Purpose of Review
To review and discuss recent advances in evidence-based interventions (EBIs) for youth suicide risk.
There is a growing body of research on the effectiveness of interventions targeting suicidal ideation and behavior among adolescents. Dialectical Behavioral Therapy-Adolescent has shown effectiveness across two independent randomized controlled trials (RCTs). Several other interventions have shown effectiveness in only one trial and are in need of replication. New interventions are also being developed that incorporate developments in technology and adaptive intervention designs. It is recommended that future research focus on strategies for engaging underserved youth with interventions, consider the broader needs of youth living in poverty, and further tailor interventions to subgroups with distinct risk profiles. Limited EBIs exist for preadolescents, despite evidence for an increasing rate of suicidal behavior for these youth.
Several interventions for youth suicide risk are highly promising, but further investigation is necessary. EBIs that are effective for preadolescents are needed, and greater efforts to tailor interventions for distinct subgroups of youth at risk are recommended.
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Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control. 2019. www.cdc.gov/injury/wisqars/index.html. Accessed 13 Jan 2020.
World Health Organization. Public health action for the prevention of suicide: A framework. 2012.
Castellví P, Lucas-Romero E, Miranda-Mendizábal A, Parés-Badell O, Almenara J, Alonso I, et al. Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis. J Affect Disord. 2017;215:37–48. https://doi.org/10.1016/j.jad.2017.03.035.
Monto MA, McRee N, Deryck FS. Nonsuicidal self-injury among a representative sample of US adolescents, 2015. Am J Public Health. 2018;108(8):1042–8. https://doi.org/10.2105/AJPH.2018.304470.
Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth risk behavior surveillance—United States, 2017. MMWR Surveill Summ. 2018;67(8):1.
Glenn CR, Franklin JC, Nock MK. Evidence-based treatments for self-injurious thoughts and behaviors in youth. J Clin Child Adolesc Psychol. 2015;44(1):1–29. https://doi.org/10.1037/e521702015-006.
Ougrin D, Tranah T, Stahl D, Moran P, Asarnow JR. Therapeutic interventions for suicide attempts and self-harm in adolescents: Systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2015;54(2):97–107.e2. https://doi.org/10.1016/j.jaac.2014.10.009.
•• Glenn CR, Esposito EC, Porter AC, Robinson DJ. Evidence-base update of psychosocial treatments for self-injurious thoughts and behaviors in youth. J Clin Child Adolesc Psychol. 2019. This article provides a comprehensive and systematic review of the evidence to-date regarding psychosocial interventions for youth at elevated risk for suicide attempts and suicide.
Southam-Gerow MA, Prinstein MJ. Evidence base updates: The evolution of the evaluation of psychological treatments for children and adolescents. J Clin Child Adolesc Psychol. 2014;43(1):1–6.
•• McCauley E, Berk MS, Asarnow JR, Adrian M, Cohen J, Korslund K, et al. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry. 2018;75(8):777–85. This efficacy trial demonstrates that dialectical behavior therapy, compared to individual and group supportive therapy, for highly suicidal adolescents was associated with a lower likelihood of suicide attempt and nonsuicidal self-injury at the end of 6-month treatment, although this difference did not persist.
Esposito-Smythers C, Spirito A, Kahler CW, Hunt J, Monti P. Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial. J Consult Clin Psychol. 2011;79(6):728–39.
Esposito-Smythers C, Wolff JC, Liu RT, Hunt JI, Adams L, Kim K, et al. Family-focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co-occurring risk factors: A randomized trial. J Child Psychol Psychiatry. 2019. https://doi.org/10.1111/jcpp.13095.
•• Asarnow JR, Hughes JL, Babeva KN, Sugar CA. Cognitive-behavioral family treatment for suicide attempt prevention: A randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2017;56(6):506–14. https://doi.org/10.1016/j.jaac.2017.03.015. This efficacy trial demonstrates that the Safe Alternatives for Teens and Youths (SAFETY) intervention for adolescents with recent self-harm, which integrates cognitive-behavioral and dialectical behavior therapy components into a family treatment, was associated with a lower probability of suicide attempt than treatment as usual at 3-month follow-up.
Asarnow JR, Baraff LJ, Berk M, Grob CS, Devich-Navarro M, Suddath R, et al. An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatr Serv. 2011;62(11):1303–9.
King CA, Klaus N, Kramer A, Venkataraman S, Quinlan P, Gillespie B. The Youth-Nominated Support Team–version II for suicidal adolescents: A randomized controlled intervention trial. J Consult Clin Psychol. 2009;77(5):880–93. https://doi.org/10.1037/a0016552.
•• King CA, Arango A, Kramer A, Busby DR, Czyz EC, Ewell Foster CJ, et al. Association of the Youth-Nominated Support Team Intervention for Suicidal Adolescents with 11-to 14-year mortality outcomes. Secondary analysis of a randomized clinical trial. JAMA Psychiatry. 2019. https://doi.org/10.1001/jamapsychiatry.2018.4358. This examination of the long-term mortality outcomes associated with treatment as usual plus the Youth-Nominated Support Team Intervention (YST), relative to treatment as usual only, indicates that YST was associated with reduced overall mortality and reduced mortality due to suicide or drug overdose with unknown intent.
Diamond GS, Reis BF, Diamond GM, Siqueland L, Isaacs L. Attachment-based family therapy for depressed adolescents: A treatment development study. J Am Acad Child Adolesc Psychiatry. 2002;41(10):1190–6. https://doi.org/10.1097/00004583-200210000-00008.
Diamond GS, Kobak RR, Krauthamer Ewing ES, Levy SA, Herres JL, Russon JM, et al. A randomized controlled trial: Attachment-based family and nondirective supportive treatments for youth who are suicidal. J Am Acad Child Adolesc Psychiatry. 2019;58(7):721–31. https://doi.org/10.1016/j.jaac.2018.10.006.
Cottrell DJ, Wright-Hughes A, Collinson M, Boston P, Eisler I, Fortune S, et al. Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: A pragmatic, phase 3, multicentre, randomised controlled trial. Lancet Psychiatry. 2018;5(3):203–16.
Allison S, Perlesz A, Pote H, Stratton P, Cottrell D. Extended dialogue about significant developments: Manualising systemic family therapy: The Leeds manual. Aust N Z J Fam Ther. 2002;23(3):153–8.
Lorås L. Systemic family therapy competences in child and adolescent mental health care. Contemp Fam Ther. 2018;40(1):1–9.
Kennard B, Goldstein T, Foxwell A, McMakin D, Wolfe K, Biernesser C, et al. As safe as possible (ASAP): A brief app-supported inpatient intervention to prevent postdischarge suicidal behavior in hospitalized, suicidal adolescents. Am J Psychiatry. 2018;175(9):864–72. https://doi.org/10.1176/appi.ajp.2018.17101151.
Hetrick SE, Yuen HP, Bailey E, Cox GR, Templer K, Rice SM, et al. Internet-based cognitive behavioural therapy for young people with suicide-related behaviour (reframe-IT): A randomised controlled trial. Evid Based Ment Health. 2017;20(3):76–82.
McManama O'Brien KH, LeCloux M, Ross A, Gironda C, Wharff EA. A pilot study of the acceptability and usability of a smartphone application intervention for suicidal adolescents and their parents. Archives of Suicide Research. 2017;21(2):254–64.
Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance — United States, 2017. MMWR CDC Surveill Summ. 2018;67(SS-8):1–114. https://doi.org/10.15585/mmwr.ss6708a1.
Houle J, Mishara BL, Chagnon F. An empirical test of a mediation model of the impact of the traditional male gender role on suicidal behavior in men. J Affect Disord. 2008;107(1):37–43. https://doi.org/10.1016/j.jad.2007.07.016.
Schrijvers DL, Bollen J, Sabbe BG. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord. 2012;138(1):19–26. https://doi.org/10.1016/j.jad.2011.03.050.
Chang HJ, Lai YL, Chang CM, Kao CC, Shyu ML, Lee MB. Gender and age differences among youth, in utilization of mental health services in the year preceding suicide in Taiwan. Community Ment Health J. 2012;48(6):771–80. https://doi.org/10.1007/s10597-011-9470-1.
Rhodes AE, Khan S, Boyle MH, Wekerle C, Goodman D, Tonmyr L, et al. Sex differences in suicides among children and youth: The potential impact of misclassification. Can J Public Health. 2012;103(3):213–7.
King CA, Ewell Foster C, Rogalski KM. Teen suicide risk: A practitioner guide to screening, assessment, and management. New York: Guilford Press; 2013.
King CA, Jiang Q, Czyz EK, Kerr DC. Suicidal ideation of psychiatrically hospitalized adolescents has one-year predictive validity for suicide attempts in girls only. J Abnorm Child Psychol. 2014;42(3):467–77. https://doi.org/10.1007/s10802-013-9794-0.
Lewinsohn PM, Rohde P, Seeley JR, Baldwin CL. Gender differences in suicide attempts from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry. 2001;40(4):427–34. https://doi.org/10.1097/00004583-200104000-00011.
Oquendo MA, Bongiovi-Garcia ME, GaIfaIvy H, Goldberg PH, Grunebaum MF, Burke AK, et al. Sex differences in clinical predictors of suicidal acts after major depression: A prospective study. Am J Psychiatry. 2007;164(1):134–41. https://doi.org/10.1176/appi.ajp.164.1.134.
Conner KR, Swogger MT, Houston RJ. A test of the reactive aggression-suicidal behavior hypothesis: Is there a case for proactive aggression? J Abnorm Psychol. 2009;118(1):235–40.
Monnin J, Thiemard E, Vandel P, Nicolier M, Tio G, Courtet P, et al. Sociodemographic and psychopathological risk factors in repeated suicide attempts: Gender differences in a prospective study. J Affect Disord. 2012;136(1):35–43. https://doi.org/10.1016/j.jad.2011.09.001.
Ilgen MA, Bohnert AS, Chermack S, Conran C, Jannausch M, Trafton J, et al. A randomized trial of a pain management intervention for adults receiving substance use disorder treatment. Addiction. 2016;111(8):1385–93.
Ford JD, Hartman JK, Hawke J, Chapman JF. Traumatic victimization, posttraumatic stress disorder, suicidal ideation, and substance abuse risk among juvenile justice-involved youth. J Child Adolesc Trauma. 2008;1(1):75–92.
Abram KM, Choe JY, Washburn JJ, Teplin LA, King DC, Dulcan MK. Suicidal ideation and behaviors among youths in juvenile detention. J Am Acad Child Adolesc Psychiatry. 2008;47(3):291–300.
Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147-52.
U.S. Census Bureau. The Supplemental Poverty Measure: 2017. 2018.
Chen E, Langer DA, Raphaelson YE, Matthews KA. Socioeconomic status and health in adolescents: The role of stress interpretations. Child Dev. 2004;75(4):1039–52.
Bernburg JG, Thorlindsson T, Sigfusdottir ID. The spreading of suicidal behavior: The contextual effect of community household poverty on adolescent suicidal behavior and the mediating role of suicide suggestion. Soc Sci Med. 2009;68(2):380–9.
Hanratty M. Do local economic conditions affect homelessness? Impact of area housing market factors, unemployment, and poverty on community homeless rates. Hous Policy Debate. 2017;27(4):640–55.
Ensign J, Panke A. Barriers and bridges to care: Voices of homeless female adolescent youth in Seattle, Washington. USA J Adv Nurs. 2002;37(2):166–72.
Pew Research Center. Teens, Social Media, & Technology 2018. In: Internet & Technology 2018. https://www.pewinternet.org/2018/05/31/teens-social-media-technology-2018/. Accessed 13 Jan 2020.
National Consumers League. Survey: Majority of 'tweeners' now have cell phones, with many parents concerned about cost. 2012. https://www.nclnet.org/survey_majority_of_tweeners_now_have_cell_phones_with_many_parents_concerned_about_cost. Accessed 13 Jan 2020.
Influence Central. Kids & tech: The evolution of today’s digital natives. 2016. http://influence-central.com/kids-tech-the-evolution-of-todays-digital-natives/. Accessed 13 Jan 2020.
Allen NB, Nelson BW, Brent D, Auerbach RP. Short-term prediction of suicidal thoughts and behaviors in adolescents: Can recent developments in technology and computational science provide a breakthrough? J Affect Disord. 2019;250:163–9.
• Torous J, Larsen ME, Depp C, Cosco TD, Barnett I, Nock MK, et al. Smartphones, sensors, and machine learning to advance real-time prediction and interventions for suicide prevention: A review of current progress and next steps. Curr Psychiatry Rep. 2018;20(7):51. https://doi.org/10.1007/s11920-018-0914-y. This article reviews the potential of, and current evidence for, smartphones and other new technologies for understanding, predicting outcomes, and intervening with individuals at risk for suicide.
Kelly J, Gooding P, Pratt D, Ainsworth J, Welford M, Tarrier N. Intelligent real-time therapy: Harnessing the power of machine learning to optimise the delivery of momentary cognitive–behavioural interventions. J Ment Health. 2012;21(4):404–14.
Berona J, Horwitz AG, Czyz EK, King CA. Psychopathology profiles of acutely suicidal adolescents: Associations with post-discharge suicide attempts and rehospitalization. J Affect Disord. 2017;209:97–104. https://doi.org/10.1016/j.jad.2016.10.036.
Pistorello J, Jobes DA, Compton SN, Locey NS, Walloch JC, Gallop R, et al. Developing adaptive treatment strategies to address suicidal risk in college students: A pilot sequential, multiple assignment, randomized trial (SMART). Arch Suicide Res. 2018;22(4):644–64.
Conflict of Interest
Danielle R. Busby, Claire Hatkevich, and Taylor C. McGuire each declare no potential conflicts of interest. Cheryl A. King has received consultancy fees from the American Foundation for Suicide Prevention and the National Advisory Mental Health Council, grants from the NIMH, honoraria payments from Florida International University, Duke University, Indiana University School of Medicine, American Academy of Child and Adolescent Psychiatry, West Virginia University, and the University of Pittsburgh. Dr. King has also received book royalties from Guilford Publications and paid travel accommodations from Florida International University, Duke University, Indiana University, Mayo Clinic, West Virginia University, University of Pittsburgh, American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association.
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Busby, D.R., Hatkevich, C., McGuire, T.C. et al. Evidence-Based Interventions for Youth Suicide Risk. Curr Psychiatry Rep 22, 5 (2020). https://doi.org/10.1007/s11920-020-1129-6
- Suicide risk
- Suicidal thoughts and behaviors