Skip to main content

Advertisement

Log in

Evidence-Based Interventions for Youth Suicide Risk

  • Child and Adolescent Disorders (TD Benton, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review and discuss recent advances in evidence-based interventions (EBIs) for youth suicide risk.

Recent Findings

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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.

  2. World Health Organization. Public health action for the prevention of suicide: A framework. 2012.

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. •• 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.

  9. 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.

    Article  Google Scholar 

  10. •• 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.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. •• 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. •• 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.

    Article  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. Lorås L. Systemic family therapy competences in child and adolescent mental health care. Contemp Fam Ther. 2018;40(1):1–9.

    Article  Google Scholar 

  22. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. King CA, Ewell Foster C, Rogalski KM. Teen suicide risk: A practitioner guide to screening, assessment, and management. New York: Guilford Press; 2013.

    Google Scholar 

  31. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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.

    Article  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. 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.

    Article  Google Scholar 

  39. 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.

    CAS  PubMed  Google Scholar 

  40. U.S. Census Bureau. The Supplemental Poverty Measure: 2017. 2018.

  41. 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.

    Article  Google Scholar 

  42. 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.

    Article  Google Scholar 

  43. 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.

    Article  Google Scholar 

  44. 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.

    Article  Google Scholar 

  45. 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.

  46. 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.

  47. 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.

  48. 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.

    Article  Google Scholar 

  49. • 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.

    Article  PubMed  Google Scholar 

  50. 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.

    Article  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cheryl A. King.

Ethics declarations

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.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Topical Collection on Child and Adolescent Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-020-1129-6

Keywords

Navigation