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Cited by 235Suicide and Self-Harm StudiesPersonality Disorders and PsychopathologyCounseling, Therapy, and Family Dynamics

Cognitive-behavioral family treatment for suicide attempt prevention: A randomized controlled trial

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Asarnow, Joan Rosenbaum, Hughes, Jennifer L., Babeva, Kalina N., Sugar, Catherine A.·2017·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2017.03.015PMC PMC5474088
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Abstract

Objective Suicide is a leading cause of death. New data indicate alarming increases in suicide death rates, yet no treatments with replicated efficacy or effectiveness exist for youths with self-harm presentations, a high-risk group for both fatal and nonfatal suicide attempts. We addressed this gap by evaluating Safe Alternatives for Teens and Youths (SAFETY), a cognitive-behavioral, dialectical behavior therapy-informed family treatment designed to promote safety.Method Randomized controlled trial for adolescents (12-18 years of age) with recent (past 3 months) suicide attempts or other self-harm. Youth were randomized either to SAFETY or to treatment as usual enhanced by parent education and support accessing community treatment (E-TAU). Outcomes were evaluated at baseline, 3 months, or end of treatment period, and were followed up through 6 to 12 months. The primary outcome was youth-reported incident suicide attempts through the 3-month follow-up.Results Survival analyses indicated a significantly higher probability of survival without a suicide attempt by the 3-month follow-up point among SAFETY youths (cumulative estimated probability of survival without suicide attempt = 1.00, standard error = 0), compared to E-TAU youths (cumulative estimated probability of survival without suicide attempt = 0.67, standard error = 0.14; z = 2.45, p = .02, number needed to treat = 3) and for the overall survival curves (Wilcoxon χ 21 = 5.81, p = .02). Sensitivity analyses using parent report when youth report was unavailable and conservative assumptions regarding missing data yielded similar results for 3-month outcomes.Conclusion Results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm. This is the second randomized trial to demonstrate that treatment including cognitive-behavioral and family components can provide some protection from suicide attempt risk in these high-risk youths. Clinical trial registration information-Effectiveness of a Family-Based Intervention for Adolescent Suicide Attempters (The SAFETY Study); http://clinicaltrials.gov/; NCT00692302.

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  • Little is known about processes immediately preceding suicide, and few effective strategies exist to intervene in the hours or minutes before suicidal behavior, perhaps particularly among youths.

    “Consequently, little is known regarding the processes that may immediately precede suicide, and few effective strategies designed to intervene in the hours or minutes before individuals engage in suicidal behavior are available (Asarnow et al. 2017, Cha et al. 2018, Miller et al. 2017a), perhaps particularly among youths.”

    From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Asarnow et al. 2017

    The Introduction says that treatments with replicated efficacy for youth suicide attempts and self-harm are lacking, supporting the claim that effective strategies are limited among youths. It does not address what is known about processes immediately preceding suicide or whether effective interventions are available in the hours or minutes before suicidal behavior; the Method describes a safety plan but does not establish its effectiveness on that timescale. Page numbers are unavailable in our copy. (LLM, conf=0.85)

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  • Only three randomized controlled trials have demonstrated efficacy in temporarily reducing risk for suicidal behavior among adolescents with a history of suicide attempts or self-harm.

    “Only three randomized controlled trials have demonstrated efficacy in temporarily reducing the risk for suicidal behavior among adolescents with a history of suicide attempts or self-harm (Asarnow et al. 2017, Esposito-Smythers et al. 2011, McCauley et al. 2018).”

    From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Asarnow et al. 2017

  • Family intervention and Cognitive Behavior Therapy contribute to reductions in suicidality in adolescents.

    “consistent with findings of other studies demonstrating that family intervention and Cognitive Behavior Therapy (CBT) contribute to reductions in suicidality in adolescents (e.g.Asarnow, Hughes, Babeva, & Sugar, 2017;Esposito-Smythers, Spirito, Hahler, Hunt, & Monti, 2011).”

    From The rapid stabilization pathway: impact of a brief inpatient intervention on the length of stay and readmissions among psychiatrically hospitalized adolescents (2023) · cites this paper as Asarnow, Hughes, Babeva, & Sugar, 2017

  • FISP is the first session in the evidence-based outpatient intervention SAFETY for youth with a recent suicide attempt.

    “FISP is also the first session in an evidence-based outpatient intervention for youth with a recent suicide attempt, SAFETY.65-68”

    From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [67]

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Authors
Asarnow, J. R., Hughes, J. L., Babeva, K. N., & Sugar, C. A.
Affiliations
  • University of California, Los Angeles (US)
  • The University of Texas Southwestern Medical Center (US)
Corresponding author
Asarnow, Joan Rosenbaum
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2017-06
Volume
56
Issue
6
Pages
506-514
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2017.03.015
PMC
PMC5474088
OpenAlex
W2605081163
Cited by
234
References
33
Citations by year
2026: 24 · 2025: 26 · 2024: 22 · 2023: 27 · 2022: 26 · 2021: 42 · 2020: 19 · 2019: 23 · 2018: 20 · 2017: 5
FWCI
22.73
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R34MH078082)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
Keywords
suicide attempt prevention, adolescent self-harm, family intervention, cognitive behavioral therapy, dialectical behavior therapy, safety, parent education, at-risk youth
MeSH terms
Adolescent, Family Therapy, Female, Humans, Male, Suicide, Attempted, Cognitive Behavioral Therapy, Self-Injurious Behavior, Treatment Outcome

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