.9% Post-treatment: T: 11.4% C: 6.5% 24-week F/U: T: 11.4% C: 16.1% |
Significant decrease in SI (self- and clinician-reported) for T as compared to C at post-treatment and 24-week F/U. Significantly greater rate of change in SI over treatment period for T as compared to C. Significantly greater proportion of T reported no past-week SI as compared to C at post-treatment and 24-week F/U (self- and clinician-reported). |
| Psychodynamic Therapy — Family-Based | Diamond et al. (2018) | 129; T=66, C=63 |
12–18 years old; 82% female; 50% African American, 29% Caucasian, 2% Asian, 2% American Indian or Alaskan Native, <1% Native Hawaiian/Pacific Islander, 8% mixed race, 9% other; 31% identified as lesbian, gay, or bisexual | ED, inpatient, mental health agencies, primary care, schools, community | In: SI (SIQ-Jr≥31) and moderate depressive symptoms (BDI-II >20) at 2 pre-BL screenings Ex: Imminent risk of harm to self or others; psychosis; severe cognitive impairment; start psychiatric medication within 3-weeks of BL; parent not fluent in English |
ANX (47%); MDD (41%) |
SI (SIQ-Jr); SA (C-SSRS); NSSI (C-SSRS) |
T: Attachment-Based Family Therapy (ABFT; individual youth and parent sessions, joint parent-youth sessions); Dose: 16 weeks C: Family-enhanced nondirective supportive therapy (FE-NST; individual youth and parent sessions, joint parent-youth sessions); Dose: 16 weekly individual sessions, 1 joint youth-parent session, 4 parent education sessions Assessments: Pre-treatment (BL), post-treatment (4, 8, 12, and 16 weeks), (F/U data collected at 24, 32, 40, and 52 weeks not reported here) |
Treatment completion: T: 81.8% C: 82.5% Attrition: T: 18.2% C: 17.5% |
NS between group differences in rate of change of SI, SI remission rate (SIQ-Jr <12), and SI response rate (≥50% decrease from BL SIQ-Jr) over treatment period. NS between group difference in SA over treatment period. |
| Family Therapy | Cottrell et al. (2018) | 832; T=415, C=417 |
11–17 years old; 89% female; race/ethnicity NR | Mental health services | In: ≥2 DSH episodes prior to referral to Child and Adolescent Mental Health Services (CAMHS); living with primary caregiver willing to participate Ex: Severe suicide risk; ongoing child protection investigation; pregnancy; treatment by CAMHS specialist; residence in short-term foster care; learning disabilities; involvement in another study in past 6 months; sibling participation in other CAMHS family therapy trial; youth not proficient in English |
NR | SI (BSS); DSH (SASII) |
T: Self-Harm Intervention Family Therapy (SHIFT); Dose: 6–8, 1.25-hour sessions over 6 months C: TAU; Dose: Varied Assessments: Pre-treatment (BL), F/U at 3, 6, 12, and 18 months |
Treatment completion (≥ 1 session): T: 94.9% C: 81.3% Attrition: 3-month F/U: T: 45.1% C: 52.5% 6-month F/U: T: 50.8% C: 64.3% 12-month F/U: T: 40.2% C: 54.7% 18-month F/U: T: 50.8% C: 60.4% Withdrew over F/U: T: 26% C: 46.5% |
Significantly greater decrease in SI for T as compared to C at 12-month F/U. NS between group differences in SI at 18-month F/U. NS between group differences in hospitalizations for DSH at 12- or 18-month F/U. |
| Family Therapy | Harrington et al. (1998)1 | 162; T=85, C=77 |
10–16 years old; 90% female; race/ethnicity NR | Inpatient | In: DSP Ex: DSH (other than DSP); inability to engage in family intervention; psychiatrist decided participation was contraindicated (e.g., psychosis); cases where unclear if overdose was deliberate |
MDD (67%); CD (10%) |
SI (SIQ) |
T: Family-based problem solving (youth and at least 1 parent present at all sessions), TAU; Dose: 5 home sessions C: TAU; Dose: Varied Assessments: Pre-treatment (BL), F/U at 2 and 6 months |
Treatment completion (≥ 1 session): T: 74% C: NR Attrition (Total sample): 2-month F/U: 4% 6-month F/U: 8% |
NS between group difference in SI at 2- and 6-month F/U. Significantly greater decrease in SI for T as compared to C at 2- and 6-month F/U in a subsample of non-depressed adolescents. |
| Multiple Systems Therapy | Huey et al. (2004)1 | T and C sample size NR | 10–17 years old; 35% female; 65% African American, 33% Caucasian |
ED, inpatient | In: Hospitalization for SA, SI, or SP; homicidal ideation or behavior; psychosis; threat to harm self or others; Medicaid-funded or w/out health insurance; residing in non-institutional environment Ex: ASD |
NR | DSH or SA (CBCL – caregiver-reported); SA (YRBS – self-reported); SI (BSI and YRBS) |
T: Multisystemic Therapy; Dose: Daily contact if needed for 3–6 months C: Inpatient hospitalization; Dose: Daily behaviorally-based milieu program Assessments: Pre-treatment, 4 months post-recruitment, F/U at 1 year post-treatment |
NR | Reduced SAs from pre- to post-treatment in T as compared to C (YRBS only); NS for SI. |
| Integrated Family Therapy | Asarnow, Hughes, Babeva, & Sugar (2017) | 42; T=20, C=22 |
11–18 years old; 88% female; 83% Caucasian, 21% Hispanic, 12% Asian, 5% African American, 7% other; 22% identified as lesbian, gay, or bisexual | ED, inpatient, partial hospitalization, outpatient | In: NSSI as primary problem (with ≥3 lifetime DSH episodes) or SA in past 3 months; stable family situation; parent willing to participate in treatment Ex: Psychosis; substance dependence; youth not fluent in English |
MDD (55%); Problematic substance use (48%) |
SA (C-SSRS); DSH (C-SSRS) |
T: Safe Alternatives for Teens and Youths (SAFETY; youth and parent individual sessions + joint parent-youth sessions; CBT + DBT skills + homework); Dose: 12 weeks C: Enhanced TAU (E-TAU; in-clinic parent session, phone calls ensuring treatment adherence); Dose: In-clinic parent session and >3 telephone calls Assessments: Pre-treatment (BL), F/U at 3 months and between 6 and 12 months |
Treatment completion: T (9–12 sessions): 70% C: 95.5% received in-clinic parent session (M=1.56 F/U calls) Attrition (Youth report): T: 0% C: 45% |
Significantly longer time to first SA for T as compared to C over 3-month F/U. NS between group differences in NSSI or in time to first NSSI event at any F/U time point. |
| Brief Family-Based Therapy | Asarnow et al. (2011)1 | 181; T=89, C=92 |
10–18 years old; 69% female; 45% Hispanic, 33% Caucasian, 13% African American, 9% other |
ED | In: Presented to ED with SA and/or SI Ex: Acute Psychosis; symptoms or other factors that interfered with ability to provide consent; no parent/guardian to provide consent; youth not fluent in English |
UMD (40%) | SA (DISC-IV and HASS); SI (HASS) |
T: Family Intervention for Suicide Prevention; Dose: One family-based CBT session in ED, phone contact 48 hours post-discharge and several other times over 1 month C: Enhanced ED TAU; Dose: ED usual care, specialized staff training Assessments: Pre-treatment, F/U at 2 months |
Treatment completion: 100% Attrition: 2-month F/U: T: 15% C: 9% |
NS differences between groups for all SITB outcomes. |
| Brief Family-Based Therapy | Ougrin et al. (2011; 2013)1 | 69; T=35, C=34 Originally randomized 70 (35 in each group) but analysis done with 69 |
12–18 years old; 80% female; 53% Caucasian, 20% African American, 11% Asian | Mental health services | In: Recent DSH or DSP but not currently receiving psychiatric services Ex: Gross reality distortion; history of at least moderately severe intellectual disability; imminent violence or suicide risk; need for inpatient psychiatric admission; youth not fluent in English |
EMD (60%); DBD (13%) |
DSH (accident and ED reports and patient health records) | T: Therapeutic Assessment; Dose: 1-hour Psychosocial history and risk assessment (“Assessment as Usual” per NICE guidelines), 30-minute session using cognitive analytic therapy paradigm with family C: Assessment as Usual; Dose: 1-hour Psychosocial history and risk assessment Assessments: Data on SITB outcomes were collected 2 years post-intervention via electronic hospital, primary care, and patient health records |
Treatment completion: 100% Attrition: F/U: T: 6% C: 9% |
NS between groups for all DSH outcomes. |
| Parent Training | Pineda & Dadds (2013)1 | 48; T=24, C=24 |
12–17 years old; T: 73% female; C: 78% female; T: 64% Caucasian, 27% mixed race; C: 50% Caucasian, 44% mixed race | ED | In: Residing with at least one parent; ≥1 SITBs in past two months; primary diagnosis of MDD, PTSD, or ANX Ex: PDD; psychosis; poisoning from recreational drugs |
MDD (100%); At least 2 psychiatric diagnoses (38%) |
SITB (ASQ-R) | T: Resourceful Adolescent Parent Program (RAP-P); Dose: Four 2-hour sessions weekly or biweekly, crisis management and safety planning, parents invited to all programs C: TAU; Dose: Varied outpatient treatment, family intervention limited to crisis management and safety planning only Assessments: Pre- and post-treatment, F/U at 6 months |
Treatment completion (all four sessions): 100% Attrition: 6-month F/U: T: 8.3% C: 25% |
Reduced SITBs in T as compared to C from pre- to post-treatment; reductions maintained at 6-month F/U. |
| Support-Based Therapy | King et al. (2006)1 | 289; T=151, C=138 |
12–17 years old; 68% female; 82% Caucasian, 10% African American, 7% other | Inpatient | In: Recent psychiatric hospitalization; past month SA or SI; CAFAS self-harm subscale = 20 or 30 Ex: Psychosis; severe mental disability |
NR | SI (SIQ-Jr, SSBS); SA (SSBS) |
T: Youth-nominated Support Team-I + TAU (varied); Dose: Psychoeducation for supports, weekly contact between supports and adolescents, supports contacted by intervention specialists over 6 months C: TAU (varied); Dose: 6 months Assessments: Pre-treatment (BL), post-treatment (6 months) |
Treatment completion: T: 76% C: 87% Attrition: T: 25.1% C: 10.9% |
NS between group differences in SI and the proportion of participants reporting ≥ 1 SA at post-treatment. Significantly greater decrease in SI for T as compared to C at post-treatment in a subsample of female adolescents. |
| Support-Based Therapy | King et al. (2009)1 | 448; T=223, C=225 |
13–17 years old; 71% female; 84% Caucasian, 6% African American, 2% Hispanic, 8% other | Inpatient | In: Recent psychiatric hospitalization; past month SA or frequent (“many times”) SI 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%) |
SI (SIQ-Jr); SA (DISC-IV) |
T: Youth-nominated Support Team-II, TAU (varied); Dose: Psychoeducation for supports, weekly contact between supports and adolescents for 3 months C: TAU (varied); Dose: 3 months Assessments: Pre-treatment (BL), mid-treatment (6 weeks), post-treatment (3 months), F/U at 6 and 12 months |
Treatment completion (≥ 2 support people for 12 weeks): T: 74% Attrition: Post-treatment: T: 23.7% C: 21.8% 12-month F/U: T: 19.3% C: 21.8% |
Significantly greater decrease in SI for T as compared to C at mid-treatment. NS between group differences in SI at post-treatment and over 12-month F/U. NS between group differences in frequency of SA or SA rate over 12-month F/U. |
| Eclectic Group Therapy | Green et al. (2011)1 | 366; T=183, C=183 |
12–17 years old; 89% female; 94% Caucasian | Mental health service | In: ≥2 DSH episodes in past year Ex: Severe AN; active psychosis; current confinement in secure care; attendance at special learning disability school; youth not fluent in English |
UMD (62%); DBD (33%) |
DSH (interview validated in Harrington et al., 1998); SI (SIQ) |
T: DGT (see Wood et al., 2001), TAU; Dose: (see Wood et al.) C: TAU, no group therapy permitted during trial; Dose: Varied Assessments: Pre-treatment (BL), F/U at 6 and 12 months |
Treatment completion (≥ 5 sessions): T: 79% C: 63% Attrition: T: 1.6% C: 2.3% |
NS between group differences in frequency of DSH, severity of DSH, or SI at 6- and 12-month F/U. |
| Eclectic Group Therapy | Hazell et al. (2009)1 | 72; T=35, C=37 |
12–16 years old; 90% female; race/ethnicity NR | Mental health service | In: ≥2 DSH episodes in past year + at least 1 DSH episode in past 3 months Ex: More intensive treatment required; active psychosis; inability to attend groups; intellectual disability |
MDD (57%); DBD (7%); Alcohol problems (4%) |
DSH (PHI); SI (SIQ) |
T: DGT (see Wood et al.) + TAU; Dose: 1 hour/week for 6 sessions for up to 1 year (see Wood et al.) C: TAU (individual or family sessions); Dose: Varied Assessments: Pre-treatment (BL), F/U at 2, 6, and 12 months |
Treatment completion (≥ 4 sessions): T: 71.4% C: 62.2% Attrition: T: 2.8% C: 8.1% |
Significantly more participants in T reported DSH behavior as compared to C at 6-month F/U. NS between group difference in the proportion of participants reporting DSH behavior between 6- and 12-month F/U. NS between group differences in the proportion of participants engaging in >1 DSH episode between BL and 6-month F/U or between 6- and 12-month F/U. NS between group difference in SI over 12-month F/U. |
| Eclectic Group Therapy | Rudd et al. (1996)1 | 264; T=143, C=121 |
15–24 years old; 18% female; 61% Caucasian, 26% African American, 11% Hispanic | Mental health service | In: Previous SA; UMD + SI; AUD + SI Ex: SUD or chronic abuse; psychosis or thought disorder; severe PD |
MD (72%); AUD (44%); ANX (37%) |
SI (MSSI) | T: Time-limited CBT group therapy (psychoeducation classes, problem-solving group, experiential-affective group, homework), TAU; Dose: 9 hours daily for 2 weeks C: TAU (inpatient, outpatient); Dose: Varied combination of individual and group therapy Assessments: Pre-treatment (BL), post-treatment (1 month), F/U at 6 and 12 months (18- and 24-month F/U data not reported here) |
Treatment completion: T: 79% C: NR Attrition: Post-treatment: T: 16.1% C: 24.8% 6-month F/U: T: 47.6% C: 54.5% 12-month F/U: T: 67.8% C: 79.3% |
NS between group differences in SI at post-treatment and at 6- and 12-month F/U. |
| Eclectic Group Therapy | Wood, Trainor, Rothwell, Moore, & Harrington (2001)1 | 63; T=32, C=31 |
12–16 years old; 78% female; race/ethnicity NR | Mental health service | In: ≥1 DSH episode in past year; referred to mental health services following DSH incident Ex: Severe suicide risk; inability to attend groups; psychosis; significant learning problems |
MDD (83%); DBD (67%) |
DSH (interview-see Kerfoot, 1984); SI (SIQ) |
T: Developmental group psychotherapy (DGT; acute and long-term groups, individual sessions [as needed]), TAU; Dose: 6 acute sessions, weekly long-term group as needed for 6 months C: TAU; Dose: Varied Assessments: Pre-treatment (BL), F/U at 6 weeks and 7 months |
Treatment completion (≥ 4 sessions): T: 71.9% C: 61.3% Attrition: 7-month F/U: T: 3.1% C: 0% |
Significantly greater decrease in DSH episodes for T as compared to C. Significantly longer time to first DSH episode for T as compared to C over 7-month F/U. NS between group differences in SI at post-treatment and at 7-month F/U. |
| Resource Intervention | Cotgrove, Zirinsky, Black, & Weston (1995)1 | 105; T=47, C=58 |
12–16 years old; 85% female; race/ethnicity NR | Inpatient | In: Admitted for DSH, DSP, or SA Ex: NR |
NR | SA (unspecified psychiatrist questionnaire) | T: Green card for re-admission to the hospital C: Clinic or child psychiatry department TAU Assessments: Pre-treatment and F/U at 1 year |
Treatment completion: T: 11% used green card Attrition: Total sample: 0% |
NS between group differences in SA (statistically), but some lower rates of SA in treatment group. |
| Resource Intervention | Morthorst, Krogh, Erlangsen, Alberdi, & Nordentoft (2012) | 243; T=123, C=120 |
≥ 12 years old; 76% female; 68% Danish, 14% Middle Eastern, 8% European and American, 10% other | ED, intensive care, pediatric units | In: Admitted to hospital after SA (within past 14 days); self-injuries included if they met WHO definition of SA Ex: Admitted to psychiatric ward for more than 14 days after attempt; SZ spectrum disorders; severe MDD; severe BP; severe dementia; needed inpatient care; receiving outreach services from social services; living in institutions |
NR | SA (unspecified self-report) | T: Assertive Intervention for Deliberate Self-harm (AID), TAU; Dose: 8–20 outreach consultations over 6 months C: TAU; Dose: Optional 6–8 sessions for those not receiving other care Assessment: Pre-treatment, F/U at 1 year |
Treatment completion: T: 96% C: 100% Attrition: F/U: T: 22.8% C: 38.3% |
NS between rates of subsequent suicide attempts in treatment and control groups. |
| Resource Intervention | Robinson et al. (2012)1 | 164; T=81, C=83 |
15–24 years old; 65% female; race/ethnicity NR | Community | In: Living inside target area; did not meet entry criteria for mental health service; history of DSH or SRB Ex: Known organic cause for DSH/SRB; intellectual disability; youth not fluent in English |
MD (67%); ANX (63%); SUD (25%) |
DSH (SBQ-14, BRFL-Adolescent); SA (SBQ-14, BRFL-Adolescent); SI (BSS) |
T: Post cards promoting well-being and evidence-based skills use, community-based TAU; Dose: Monthly for 12 months C: Community-based TAU; Dose: 12 months Assessments: Pre-treatment, F/U at 12 and 18 months |
Attrition: 12-month F/U: T: 25.9% C: 37.4% 18-month F/U: T: 38.3% C: 55.4% |
Reduced DSH and SI in both groups, but NS between groups. |
| Motivational Interviewing | King et al. (2015) | 49; T=27, C=22 |
14–19 years old; 80% female; 57% African American, 39% Caucasian, 4% American Indian or Alaskan Native, 2% Hispanic, 2% Native Hawaiian/Pacific Islander, 2% other | ED | In: Positive suicide risk screen (SI, recent SA, or depression and substance abuse); presented with non-psychiatric complaint Ex: Level 1 trauma; significant cognitive impairment; psychiatric hospitalization |
NR | SI (SIQ-Jr) | T: Teen Options for Change (TOC); Dose: Crisis card + resources, feedback on screenings, 35–45 minute adapted motivational interview C: Enhanced TAU (crisis card for suicidal emergency support) Assessments: Pre-treatment (BL), F/U at 2 months |
Treatment completion: Total: 85% Attrition: Total: 6% |
NS between-group differences in SI. |
| Brief Skills Training | Kennard et al. (2018) | 66; T=34, C=32 |
12–18 years old; 89% female; 77% Caucasian | Inpatient | In: Presented to psychiatric inpatient unit with recent SP or recent SA Ex: Needed residential treatment; active involvement in child protective services; mania; psychosis; autism; intellectual disability |
MDD (86%); Of those with MDD, 58% had a comorbid ANX |
SI (SIQ-Jr); SA (C-SSRS); NSSI (C-SSRS) |
T: As Safe as Possible (ASAP), TAU; Dose: 3-hour ASAP intervention, BRITE app use C: TAU; Dose: Varied Assessments: Pre-treatment, F/U at 4, 12, and 24 weeks post-discharge |
Treatment completion: Varies based on treatment component Attrition: 4-week F/U: T: 8.8% C: 21.9% 12-week F/U: T: 20.6% C: 28.1% 24-week F/U: T: 17.6% C: 18.8% |
NS for all SITB outcomes. |
BL=baseline assessment; ED=emergency department; F/U=follow-up; NR=not reported; NS=non-significant
Major Diagnoses: ADHD=attention-deficit/hyperactivity disorder; AN=anorexia nervosa; ANX=anxiety disorder–type not specified; ASD=autism spectrum disorder; AUD=alcohol use disorder; BP=bipolar disorder; BPD=borderline personality disorder; CD=conduct disorder; CUD=cannabis use disorder; DBD=disruptive behavior disorder; ED=eating 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; SCAD=schizoaffective disorder; SUD=substance use disorder; SZ=schizophrenia; UMD=unipolar mood disorder
Measures: ASQ-R=Adolescent Suicide Questionnaire Revised; BAI=Beck Anxiety Inventory; BDI=Beck Depression Inventory; BHS=Beck Hopelessness Scale; BRFL=Brief Reasons for Living Inventory; BSI=Brief Symptom Inventory; BSS=Beck Scale for Suicide Ideation; CAFAS=Child and Adolescent Functional Assessment Scale; CBCL=Children Behavior Checklist; C-SSRS=Columbia Suicide Severity Rating Scale; 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; MSSI=Modified Scale for Suicide Ideation; PHI=Parasuicide History Interview; RTSHI=Risk Taking and Self Harm Inventory; SASII=Suicide Attempt Self-Injury Interview; SBQ-14=Suicide Behavior Questionnaire; SIQ (Jr or Sn)=Suicide Ideation Questionnaire; SSBS=Spectrum of Suicide Behavior Scale; SSI=Scale for Suicidal Ideation; YRBS=Youth Risk Behavior Survey
Self-Injurious Outcomes: DSH=deliberate self-harm; DSP=deliberate self-poisoning; NSSI=nonsuicidal self-injury; SA=suicide attempt; 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)
Treatments and Conditions: C=control or comparison group; CBT=Cognitive-Behavioral Therapy; DBT-A=Dialectical Behavior Therapy for adolescents; EUC=Enhanced Usual Care; IPT-A=interpersonal psychotherapy for adolescents; MI=Motivational Interviewing; T=experimental treatment group; TAU=treatment as usual
1
Trial was included in the prior JCCAP Evidence Base Update (Glenn et al., 2015).