Family‐focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co‐occurring risk factors: a randomized trial

Background Suicide is the second leading cause of death among adolescents. The purpose of this study was to test a family‐focused outpatient cognitive behavioral treatment (F‐CBT) protocol for depressed adolescents following psychiatric hospitalization for a suicide attempt or suicidal ideation, and who had a co‐occurring risk factor (suicidal behavior prior to the index admission, nonsuicidal self‐injury, and/or a substance use disorder), in a randomized Phase 2 efficacy trial. Method One hundred forty‐seven adolescents (mean age = 14.91 years; 76.2% female, 85.5% White) and their families, recruited primarily from an inpatient psychiatric hospitalization program, were randomly assigned to F‐CBT or enhanced treatment‐as‐usual (E‐TAU). A suicide attempt was the primary outcome variable. Depression, suicidal ideation, and nonsuicidal self‐injury are also reported here. Assessments were completed at pretreatment as well as 6, 12, and 18‐months postrandomization (Trial Registration ClinicalTrials.gov Identifier: NCT01732601). Results In the sample as a whole, rates of attempts decreased from 20% at 6 months to 9% at 12 months to 7% at 18 months. There was no evidence of a significant difference between treatment arms in rates of suicide attempts, major depressive disorder, suicidal ideation, or nonsuicidal self‐injury at any of the postrandomization assessment points. Conclusions Though F‐CBT was associated with reductions in suicidality, depression, and nonsuicidal self‐injury, E‐TAU showed an equally strong effect. Greater frequency of F‐CBT treatment sessions, particularly at the start of care, and alternative approaches to transitioning to care at 12 months, may be necessary when using F‐CBT with this population.