Developing adaptive treatment strategies to address suicidal risk in college students: A pilot sequential, multiple assignment, randomized trial (SMART)
Open accessAbstract
This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4-8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions-both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4-16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.
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In the Pistorello et al. Phase 1 results, CAMS was significantly more effective than TAU in terms of the primary outcome of suicidal ideation and the secondary outcome of depression.
“Phase 1 results only were thus published showing that CAMS was significantly more effective than TAU in terms of the primary outcome of suicidal ideation and the secondary outcome of depression.”
From The use of CAMS and DBT to effectively treat patients who are suicidal (2024) · cites this paper as [32]
The Results section (Acceptability: Attendance, Treatment Attrition, and Sufficient Response; page unavailable) reports that Stage 1 treatment response did not differ significantly between CAMS and TAU (p=.44). The Discussion (Summary of Findings; page unavailable) says the pilot was not designed to examine relative efficacy. Our copy therefore does not report the claimed significant advantage on suicidal ideation and depression. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn an alternative moderator finding from the Pistorello et al. trial, in clients who were newer to suicidal ideation with no attempt history or borderline features, CAMS significantly decreased a secondary outcome measure of hopelessness compared to TAU.
“An alternative moderator finding was that, in clients who were “newer” to suicidal ideation with no attempt history or borderline features, CAMS significantly decreased a secondary outcome measure of hopelessness when compared to TAU.”
From The use of CAMS and DBT to effectively treat patients who are suicidal (2024) · cites this paper as [32]
The Method describes randomization to CAMS or TAU, and the Results report baseline hopelessness, attempt history, and borderline features. Neither those passages nor the Discussion’s summary of findings reports a moderator analysis or a significant reduction in hopelessness for the specified subgroup. Searches for the subgroup, moderator finding, and hopelessness outcome found no such result in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Pistorello, J., Jobes, D. A., Compton, S. N., Locey, N. S., Walloch, J. C., Gallop, R., Au, J. S., Noose, S. K., Young, M., Johnson, J., Dickens, Y., Chatham, P., Jeffcoat, T., Dalto, G., & Goswami, S.
- Affiliations
- University of Nevada, Reno (US)
- Catholic University of America (US)
- Duke University (US)
- West Chester University (US)
- Saint Louis University (US)
- Corresponding author
- Pistorello, Jacqueline
- ORCID
- Venue
- Archives of Suicide Research
- Publisher
- Informa UK Limited
- Published
- 2018-02-12
- Volume
- 22
- Issue
- 4
- Pages
- 644-664
- ISSN
- 1381-1118 (ISSN-L)
- 1543-6136
- PMC
- PMC6125229
- OpenAlex
- W2773460290
- Cited by
- 29
- References
- 54
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 1
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Suicide Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH104714)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- suicide risk, university students, adaptive therapy, sequential multiple assignment randomized trial, treatment acceptability, treatment feasibility, treatment discontinuation, treatment satisfaction, university mental health services
- MeSH terms
- Help-Seeking Behavior, Suicide Prevention, Adaptation, Psychological, Adolescent, Female, Humans, Male, Pilot Projects, Psychological Techniques, Risk Factors, Students, Suicide, Cognitive Behavioral Therapy, Self-Injurious Behavior, Treatment Outcome, Risk Assessment, Suicidal Ideation
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