Suicide Prevention Among Substance Abusing Homeless Youth

While research on homeless youth is increasing, there is a dearth of information regarding
effective interventions for these youth. This is of significant concern because studies
indicate that 70-95% report problem alcohol or drug use and 66% to 89% of homeless youth have
a mental health disorder. Suicide is the leading cause of death with up to 68% of youth
reporting a lifetime suicide attempt. Among those who have attempted, an average of 6.2
attempts is reported. In addition, lifetime suicide ideation rates have ranged from 14% to
66.5%. Some predictors of suicide among homeless youth have been identified. These include
substance use, childhood physical and sexual abuse, victimization experiences while living on
the streets, and psychological functioning, including depression, hopelessness, distress
tolerance, impulse control, social support, and problem solving. This study uses general
cognitive theory, complemented with concepts from two suicide specific theoretical models, to
guide our intervention and conceptual change model. Consonant with the pilot R34
announcement, this study's goal is to pilot test an intervention that has previously
demonstrated feasibility and promise with adolescent suicide attempters and efficacy with a
low-income sample of adults, "The Cognitive Therapy Intervention for Suicide Attempters."
One-hundred fifty homeless youth with recent severe suicide ideation will be randomly
assigned to the experimental cognitive therapy for suicide prevention (CTSP) + services as
usual (SAU) (n=75) or to SAU alone (n=75). SAU includes those services normally offered
through a local drop-in center. Follow-up assessments will be conducted at 3, 6, and 9-months
post-baseline. It is hypothesized that youth receiving CTSP+SAU will show greater reductions
in suicide ideation (primary outcome), substance use and depressive symptoms (secondary
outcomes) over time compared to SAU alone. Furthermore, theoretically-derived mediators will
be tested to shed light on mechanisms associated with change. The data from this study will
be used to determine the initial efficacy of this promising intervention, and determine
whether findings warrant a broader scale effectiveness trial. Ultimately, attention towards
reducing suicide risk among these youth has the potential to reduce premature mortality,
hospitalization and loss of human capital in a very high risk population of youth.

Inclusion Criteria:

- 18-24

- meet McKinney Vento definition for homelessness.

- Youth reports at least one episode of severe suicide ideation in the past 90 days.

Exclusion Criteria:

- Evidence of unremitted psychosis or other condition which would impair youth's ability
to understand and participate in the research.

- Youth requires psychiatric hospitalization.