Family Safety Net II

Nearly 500,000 adolescents are admitted, per year, to psychiatric hospitals from emergency rooms for suicide attempts or serious suicidal ideation (Institute of Medicine, 2002), both of which lead to high emotional costs for families and financial costs for the health care system. Family-based treatments for youth suicide are promising. Negative family functioning (e.g., high conflict, low cohesion, ineffective parenting, etc.) is a strong risk factor for youth suicide and depression (Wagner et al., 2003). In contrast, family cohesion, emotional support, and appropriate supervision are protective factors in preventing suicide and depression (Wagner et al., 2003). The current study will test the efficacy of two treatments, Attachment-Based Family Therapy (ABFT) and Non-Directive Supportive Therapy with Parent Psychoeducation (NDST-P), in improving depression and suicide ideation in high-risk adolescents. Our target population is adolescents with severe and persistent suicidal ideation (a serious risk factor for suicidal behavior and hospitalization, and a condition usually requiring attention by health professional) (Spirito & Esposito-Smythers, 2006; Prinstein et al., 2008). The sample will include a significant proportion of inner city, minority youth; a group whose risk for suicide has increased dramatically (Joe et al. 2006). One hundred and twenty adolescents will be recruited from primary care, emergency rooms, schools and the general community. Patients will be randomized to 16 weeks of ABFT or NDST. Assessments will be conducted at baseline, 4, 8, 12, 16, (post treatment), and every 8 weeks during the follow-up phase (weeks 24, 32, and 40) through week 52. The primary outcome measure is changes in suicide ideation. Secondary and exploratory outcomes include changes in depression, attachment relationships, and parent-child conflict resolution.

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