This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. As the third leading cause of death among youth 15-19 years old, adolescent suicide is a major public health concern. Despite important advances in our understanding of the risk factors for adolescent suicidal behavior, there is little known about its treatment because: 1) although there is evidence that both depression and past suicide attempt are strong risk factors for adolescent suicide, suicidal adolescents have been routinely excluded from clinical treatment trials of adolescent depression and 2) there are few well-controlled studies conducted in which adolescent suicidal behavior was the primary focus. As such, the proper approach to treatment of depressed adolescent suicide attempters is not known. Practice parameter/guidelines have been published by the American Academy of child and Adolescent Psychiatry (AACAP) and set a minimal standard for the assessment and treatment of adolescents in TASA, but these guidelines are not empirically supported. The proposed study will provide feasibility data on the potential for a large multisite clinical trial comparing medication plus supportive clinical care (MM) vs. cognitive behavior therapy (CBT-TASA) vs. combination treatment (MM+CBT-TASA) for adolescents with depressive disorders and a recent suicide attempt. We propose a three group mixed randomized, controlled/preference trial of 120 depressed adolescent suicide attempters (24 per site) ages 12-18 years. In this design, not all patients will be randomized to one of the treatment conditions; instead patients may choose to be randomly assigned to one of the available treatment conditions or they may choose one of the available treatment conditions. Those patients or families who do not have a treatment preference will be randomly assigned to one of the three treatment conditions. Subjects who enter the study on a stable dose of antidepressant medication will only be eligible to be randomized or to choose the MM or MM+CBT treatment conditions.
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