- Email: [email protected]
3.49 Intensive Crisis Intervention (ICI) for Adolescent Suicidality: An Open Pilot Trial
NEW RESEARCH POSTERS 3.49 — 3.50
York State Psychiatric Institute, [email protected]; Camilla Wasserman, PhD, Columbia University and The New York State Psychiatric Institute, camillawasserman@gmail. com; Marco Sarchiapone, MD, Department of Health Sciences, University of Molise, Campobasso, Italy, marco. [email protected]; Danuta Wasserman, MD, National Centre for Suicide Research and Prevention of Mental Ill; Health (NASP), Karolinska Institute, [email protected] Objectives: We aimed to test the interpersonal theory of suicide (IPTS) predictions in a large multi-national sample group of adolescents in a prospective manner. We hypothesized the following: 1) that baseline assumptions of IPTS will be associated with a higher likelihood of incident suicide attempts between baseline and after three- and 12-month followup evaluations; 2) that acquired capability for self-harm, measured by health risk behaviors (HRB) and direct self-injurious behaviors (D-SIB), will be associated with incident suicide attempts during follow-up evaluations beyond suicide ideation; and 3) that the interaction between suicidal ideation and HRB/D-SIB will additionally increase the likelihood of the first suicide attempts. Methods: Data were collected as part of the Saving and Empowering Young Lives in Europe (SEYLE) study. Pupils (N ¼ 7,738) from 10 countries in the European Union who were evaluated at baseline and followed up at three months and 12 months were included in this study. A self-report questionnaire was used to measure perceived burdensomeness, thwarted belongingness, HRB, D-SIB, and suicidal ideation and attempts. We used multilevel mixedeffect logistic regression analyses to examine univariate and multivariate associations between baseline predictors and incident suicide attempt at three and 12 months. Results: In line with IPTS predictions, thwarted peer/parental belongingness and burdensomeness predicted suicide attempts during follow-up (OR ¼ 1.26, 1.16, 1.23, P < 0.001 respectively), but not beyond the effect of suicidal ideation (OR ¼ 1.90, P ¼ 0.002). Acquired capability for self-harm, measured by HRB (OR ¼ 1.20, P ¼ 0.01) and D-SIB (OR ¼ 3.67, P < 0.001), predicted incident suicide attempts beyond suicidal ideation. This effect operated independently from suicidal ideation rather than collectively with it. Conclusions: Direct and indirect acts of self-harm are important predictors in the pathway of suicide attempts in adolescents, regardless of suicidal ideation. Suicide prevention strategies are encouraged to attend to distinguished risk groups, one associated with suicidal ideation and interpersonal vulnerabilities and the other with self-harm practices.
ADOL, SIB, S Supported by the European Union through the Seventh Framework Program Grant HEALTH-F2-2009-223091. http://dx.doi.org/10.1016/j.jaac.2017.09.196
3.49 INTENSIVE CRISIS INTERVENTION (ICI) FOR ADOLESCENT SUICIDALITY: AN OPEN PILOT TRIAL Glenn Thomas, PhD, Nationwide Children’s Hospital, glenn. [email protected]; Ericka M. Bruns, MS, Nationwide Children’s Hospital, Ericka.Bruns@ nationwidechildrens.org; Sandra M. McBee-Strayer, PhD, The Research Institute at Nationwide Children’s Hospital, sandy. [email protected]; Kendra M. Heck, MPH, The Research Institute at Nationwide Children’s Hospital, [email protected]; Jeffrey A. Bridge, PhD, Research Institute at Nationwide Children’s Hospital, [email protected] Objectives: Adolescent suicide is a major public health concern, but evidence regarding the effectiveness of interventions addressing youth suicide risk is limited. The goal of this study was to evaluate the feasibility and acceptability of Intensive Crisis Intervention (ICI) for targeting adolescent suicidal thoughts and behaviors in adolescents at risk for suicide.
S220
www.jaacap.org
Methods: ICI was piloted over a two-year period, with 50 adolescents admitted to an intensive crisis stabilization unit as a result of suicidal ideation and/or behavior. All subjects had to score in the clinical range on the Suicidal Ideation Questionnaire–Junior (SIQ-Jr) upon admission to participate (score > 31). The Columbia Impairment Scale (CIS) was also administered to assess global functioning. Data were collected upon admission, as well as 30-day (n ¼ 41) and 90-day (n ¼ 39) follow-up. Feasibility and acceptability of ICI were assessed by monitoring treatment adherence, treatment outcome measure completion, consumer satisfaction using the Consumer Satisfaction Questionnaire (CSQ-8), and readiness for care transition upon discharge using the Care Transitions Measure (CTM-15). Exploratory analyses examined potential predictors (e.g., baseline levels of depression, anxiety and suicidal ideation, previous suicide attempts, diagnosis, family conflict) of future suicide events. Results: On the SIQ-Jr, subjects reported significantly lower suicidal ideation at 30 days (mean score ¼ 13.5) and three months (mean score ¼ 12.8) than at baseline (mean score ¼ 54.3; P < 0.0001). On the CIS, parents/guardians reported significantly improved levels of functioning for adolescents at 30 days (mean score ¼ 16.2) and three months (mean score ¼ 15.1) than at baseline (mean score ¼ 19.7; P ¼ 0.003 and P ¼ 0.002, respectively). Very high rates of consumer satisfaction (CSQ-8 mean score ¼ 30.21) and readiness for care transition (CTM-15 mean score ¼ 90.52) were also reported by parents/ guardians. There were no significant findings for potential predictors of suicide events. Conclusions: Findings provide preliminary evidence of the feasibility and acceptability of the ICI model targeting adolescent suicidal ideation and behavior. Significant reductions in suicidal ideation, as well as improvements in functioning, were sustained over the three-month follow-up.
RF, DDD, S Supported by the Research Institute at Nationwide Children's Hospital intramural funding http://dx.doi.org/10.1016/j.jaac.2017.09.197
3.50 FEASIBILITY OF A THERAPEUTIC ASSESSMENT PATHWAY FOR SUICIDAL YOUTH Meredith R. Chapman, MD, University of Texas Southwestern Medical Center, [email protected]; Jane J. Miles, MD, University of Texas Southwestern Medical Center, [email protected]; Syed Sarosh Nizami, MD, University of Texas Southwestern Medical Center, sarosh. [email protected]; Alexandra Moorehead, BS, Children’s Health System of Texas, alexandra.moorehead@ UTSouthwestern.edu; Betsy D. Kennard, PsyD, University of Texas Southwestern Medical Center, beth.kennard@ utsouthwestern.edu; Graham J. Emslie, MD, University of Texas Southwestern Medical Center, graham.emslie@ UTsouthwestern.edu Objectives: The Family Intervention for Suicide Prevention (FISP) is a brief and efficacious CBT approach that aims to increase family support and youth coping and facilitate community care linkage. FISP tasks include individual/ family strengths identification and mood thermometer, followed by safety planning and enhancing motivation for aftercare. This study explored the feasibility of FISP as an assessment tool and treatment intervention in a busy clinical setting. Methods: A therapeutic assessment pathway [clinical interview, FISP, and Concise Health Risk Tracking (CHRT)] was developed to classify medically stable youth ages 10–17 years into low, moderate, and high-risk groups. Low-risk patients had an uneventful CHRT and successfully completed both FISP tasks. Patients in the moderate-risk group scored in the clinically significant range on the CHRT or had difficulty completing either of the two FISP tasks. Youth in the high-risk group had elevated CHRT scores, were unable to complete FISP tasks, and were referred for hospitalization. Patients from low-risk and moderate-risk groups completed safety planning and were discharged home. Clinicians who delivered the FISP completed a checklist measuring satisfaction, influence, and
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
York State Psychiatric Institute, [email protected]; Camilla Wasserman, PhD, Columbia University and The New York State Psychiatric Institute, camillawasserman@gmail. com; Marco Sarchiapone, MD, Department of Health Sciences, University of Molise, Campobasso, Italy, marco. [email protected]; Danuta Wasserman, MD, National Centre for Suicide Research and Prevention of Mental Ill; Health (NASP), Karolinska Institute, [email protected] Objectives: We aimed to test the interpersonal theory of suicide (IPTS) predictions in a large multi-national sample group of adolescents in a prospective manner. We hypothesized the following: 1) that baseline assumptions of IPTS will be associated with a higher likelihood of incident suicide attempts between baseline and after three- and 12-month followup evaluations; 2) that acquired capability for self-harm, measured by health risk behaviors (HRB) and direct self-injurious behaviors (D-SIB), will be associated with incident suicide attempts during follow-up evaluations beyond suicide ideation; and 3) that the interaction between suicidal ideation and HRB/D-SIB will additionally increase the likelihood of the first suicide attempts. Methods: Data were collected as part of the Saving and Empowering Young Lives in Europe (SEYLE) study. Pupils (N ¼ 7,738) from 10 countries in the European Union who were evaluated at baseline and followed up at three months and 12 months were included in this study. A self-report questionnaire was used to measure perceived burdensomeness, thwarted belongingness, HRB, D-SIB, and suicidal ideation and attempts. We used multilevel mixedeffect logistic regression analyses to examine univariate and multivariate associations between baseline predictors and incident suicide attempt at three and 12 months. Results: In line with IPTS predictions, thwarted peer/parental belongingness and burdensomeness predicted suicide attempts during follow-up (OR ¼ 1.26, 1.16, 1.23, P < 0.001 respectively), but not beyond the effect of suicidal ideation (OR ¼ 1.90, P ¼ 0.002). Acquired capability for self-harm, measured by HRB (OR ¼ 1.20, P ¼ 0.01) and D-SIB (OR ¼ 3.67, P < 0.001), predicted incident suicide attempts beyond suicidal ideation. This effect operated independently from suicidal ideation rather than collectively with it. Conclusions: Direct and indirect acts of self-harm are important predictors in the pathway of suicide attempts in adolescents, regardless of suicidal ideation. Suicide prevention strategies are encouraged to attend to distinguished risk groups, one associated with suicidal ideation and interpersonal vulnerabilities and the other with self-harm practices.
ADOL, SIB, S Supported by the European Union through the Seventh Framework Program Grant HEALTH-F2-2009-223091. http://dx.doi.org/10.1016/j.jaac.2017.09.196
3.49 INTENSIVE CRISIS INTERVENTION (ICI) FOR ADOLESCENT SUICIDALITY: AN OPEN PILOT TRIAL Glenn Thomas, PhD, Nationwide Children’s Hospital, glenn. [email protected]; Ericka M. Bruns, MS, Nationwide Children’s Hospital, Ericka.Bruns@ nationwidechildrens.org; Sandra M. McBee-Strayer, PhD, The Research Institute at Nationwide Children’s Hospital, sandy. [email protected]; Kendra M. Heck, MPH, The Research Institute at Nationwide Children’s Hospital, [email protected]; Jeffrey A. Bridge, PhD, Research Institute at Nationwide Children’s Hospital, [email protected] Objectives: Adolescent suicide is a major public health concern, but evidence regarding the effectiveness of interventions addressing youth suicide risk is limited. The goal of this study was to evaluate the feasibility and acceptability of Intensive Crisis Intervention (ICI) for targeting adolescent suicidal thoughts and behaviors in adolescents at risk for suicide.
S220
www.jaacap.org
Methods: ICI was piloted over a two-year period, with 50 adolescents admitted to an intensive crisis stabilization unit as a result of suicidal ideation and/or behavior. All subjects had to score in the clinical range on the Suicidal Ideation Questionnaire–Junior (SIQ-Jr) upon admission to participate (score > 31). The Columbia Impairment Scale (CIS) was also administered to assess global functioning. Data were collected upon admission, as well as 30-day (n ¼ 41) and 90-day (n ¼ 39) follow-up. Feasibility and acceptability of ICI were assessed by monitoring treatment adherence, treatment outcome measure completion, consumer satisfaction using the Consumer Satisfaction Questionnaire (CSQ-8), and readiness for care transition upon discharge using the Care Transitions Measure (CTM-15). Exploratory analyses examined potential predictors (e.g., baseline levels of depression, anxiety and suicidal ideation, previous suicide attempts, diagnosis, family conflict) of future suicide events. Results: On the SIQ-Jr, subjects reported significantly lower suicidal ideation at 30 days (mean score ¼ 13.5) and three months (mean score ¼ 12.8) than at baseline (mean score ¼ 54.3; P < 0.0001). On the CIS, parents/guardians reported significantly improved levels of functioning for adolescents at 30 days (mean score ¼ 16.2) and three months (mean score ¼ 15.1) than at baseline (mean score ¼ 19.7; P ¼ 0.003 and P ¼ 0.002, respectively). Very high rates of consumer satisfaction (CSQ-8 mean score ¼ 30.21) and readiness for care transition (CTM-15 mean score ¼ 90.52) were also reported by parents/ guardians. There were no significant findings for potential predictors of suicide events. Conclusions: Findings provide preliminary evidence of the feasibility and acceptability of the ICI model targeting adolescent suicidal ideation and behavior. Significant reductions in suicidal ideation, as well as improvements in functioning, were sustained over the three-month follow-up.
RF, DDD, S Supported by the Research Institute at Nationwide Children's Hospital intramural funding http://dx.doi.org/10.1016/j.jaac.2017.09.197
3.50 FEASIBILITY OF A THERAPEUTIC ASSESSMENT PATHWAY FOR SUICIDAL YOUTH Meredith R. Chapman, MD, University of Texas Southwestern Medical Center, [email protected]; Jane J. Miles, MD, University of Texas Southwestern Medical Center, [email protected]; Syed Sarosh Nizami, MD, University of Texas Southwestern Medical Center, sarosh. [email protected]; Alexandra Moorehead, BS, Children’s Health System of Texas, alexandra.moorehead@ UTSouthwestern.edu; Betsy D. Kennard, PsyD, University of Texas Southwestern Medical Center, beth.kennard@ utsouthwestern.edu; Graham J. Emslie, MD, University of Texas Southwestern Medical Center, graham.emslie@ UTsouthwestern.edu Objectives: The Family Intervention for Suicide Prevention (FISP) is a brief and efficacious CBT approach that aims to increase family support and youth coping and facilitate community care linkage. FISP tasks include individual/ family strengths identification and mood thermometer, followed by safety planning and enhancing motivation for aftercare. This study explored the feasibility of FISP as an assessment tool and treatment intervention in a busy clinical setting. Methods: A therapeutic assessment pathway [clinical interview, FISP, and Concise Health Risk Tracking (CHRT)] was developed to classify medically stable youth ages 10–17 years into low, moderate, and high-risk groups. Low-risk patients had an uneventful CHRT and successfully completed both FISP tasks. Patients in the moderate-risk group scored in the clinically significant range on the CHRT or had difficulty completing either of the two FISP tasks. Youth in the high-risk group had elevated CHRT scores, were unable to complete FISP tasks, and were referred for hospitalization. Patients from low-risk and moderate-risk groups completed safety planning and were discharged home. Clinicians who delivered the FISP completed a checklist measuring satisfaction, influence, and
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017