Suicide attempts among adolescents are very common (up to 10% of adolescents report having made a prior suicide attempt). Unfortunately, psychotherapy drop-out rates among adolescent suicide attempters are even higher than the rate for other adolescents in therapy, which makes it difficult to study the efficacy of community-based mental health interventions for this significant problem. Because adolescents typically have their first contact with the health care system in the general hospital, this proposal will test whether an intervention for adolescent suicide attempters in a general hospital will enhance compliance with outpatient psychotherapy. The intervention can he easily applied to the management of adolescent suicide attempters in other general hospitals and community agencies and the information obtained can improve understanding of the reasons suicide attempters are a particularly difficult group of adolescents to keep in treatment. The proposed study will include final revisions of a detailed treatment manual, development of a training program to accompany its use, and an intervention project. In the intervention project, 100 adolescents seen in an emergency department or pediatrics floor and discharged to outpatient care following a suicide attempt will receive a baseline psychological evaluation assessing selected factors pertinent to attempted suicide in adolescence including suicidal intent, family conflict, and substance abuse. Subjects will then he randomly assigned to receive either standard care or a compliance enhancement intervention (a multicomponent intervention emphasizing problem-solving skills with both the adolescents and their parents) which includes a telephone follow-up component to ensure families access services. Outcome (number of psychotherapy sessions attended) will he assessed via a one-month telephone follow-up interview and a clinic interview held with the adolescents and their parents/guardians at three months following the suicide attempt. Interview data from other community professionals, i.e., school teachers, guidance counselors, community therapists, and police/court officials,~will also be used as outcome data.
