Brief Intervention for Suicide Risk Reduction in High Risk Adolescents

This 2-site R34 project developed a brief, flexible, manualized intervention with supporting
phone app with the purpose of reducing the risk of suicidal behavior in adolescents with high
suicidal ideation or a recent suicide attempt, during the transition from inpatient to
outpatient care. This transition period is the highest risk period for attempted and
completed suicide. Suicide is the 2nd leading cause of adolescent mortality, and there are
currently no established interventions for suicidal teens. By developing a treatment that can
be delivered on an inpatient unit prior to the transition to outpatient treatment, we
anticipated being able to lower suicidal risk and increase the likelihood that participants
will attend subsequent outpatient treatment. In keeping with the priorities of NIMH, this
intervention aimed at reducing the risk of suicide and suicidal behavior was
trans-diagnostic. We term the intervention ASAP, with anticipated components: (1)
Adherence—promoting engagement and adherence to treatment through motivational interviewing;
(2) Safety planning; and (3) Affect Protection- selecting from a menu of techniques for
maintaining positive affect (e.g. savoring and switching strategies, mobilizing social
support, engaging in emotion regulation and distress tolerance skills). Each of these
components was delivered within a Motivational Interviewing framework for enhancing intrinsic
motivation for change. Treatment was brief (3-5 hours), and flexibly delivered on inpatient
units prior to initiation of outpatient treatment.

ASAP included the family in the treatment, and a safety plan phone app to extend the impact
of treatment was also developed. Innovative features included: (1) delivery of an
intervention at a time and place when suicidal risk is highest; (2) augmentation of
protective factors against recurrent suicidal behavior, specifically by promoting development
of positive affect, emotion regulation, distress tolerance, and social support; (3) a Safety
plan phone app to extend the impact of treatment; and (4) liaison with the outpatient
therapist to ensure continuity of care.

This project conducted an RCT of ASAP followed by Aftercare (AC) vs. AC alone to determine
ASAP's feasibility, acceptability, impact on proximal targets (e.g., adherence to outpatient
care, sleep, positive affect, substance use), suicidal ideation and behavior. In total 68
suicidal adolescents were enrolled, 2 of whom were withdrawn following baseline assessment
and were excluded from analyses, resulting in the final study sample size of 66. ASAP,
developed with and intended for community clinicians, has the potential to be a sustainable
intervention to reduce the burden of adolescent suicidality. Data analyses have been
completed and results are being finalized.

Inclusion Criteria:

- Child participants will be adolescents (aged 12-17.11 years) admitted to an inpatient
unit for a recent suicide attempt or significant suicidal ideation with a plan or
intent. We define a suicide attempt, as per the Columbia Clinical Algorithm for
Suicide Assessment (C-CASA), as "self-destructive behavior with inferred or stated
intent to die."

- Participants must be English-speaking.

- Participants can have unipolar or bipolar disorder, conduct or oppositional disorder,
eating disorder, or alcohol or substance use or abuse or dependence.

Exclusion Criteria:

- Child participants to be excluded will be those with current psychosis, mania, <90% of
ideal body weight, or IQ<70 (based on the age-appropriate Wechsler Intelligence Scale
if concerns about intellectual capabilities are evident at assessment), as these
conditions may require more intensive interventions or limit comprehension of the
intervention components.