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Evidence-Based Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth
Open accessAbstract
The purpose of this study was to review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) in youth. We reviewed major scientific databases (HealthSTAR, MEDLine, PsycINFO, PubMed) for relevant studies published prior to June 2013. The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions currently meet the Journal of Clinical Child and Adolescent Psychology standards for Level 1: well-established treatments. Six treatment categories were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious treatments included family skills training (e.g., family communication and problem solving), parent education and training (e.g., monitoring and contingency management), and individual skills training (e.g., emotion regulation and problem solving). Several treatments have shown potential promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only a single randomized controlled trial. Future research should focus on replicating studies of promising treatments, identifying active treatment ingredients, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g., following hospital discharge).
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“Similarly, a systematic review of 29 treatment studies (including 18 RCTs) for suicidal and nonsuicidal self-injurious thoughts and behaviours (SITBs) in youth found that no intervention met the standard to be classified as a ‘well-established intervention’, and only six interventions could be classified as ‘probably efficacious’ [21].”
From Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents (2020) · cites this paper as [21]
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“However, previous meta-analysis focused exclusively on a small number (k = 3) of randomized controlled trials (RCTs; Kothgassner et al., 2020), and the systematic review of controlled clinical trials (CCTs, trials including a control group, but which lack randomization) and pre-post evaluations only included studies published prior to July 2013 (k = 5, no RCTs; Glenn et al., 2015).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Glenn et al., 2015
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“Until recently, standard treatment of suicidality consisted of cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and/or medication, but all showed limited effects on suicidality [11, 13, 14].”
From The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial (2024) · cites this paper as [13]
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“To date, two reviews evaluating the efficacy of psychosocial treatments for reducing adolescent self-harm and suicidal ideation have highlighted DBT-A as a promising treatment (Glenn, Franklin, & Nock, 2015; Kothgassner, Robinson, Goreis, Ougrin, & Plener, 2020).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Glenn, Franklin, & Nock, 2015
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Citations
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“It may be surprising that DBT was not classified as an efficacious treatment, given its utility for reducing SITBs in adults (e.g., Linehan, Heard, & Armstrong, 1993; Linehan et al., 2006).”
BackgroundYouth Risk Behavior Surveillance - United States, 2009
Eaton, D. K., Kann, L. K., Kinchen, S., Shanklin, S. L., Flint, K. H., Hawkins, J., Harris, W. A., Lowry, R., McManus, T., Chyen, D., et al. (2010) · PsycEXTRA Dataset · doi:10.1037/e661322010-001 · Cited by 1,754
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“, nonsuicidal self-injury [NSSI], suicide threats, and gestures) are not (Nock, 2010).”
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Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D. A. F., et al. (1997) · PsycEXTRA Dataset · doi:10.1037/e619622010-001 · Cited by 1,488 · cited 2×
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Self-citationJournal of the American Academy of Child & Adolescent Psychiatry
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International prevalence of adolescent non-suicidal self-injury and deliberate self-harm
Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-6-10 · Cited by 1,296 · cited 1×
“NSSI is even more common among adolescents with studies reporting an average lifetime prevalence of 18% in this population (Muehlenkamp et al., 2012).”
BackgroundSafety planning intervention: a brief intervention to mitigate suicide risk.
Stanley, B., & Brown, G. K. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.01.001 · Cited by 1,267 · cited 2×
“The safety planning intervention (SPI) is designed to be unique as a single-session, stand-alone treatment for individuals at risk for suicide (Stanley & Brown, 2012).”
BackgroundWhy Do People Hurt Themselves?
Nock, M. K. (2009) · Current Directions in Psychological Science · doi:10.1111/j.1467-8721.2009.01613.x · Cited by 1,245 · cited 2×
“…thoughts and behaviors (which will be referred to collectively as SITBs for the remainder of the manuscript) usually begin between the ages of 12 and 14 (Nock, 2009) and millions of adolescents engage in SITBs each year, treatments designed specifically for youth are especially important.”
BackgroundSelf-citationSingle case experimental designs: Strategieṡ for studying behavior change
Matson, J. L. (1985) · Applied Research in Mental Retardation · doi:10.1016/0270-3092(85)90012-8 · Cited by 1,191
Kessler, R. C. (2005) · JAMA · doi:10.1001/jama.293.20.2487 · Cited by 1,101 · cited 2×
“has increased (Kessler, Berglund, Borges, Nock, & Wang, 2005), the rate of suicidal behavior has not shown a similar decrease (Kessler et al., 2005).”
BackgroundSilverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.3.264 · Cited by 991
Reducing Suicide--A National Imperative
(2002) · PsycEXTRA Dataset · doi:10.1037/e719942007-001 · Cited by 947
Naturalistic Follow-up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients
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“It may be surprising that DBT was not classified as an efficacious treatment, given its utility for reducing SITBs in adults (e.g., Linehan, Heard, & Armstrong, 1993; Linehan et al., 2006).”
BackgroundMentalization-based treatment for self-harm in adolescents: a randomized controlled trial
Rossouw, T. I., & Fonagy, P. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.09.018 · Cited by 746 · cited 14×
“MBT-A proposes that DSH is a reaction to interpersonal stress when individuals are unable to mentalize, or understand how their own and others behaviors are related to internal thought and feeling states.”
BackgroundMethodInfluentialDialectical behavior therapy adapted for suicidal adolescents.
Miller, A. L., Rathus, J. H., Linehan, M., Wetzler, S., & Leigh, E. (1997) · Suicide and Life-Threatening Behaviour · doi:10.1097/00131746-199703000-00002 · Cited by 715 · cited 1×
“…1993), one of the first treatments to specifically target SITBs, was originally designed to treat adult female patients with borderline personality disorder (BPD), but has since been adapted for adolescents regardless of BPD diagnosis (DBT-A: Miller, Rathus, & Linehan, 1997; Rathus & Miller, 2014).”
BackgroundZachariae, R., Lyby, M. S., Ritterband, L. M., & O'Toole, M. S. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.10.004 · Cited by 704
Evidence-Based Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Amaya-Jackson, L. M. (2008) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410701818293 · Cited by 689
Health care contacts in the year before suicide death.
Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., Lynch, F., Owen-Smith, A., Hunkeler, E. M., Whiteside, U., et al. (2014) · Journal of General Internal Medicine · doi:10.1007/s11606-014-2767-3 · Cited by 671
Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009) · Journal of Abnormal Psychology · doi:10.1037/a0016948 · Cited by 662
Self-citationWilkinson, P., Kelvin, R., Roberts, C., Dubicka, B., & Goodyer, I. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10050718 · Cited by 645 · cited 2×
“However, it is important to note that this is not true for all risk factors: interventions that reduce depression do not decrease SITBs in youth (Asarnow et al., 2011b; Gibbons, Brown, Hur, Davis, & Mann, 2012; Wilkinson et al., 2011).”
BackgroundDialectical behavior therapy adapted for suicidal adolescents
Rathus, J. H., & Miller, A. L. (2002) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.32.2.146.24399 · Cited by 635
Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., Vitiello, B., Keller, M., Birmaher, B., McCracken, J., et al. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.04.003 · Cited by 632 · cited 3×
“However, it is important to note that this is not true for all risk factors: interventions that reduce depression do not decrease SITBs in youth (Asarnow et al., 2011b; Gibbons, Brown, Hur, Davis, & Mann, 2012; Wilkinson et al., 2011).”
BackgroundMehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., Larsson, B. S., Stanley, B. H., Miller, A. L., Sund, A. M., et al. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.07.003 · Cited by 616
Silverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.3.248 · Cited by 593
Barriers to children's mental health services
OWENS, P. L., HOAGWOOD, K., HORWITZ, S. M., LEAF, P. J., PODUSKA, J. M., KELLAM, S. G., & IALONGO, N. S. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200206000-00013 · Cited by 565
Multisystemic therapy for antisocial behavior in children and adolescents
Henggeler, S. W. (2009) · Cited by 533
Kliem, S., Kröger, C., & Kosfelder, J. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0021015 · Cited by 474
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“However, given that adolescents (and adults) are at greatest risk for attempting suicide in the six months following hospital discharge (Brent et al., 1993; Goldston et al., 1999; Prinstein et al., 2008), long-term interventions may be inadequate for helping adolescents during these high-risk periods.”
BackgroundSelf-citationArchives of Disease in Childhood
Moncrieff, A. (2013) · Archives of Disease in Childhood · doi:10.1136/archdischild · Cited by 429
Stanley, B., Brown, G., Brent, D. A., Wells, K., Poling, K., Curry, J., Kennard, B. D., Wagner, A., Cwik, M. F., Klomek, A. B., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181b5dbfe · Cited by 423 · cited 1×
“The TASA trial compared Cognitive Behavior Therapy for Suicide Prevention (CBT-SP: see Stanley et al., 2009), a medication algorithm, and the combination of CBT-SP and medication.”
MethodAttachment-Based Family Therapy for Depressed Adolescents: A Treatment Development Study
DIAMOND, G. S., REIS, B. F., DIAMOND, G. M., SIQUELAND, L., & ISAACS, L. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200210000-00008 · Cited by 382 · cited 1×
“Diamond et al. (2010) examined Attachment-Based Family Therapy (ABFT: Diamond et al., 2002), which aims to reduce SITBs by improving family relationships, and especially the parent-adolescent relationship.”
BackgroundDropping Out of Child Psychotherapy: Issues for Research and Implications for Practice
Kazdin, A. E. (1996) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104596011012 · Cited by 355 · cited 2×
“And finally, attrition is a major problem in treatment research with youth (Kazdin, 1996), and the studies in our review were no exception.”
BackgroundProximal Psychiatric Risk Factors for Suicidality in Youth
Foley, D. L., Goldston, D. B., Costello, E. J., & Angold, A. C. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.9.1017 · Cited by 344
Feasibility of dialectical behavior therapy for suicidal adolescent inpatients
Katz, L. Y., Cox, B. J., Gunasekara, S., & Miller, A. L. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200403000-00008 · Cited by 334 · cited 2×
“In a more acute setting, Katz et al. (2004) compared a brief (2-week) DBT package (individual sessions, skills group, and DBT milieu) to psychodynamic psychotherapy (TAU) for 62 adolescents receiving inpatient treatment.”
BackgroundMethodRelations between nonsuicidal self-injury and suicidal behavior in adolescence: a systematic review
Grandclerc, S., De Labrouhe, D., Spodenkiewicz, M., Lachal, J., & Moro, M.-R. (2016) · PLoS ONE · doi:10.1371/journal.pone.0153760 · Cited by 332
Multisystemic Therapy Effects on Attempted Suicide by Youths Presenting Psychiatric Emergencies
Huey, S. J., Henggeler, S. W., Rowland, M. D., Halliday‐Boykins, C. A., Cunningham, P. B., Pickrel, S. G., & Edwards, J. E. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200402000-00014 · Cited by 329 · cited 9×
“A few studies included children as young as age 10 (e.g., Asarnow et al., 2011a; Harrington et al., 1998; Huey et al., 2004) and one study focused on children ages 8 to 11 (Perepletchikova et al., 2011).”
BackgroundResultInfluentialGibbons, R. D., Brown, C. H., Hur, K., Davis, J. M., & Mann, J. J. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.2048 · Cited by 291 · cited 1×
“However, it is important to note that this is not true for all risk factors: interventions that reduce depression do not decrease SITBs in youth (Asarnow et al., 2011b; Gibbons, Brown, Hur, Davis, & Mann, 2012; Wilkinson et al., 2011).”
BackgroundWilcox, H. C., Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S., Wang, W., & Anthony, J. C. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.01.005 · Cited by 289 · cited 1×
“Further support for parent training as a mechanism of change comes from a classroom-based prevention trial indicating that behavior management strategies in childhood may reduce SI over adolescence and young adulthood (Wilcox et al., 2008).”
BackgroundRobinson, J., Cox, G., Malone, A., Williamson, M. K., Baldwin, G., Fletcher, K., & O’Brien, M. (2012) · Crisis · doi:10.1027/0227-5910/a000168 · Cited by 286 · cited 1×
“…these studies from our review: prevention programs generally aim to screen and identify high-risk youth, whereas our review was focused on interventions for youth that are already determined to be at high-risk (for reviews of prevention programs: see Katz et al., 2013; Robinson et al., 2013).”
BackgroundHARRINGTON, R., KERFOOT, M., DYER, E., McNIVEN, F., GILL, J., HARRINGTON, V., WOODHAM, A., & BYFORD, S. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/s0890-8567(14)60001-0 · Cited by 281 · cited 4×
“FBT-Problem-focused— Harrington et al. (1998) examined a family-based intervention that used behavioral (e.g., modeling, behavioral rehearsal) and family therapy techniques (e.g., psychoeducation, communication training) to target family problems hypothesized to contribute to adolescents' DSH…”
BackgroundResultInfluentialRichardson, T., Stallard, P., & Velleman, S. (2010) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-010-0069-9 · Cited by 272
Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-5-3 · Cited by 270 · cited 10×
“This is the first study to examine IPT for NSSI (Jacobson & Mufson, 2012); however, it appears that only five adolescents completed the treatment and results of the trial have not yet been published.”
BackgroundInfluentialRandomized trial of group therapy for repeated deliberate self-harm in adolescents
WOOD, A., TRAINOR, G., ROTHWELL, J., MOORE, A., & HARRINGTON, R. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200111000-00003 · Cited by 264 · cited 4×
“For instance, although Wood et al. (2001) initially reported promising results of DGT, attempts to replicate these findings by other research groups were unsuccessful (Green et al., 2011; Hazell et al., 2009).”
BackgroundResultInfluentialSilverman, W. K., & Hinshaw, S. P. (2008) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410701817725 · Cited by 263 · cited 1×
“…12 Task Force on the Promotion and Dissemination of Psychological Procedures to determine intervention potency, which were later revised and expanded to cover a wider range of treatment studies (e.g., pilot studies) (see Chambless et al., 1998; Chambless & Hollon, 1998; Silverman & Hinshaw, 2008).”
BackgroundMehlum, L. I., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B., Miller, A. L., Sund, A. M., & Grøholt, B. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2016.01.005 · Cited by 263
Brent, D. A., Greenhill, L. L., Compton, S., Emslie, G., Wells, K., Walkup, J. T., Vitiello, B., Bukstein, O., Stanley, B., Posner, K., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181b5dbe4 · Cited by 262 · cited 3×
“A CBT-individual and family intervention was also examined in the large ( n = 124) Treatment of Adolescent Suicide Attempters (TASA) study – an open trial designed to examine intensive and tailored treatments for adolescent suicide attempters with major depression (Brent et al., 2009).”
BackgroundInfluentialSoutham‐Gerow, M. A., & Prinstein, M. J. (2013) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.855128 · Cited by 256
Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial.
Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., & Monti, P. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026074 · Cited by 254 · cited 8×
“For instance, Esposito-Smythers et al. (2011) found that parent training enhanced their CBT package.”
BackgroundInfluentialAsarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., Piacentini, J. C., Rotheram-Borus, M. J., Cohen, D., & Tang, L. (2011) · Psychiatric Services · doi:10.1176/ps.62.11.pss6211_1303 · Cited by 251 · cited 3×
“However, it is important to note that this is not true for all risk factors: interventions that reduce depression do not decrease SITBs in youth (Asarnow et al., 2011b; Gibbons, Brown, Hur, Davis, & Mann, 2012; Wilkinson et al., 2011).”
A SYSTEMATIC REVIEW OF SCHOOL-BASED SUICIDE PREVENTION PROGRAMS
Katz, C., Bolton, J. M., Katz, L. Y., Isaak, C. A., Tilston-Jones, T., Sareen, J., & Swampy Cree Suicide Prevention Team (2013) · Depression and Anxiety · doi:10.1002/da.22114 · Cited by 242
Protecting Adolescents From Self-Harm: A Critical Review of Intervention Studies
Brent, D. A., McMakin, D. L., Kennard, B. D., Goldstein, T. R., Mayes, T. L., & Douaihy, A. B. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.09.009 · Cited by 240 · cited 1×
“Because no single theoretical orientation is superior, treatment efficacy is likely due to common elements across these interventions (also see review: Brent et al., 2013).”
BackgroundPrinstein, M. J., Heilbron, N., Guerry, J. D., Franklin, J. C., Rancourt, D., Simon, V., & Spirito, A. (2010) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-010-9423-0 · Cited by 234 · cited 1×
“Given the mixed results of this group therapy and the potential for contagion of SITBs among groups of adolescents (Prinstein et al., 2010; Walsh & Rosen, 1985), group therapy alone may be contraindicated for this population.”
ResultSelf-citationInterpersonal Psychotherapy for Depressed Adolescents
Moreau, D., & Mufson, L. H. (1997) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/s1056-4993(18)30322-5 · Cited by 231
Development of a Computerized Adaptive Test for Depression
Gibbons, R. D., Weiss, D. J., Pilkonis, P. A., Frank, E., Moore, T., Kim, J. B., & Kupfer, D. J. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2012.14 · Cited by 230
de Bruin, E. J., Bögels, S. M., Oort, F. J., & Meijer, A. M. (2015) · SLEEP · doi:10.5665/sleep.5240 · Cited by 214
GOLDSTON, D. B., DANIEL, S. S., REBOUSSIN, D. M., REBOUSSIN, B. A., FRAZIER, P. H., & KELLEY, A. E. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199906000-00012 · Cited by 214 · cited 4×
“…the treatment groups in SEs at six-month follow-up, but the authors noted that SE rates generally, and SA rates specifically, were lower in the TASA trial compared to those reported in naturalistic studies of high-risk adolescent samples following hospital discharge (e.g., Goldston et al., 1999).”
BackgroundResultInfluentialThe 18-month impact of an emergency room intervention for adolescent female suicide attempters.
Rotheram‐Borus, M. J., Piacentini, J. C., Cantwell, C., Belin, T. R., & Song, J. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.6.1081 · Cited by 201 · cited 2×
“, 1996), these differences did not hold at any of the follow-up assessments over the subsequent 3 to 18 months (Rotheram-Borus et al., 2000).”
BackgroundGlenn, C. R., Lanzillo, E. C., Esposito, E. C., Santee, A. C., Nock, M. K., & Auerbach, R. P. (2017) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-016-0214-0 · Cited by 197
Self-citationROTHERAM-BORUS, M. J., PIACENTINI, J., VAN ROSSEM, R., GRAAE, F., CANTWELL, C., CASTRO-BLANCO, D., MILLER, S., & FELDMAN, J. (1996) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199605000-00021 · Cited by 196 · cited 2×
“Although the initial study reported reduced SI following the specialized ED intervention (Rotheram-Borus et al., 1996), these differences did not hold at any of the follow-up assessments over the subsequent 3-18 months (Rotheram-Borus et al.”
BackgroundO'Connor, E., Gaynes, B. N., Burda, B. U., Soh, C., & Whitlock, E. P. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-10-201305210-00642 · Cited by 193
Adolescent Psychiatric Inpatients' Risk of Suicide Attempt at 6-Month Follow-up
BRENT, D. A., KOLKO, D. J., WARTELLA, M. E., BOYLAN, M. B., MORITZ, G., BAUGHER, M., & ZELENAK, J. P. (1993) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199301000-00015 · Cited by 183 · cited 2×
“However, given that adolescents (and adults) are at greatest risk for attempting suicide in the six months following hospital discharge (Brent et al., 1993; Goldston et al., 1999; Prinstein et al., 2008), long-term interventions may be inadequate for helping adolescents during these high-risk periods.”
BackgroundEffectiveness of an outpatient intervention targeting suicidal young adults: Preliminary results.
Rudd, M. D., Rajab, M. H., Orman, D. T., Stulman, D. A., Joiner, T., & Dixon, W. A. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.64.1.179 · Cited by 182 · cited 1×
“We included two studies that examined adolescents and young adults, ages 15-24 (Robinson et al., 2012; Rudd et al., 1996), because young adults are relatively close in age to older adolescents.”
Pineda, J., & Dadds, M. R. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.05.015 · Cited by 174 · cited 4×
“Pineda and Dadds (2013) reported promising findings for a brief (4-session) parent education program for reducing adolescent suicide risk – Resourceful Adolescent Parent Program (RAP-P).”
BackgroundInfluentialYouth-Nominated Support Team for suicidal adolescents (Version 1): A randomized controlled trial.
King, C. A., Kramer, A., Preuss, L. J., Kerr, D., Weisse, L., & Venkataraman, S. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.1.199 · Cited by 171 · cited 1×
“Although there was not a main effect of treatment, the YST-I was more efficacious than TAU for reducing SI in girls (King et al., 2006).”
BackgroundAdolescent Substance Use and Suicidal Behavior: A Review With Implications for Treatment Research
Esposito-Smythers, C. L., & Spirito, A. (2004) · Alcoholism Clinical and Experimental Research · doi:10.1097/01.alc.0000127417.99752.87 · Cited by 169 · cited 1×
“Given that substance use increases risk for suicidal behavior among adolescents (Esposito-Smythers & Spirito, 2004), reductions in alcohol and drug use in the I-CBT group may have been important for treatment efficacy.”
BackgroundSPIRITO, A., BOERGERS, J., DONALDSON, D., BISHOP, D., & LEWANDER, W. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200204000-00016 · Cited by 163 · cited 3×
“We excluded the following types of studies if they did not include a specific SITB outcome: treatment adherence studies (e.g., Spirito et al., 2002a) and studies including measures of broad suicide risk factors, such as psychiatric symptoms (e.g., Orbach & Bar-Joseph, 1993).”
BackgroundResultKing, C. A., Klaus, N. M., Kramer, A., Venkataraman, S., QUINLAN, P. E., & Gillespie, B. W. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0016552 · Cited by 157 · cited 5×
“King and colleagues (King et al., 2006; King et al., 2009) examined a support-based intervention for adolescents following hospitalization—Youth-nominated Support Team (YST).”
InfluentialFamily Factors in Youth Suicidal Behaviors
Wagner, B. M., Silverman, M. A. C., & Martin, C. E. (2003) · American Behavioral Scientist · doi:10.1177/0002764202250661 · Cited by 153
Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2009.11.002 · Cited by 152
Treatment for adolescents following a suicide attempt: results of a pilot trial
Donaldson, D., Spirito, A., & Esposito-Smythers, C. (2005) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200502000-00003 · Cited by 151 · cited 6×
“CBT-Individual + CBT-Family + Parent Training— Building on earlier versions of their CBT packages (Donaldson et al., 2005; Esposito-Smythers et al., 2006), Esposito-Smythers et al. (2011) added a parent training component to create integrated CBT (I-CBT), which includes a variety of individual CBT…”
BackgroundMethodInfluentialSuicide Prevention for High‐Risk Persons Who Refuse Treatment *
Motto, J. A. (1976) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1976.tb00880.x · Cited by 150 · cited 2×
“It is important to note that the original Motto (1976) study examined the postcard intervention in a sample of over 3,000 adults.”
BackgroundTang, T., Jou, S., Ko, C., Huang, S., & Yen, C. (2009) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2009.01991.x · Cited by 148 · cited 2×
“(2002b), TAU in the current review varied from supportive counseling (Tang et al., 2009) to inpatient hospitalization (Huey et al.”
BackgroundResultDBT Skills Manual for Adolescents
Miller, A. L., & Rathus, J. H. (2014) · Cited by 148
Asarnow, J. R., Berk, M., Hughes, J. L., & Anderson, N. L. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2014.940624 · Cited by 147
Regression to the mean: treatment effect without the intervention
Morton, V., & Torgerson, D. J. (2005) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2004.00505.x · Cited by 147
Secondary prevention of attempted suicide in adolescence
Cotgrove, A., Zirinsky, L., Black, D., & Weston, D. (1995) · Journal of Adolescence · doi:10.1006/jado.1995.1039 · Cited by 143 · cited 3×
“Cotgrove et al. (1995) examined a relatively simple intervention that provided adolescents with immediate access to hospital care (via a green card).”
BackgroundInfluentialDevelopmental Approach to Prevent Adolescent Suicides
Wyman, P. A. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.05.039 · Cited by 141
Evidence base update for psychosocial treatments for pediatric obsessive-compulsive disorder
Freeman, J., Garcia, A., Frank, H., Benito, K., Conelea, C., Walther, M., & Edmunds, J. (2014) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.804386 · Cited by 139 · cited 1×
“This classification is consistent with other EBT Updates in this series (e.g., Freeman et al., 2014).”
ResultGreen, J. M., Wood, A. J., Kerfoot, M. J., Trainor, G., Roberts, C., Rothwell, J., Woodham, A., Ayodeji, E., Barrett, B., Byford, S., et al. (2011) · BMJ · doi:10.1136/bmj.d682 · Cited by 137 · cited 4×
“(2001) initially reported promising results of DGT, attempts to replicate these findings by other research groups were unsuccessful (Green et al., 2011; Hazell et al., 2009).”
ResultInfluentialOverlooked and Underserved: “Action Signs” for Identifying Children With Unmet Mental Health Needs
Jensen, P. S., Goldman, E. E., Offord, D., Costello, E. J., Friedman, R., Huff, B. P., Crowe, M., Amsel, L., BENNETT, K. J., Bird, H., et al. (2011) · PEDIATRICS · doi:10.1542/peds.2009-0367 · Cited by 134
Hazell, P. L., Martin, G., Mcgill, K., Kay, T., Wood, A., Trainor, G., & Harrington, R. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181aoacec · Cited by 132 · cited 5×
“However, these initially promising treatment findings have failed to replicate in other samples of adolescents (Green et al., 2011; Hazell et al., 2009).”
BackgroundResultInfluentialJames, A. C., Taylor, A., Winmill, L., & Alfoadari, K. (2008) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2007.00470.x · Cited by 114 · cited 2×
“The three small pilot studies (sample sizes ranged from 12 to 25 adolescents) examining DBT reported significant reductions in DSH (James et al., 2008; 2011) and NSSI (Fleischhaker et al., 2011) over the course of treatment.”
BackgroundEvaluation of out-patient counselling compared with general practitioner care following overdoses
Hawton, K. E., McKeown, S., Day, A., Martin, P., O'Connor, M. E., & Yule, J. (1987) · Psychological Medicine · doi:10.1017/s0033291700025988 · Cited by 108 · cited 2×
“A number of studies were excluded because they examined interventions across adolescence and adulthood but did not examine treatment effects separately in adolescent participants (e.g., Bateman & Fonagy, 1999; Hawton et al., 1981; Hawton et al., 1987).”
BackgroundRobinson, J., Hetrick, S., Cox, G., Bendall, S., Yuen, H. P., Yung, A., & Pirkis, J. (2016) · Early Intervention in Psychiatry · doi:10.1111/eip.12137 · Cited by 108
Ougrin, D., Zundel, T., Ng, A., Banarsee, R., Bottle, A., & Taylor, E. (2011) · Archives of Disease in Childhood · doi:10.1136/adc.2010.188755 · Cited by 106 · cited 1×
“Finally, Ougrin and colleagues (Ougrin, Boege, Stahl, Banarsee, & Taylor, 2013; Ougrin et al., 2011) examined the utility of a one-session family-based ED intervention (i.”
BackgroundHsu, L. (1989) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.57.1.131 · Cited by 104
Firearms Availability and Suicide
Brent, D. A., & Bridge, J. A. (2003) · American Behavioral Scientist · doi:10.1177/0002764202250662 · Cited by 101
Orbach, I., & Bar‐Joseph, H. (1993) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1993.tb00376.x · Cited by 95 · cited 1×
“We excluded the following types of studies if they did not include a specific SITB outcome: treatment adherence studies (e.g., Spirito et al., 2002a) and studies including measures of broad suicide risk factors, such as psychiatric symptoms (e.g., Orbach & Bar-Joseph, 1993).”
Self-mutilation and contagion: an empirical test
Walsh, B. W., & Rosen, P. (1985) · American Journal of Psychiatry · doi:10.1176/ajp.142.1.119 · Cited by 95
Taylor, L. M. W., Oldershaw, A., Richards, C., Davidson, K. M., Schmidt, U. H., & Simic, M. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465811000075 · Cited by 90
Domiciliary and out-patient treatment of self-poisoning patients by medical and non-medical staff
Hawton, K. E., Bancroft, J., Catalan, J. M., Kingston, B., Stedeford, A., & Welch, N. (1981) · Psychological Medicine · doi:10.1017/s0033291700053381 · Cited by 90 · cited 1×
“A number of studies were excluded because they examined interventions across adolescence and adulthood, but did not examine treatment effects separately in adolescent participants (e.g., Bateman & Fonagy, 1999; Hawton et al., 1981; 1987).”
BackgroundPerepletchikova, F., Axelrod, S. R., Kaufman, J., Rounsaville, B. J., Douglas-Palumberi, H., & Miller, A. L. (2010) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2010.00583.x · Cited by 89 · cited 2×
“, 2004) and one study focused on children ages 8 to 11 (Perepletchikova et al., 2011).”
BackgroundMorthorst, B. R., Krogh, J., Erlangsen, A., Alberdi, F., & Nordentoft, M. (2012) · BMJ · doi:10.1136/bmj.e4972 · Cited by 84
Ougrin, D., Boege, I., Stahl, D., Banarsee, R., & Taylor, E. (2013) · Archives of Disease in Childhood · doi:10.1136/archdischild-2012-303200 · Cited by 84
King, C. A., Gipson, P. Y., Horwitz, A. G., & Opperman, K. J. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201300347 · Cited by 73
Robinson, J., Hetrick, S., Cox, G., Bendall, S., Yung, A., & Pirkis, J. (2015) · Early Intervention in Psychiatry · doi:10.1111/eip.12136 · Cited by 71
Adolescent suicidal and self-destructive behavior
Deykin, E. Y., Hsieh, C.-C., Joshi, N., & Mcnamarra, J. J. (1986) · Journal of Adolescent Health Care · doi:10.1016/s0197-0070(86)80002-x · Cited by 71 · cited 1×
“Deykin et al. (1986) examined an intervention package aimed at increasing treatment compliance among disadvantaged (e.g., Medicaid-eligible) youth.”
BackgroundRobinson, J., Yuen, H. P., Gook, S., Hughes, A., Cosgrave, E., Killackey, E. J., Baker, K., Jorm, A. F., McGorry, P. D., & Yung, A. R. (2012) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2011.00334.x · Cited by 69 · cited 1×
“We included two studies that examined adolescents and young adults, ages 15-24 (Robinson et al., 2012; Rudd et al., 1996), because young adults are relatively close in age to older adolescents.”
MethodKennard, B. D., Biernesser, C. L., Wolfe, K. L., Foxwell, A. A., Lee, S. J. C., Rial, K. V., Patel, S., Cheng, C., Goldstein, T. R., McMakin, D. L., et al. (2015) · Journal of Technology in Human Services · doi:10.1080/15228835.2015.1106384 · Cited by 67
Alavi, A., Sharifi, B., Ghanizadeh, A. J., & Dehbozorgi, G. (2013) · Europe PMC (PubMed Central) · Cited by 66
James, A. C., Winmill, L., Anderson, C., & Alfoadari, K. (2010) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2010.00571.x · Cited by 62 · cited 2×
“The three small pilot studies (sample sizes ranged from 12 to 25 adolescents) examining DBT reported significant reductions in DSH (James et al., 2008; 2011) and NSSI (Fleischhaker et al., 2011) over the course of treatment.”
BackgroundInterpersonal Psychotherapy for Depressed Adolescents ☆
Young, J. F., & Mufson, L. H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.06093-4 · Cited by 61
Suicide; Assessment and Intervention
Hatton, C. L., Valente, S. M., & Rink, A. (1978) · AJN American Journal of Nursing · doi:10.1097/00000446-197803000-00049 · Cited by 57
Spirito, A., Stanton, C. A., Donaldson, D. L., & Boergers, J. (2002) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3101_06 · Cited by 55 · cited 7×
“In a sample of 63 adolescents receiving TAU, Spirito, Stanton, Donaldson, and Boergers (2002b) found that treatments varied widely in theoretical orientation (cognitive, behavioral, psychodynamic) and frequency of sessions (Range: 0-22).”
BackgroundResultInfluentialBarriers to Outpatient Mental Health Treatment for Children and Adolescents: Parental Perspectives
Smith, T., Linnemeyer, R. M., Scalise, D., & Hamilton, J. (2013) · International Journal of Systemic Therapy · doi:10.1080/08975353.2013.792203 · Cited by 49
Physical Exercise as a Treatment for Non-Suicidal Self-Injury: Evidence From a Single-Case Study
Wallenstein, M. B., & Nock, M. K. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.164.2.350-a · Cited by 46 · cited 1×
“In contrast to RCTs that examine treatment effects on target outcomes between individuals, SCEDs examine the impact of treatment on targets within individuals (e.g., Wallenstein & Nock, 2007).”
ResultSelf-citationSpirito, A., Wolff, J. C., Seaboyer, L. M., Hunt, J., Esposito-Smythers, C. L., Nugent, N. R., Zlotnick, C., & Miller, I. (2014) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2013.0130 · Cited by 44
Wright-Hughes, A. M., Graham, L., Farrin, A. J., Collinson, M., Boston, P., Eisler, I., Fortune, S. A., Green, J., House, A. O., Owens, D., et al. (2015) · Trials · doi:10.1186/s13063-015-1007-4 · Cited by 43
A Sociable God: A Brief Introduction to a Transcendental Sociology
WALSH, R. N. (1985) · American Journal of Psychiatry · doi:10.1176/ajp.142.2.259 · Cited by 40
Brief home-based intervention with young suicide attempters and their families
Kerfoot, M., Harrington, R., & Dyer, E. J. (1995) · Journal of Adolescence · doi:10.1006/jado.1995.1038 · Cited by 39 · cited 1×
“…et al. (1998) examined a family-based intervention that used behavioral (e.g., modeling, behavioral rehearsal) and family therapy techniques (e.g., psychoeducation, communication training) to target family problems hypothesized to contribute to adolescents' DSH (Kerfoot, Harrington, & Dyer, 1995).”
BackgroundEsposito-Smythers, C., Spirito, A., Uth, R., & Lachance, H. R. (2006) · American Journal on Addictions · doi:10.1080/10550490601006188 · Cited by 32 · cited 4×
“CBT-Individual + CBT-Family + Parent Training— Building on earlier versions of their CBT packages (Donaldson et al., 2005; Esposito-Smythers et al., 2006), Esposito-Smythers et al. (2011) added a parent training component to create integrated CBT (I-CBT), which includes a variety of individual CBT…”
BackgroundInfluentialJacobson, C. M., & Mufson, L. (2012) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2012.66.4.349 · Cited by 30 · cited 7×
“This is the first study to examine IPT for NSSI (Jacobson & Mufson, 2012); however, it appears that only five adolescents completed the treatment and results of the trial have not yet been published.”
BackgroundInfluentialRobinson, J., Hetrick, S. E., Cox, G., Bendall, S., Yung, A. R., Yuen, H. P., Templer, K., & Pirkis, J. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-155 · Cited by 30
We’ve Come a Long Way, Baby!: Evolution and Revolution in CBT with Youth
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Tumilty, T. N. (1982) · doi:10.5040/9798216982968.ch-003 · Cited by 22
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Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and treatment
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Self-citationMeta-analysis of risk factors for nonsuicidal self-injury
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Metadata
- Authors
- Glenn, C. R., Franklin, J. C., & Nock, M. K.
- Affiliations
- Harvard University (US)
- Corresponding author
- Glenn, Catherine R.
- Venue
- Journal of Clinical Child & Adolescent Psychology
- Publisher
- Informa UK Limited
- Published
- 2014-09-25
- Volume
- 44
- Issue
- 1
- Pages
- 1-29
- ISSN
- 1537-4416 (ISSN-L)
- 1537-4424
- PMC
- PMC4557625
- OpenAlex
- W2081568229
- Cited by
- 288
- References
- 133
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 29 · 2023: 26 · 2022: 24 · 2021: 56 · 2020: 32 · 2019: 25 · 2018: 29 · 2017: 23 · 2016: 16 · 2015: 6
- FWCI
- 17.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Child & Adolescent Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- The research was supported, in part, by a grant from the National Institute of Mental Health (F32 MH097354) awarded to Catherine R. Glenn and a MacArthur Fellowship awarded to Matthew K. Nock. We thank Daniel Coppersmith, Sima Shabaneh, and Suzanne Shdo for their assistance reviewing the relevant literature for this manuscript.
- 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 › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- self-injurious thoughts and behaviors, suicidal ideation, non-suicidal self-injury, youth, psychosocial interventions, treatment efficacy, family skills training, parent training, contingency management, emotion regulation, problem solving, children and adolescents
- MeSH terms
- Adolescent, Behavior Therapy, Child, Humans, Randomized Controlled Trials as Topic, Self-Injurious Behavior, Treatment Outcome, Evidence-Based Medicine, Suicidal Ideation
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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