Suicide is the 3rd leading cause of death among adolescents in the United States;however, more than fifty percent of adolescents who die from suicide have never obtained any mental health services. In keeping with recommendations in the National Strategy for Suicide Prevention (2001), this R34 Exploratory Research Project will develop an intervention that has the potential to be delivered to thousands of at risk adolescents seeking emergency services each year. We will develop and pilot test a theoretically-driven intervention, Teen Options for Change (TOC), which is designed to improve problem recognition, readiness for change, and treatment linkage among disadvantaged urban adolescents at risk for suicide due to either (1) co-occurring depression and alcohol misuse, or (2) recent suicidality (suicide attempt or severe suicidal ideation). TOC incorporates motivational interviewing principles and is based on health behavior promotion models. Intervention components include an Adapted Motivational Interview (AMI) with Personalized Feedback for the adolescent, a brief conjoint AMI focusing on available treatments for the parent and adolescent, use of a culturally tailored Services Information and Decision Aid, and Personalized Follow-Up Notes.
Specific aims are: (1) to develop TOC materials (intervention manual;culturally tailored Services Information and Decision Aid;therapist training and fidelity assessment procedures);(2) to conduct a feasibility pilot study to refine the intervention and procedures for the randomized controlled trial;and (3) to conduct a pilot randomized controlled trial comparing TOC to enhanced treatment-as-usual. This trial will enable us (a) to estimate the distribution and variability of primary and secondary outcomes within conditions;and (b) to determine the social acceptance and validity of TOC. In this trial, 1120 adolescents will be screened to identify 109 who meet suicide risk criteria and assent (with parental consent) to participate. The primary outcome, assessed at 2-months, is treatment seeking (defined dichotomously and by level of engagement). Secondary analyses will address (1) the intervention effect on treatment seeking, adjusting for other possible predictors such as age, gender, and severity of index condition;and (2) the extent to which treatment-seeking impacts adolescent outcomes. This project capitalizes upon our interdisciplinary team's substantial experience with interventions for suicidal adolescents, emergency-based interventions for alcohol misuse, motivational interviewing, and the development of culturally tailored decision guides for health behaviors. The project's feasibility is strengthened by the team's extensive experience with adolescent suicide risk management.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH079123-03
Application #
7622102
Study Section
Interventions Committee for Disorders Involving Children and Their Families (ITVC)
Program Officer
Sherrill, Joel
Project Start
2007-08-01
Project End
2010-11-30
Budget Start
2009-06-01
Budget End
2010-11-30
Support Year
3
Fiscal Year
2009
Total Cost
$205,200
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Horwitz, Adam G; Berona, Johnny; Czyz, Ewa K et al. (2017) Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression, Suicidal Ideation, and Suicidal Behavior in High-Risk Adolescents. Suicide Life Threat Behav 47:168-176
King, Cheryl A; Berona, Johnny; Czyz, Ewa et al. (2015) Identifying adolescents at highly elevated risk for suicidal behavior in the emergency department. J Child Adolesc Psychopharmacol 25:100-8
King, Cheryl A; Gipson, Polly Y; Horwitz, Adam G et al. (2015) Teen options for change: an intervention for young emergency patients who screen positive for suicide risk. Psychiatr Serv 66:97-100
Kaplow, Julie B; Gipson, Polly Y; Horwitz, Adam G et al. (2014) Emotional suppression mediates the relation between adverse life events and adolescent suicide: implications for prevention. Prev Sci 15:177-185
Zahuranec, D B; Morgenstern, L B; Sanchez, B N et al. (2010) Do-not-resuscitate orders and predictive models after intracerebral hemorrhage. Neurology 75:626-33