Suicidal Ideation
Conditions
Keywords
suicide, ideation, Black youth, depression
Brief summary
The overall goal of this study is to respond to the urgent need for an effective suicide prevention strategy for Black youth by examining the effectiveness of a systems-level strategy to recognize and respond to suicide risk among Black adolescents who present to emergency departments (EDs). The proposed strategy, WeCare, combines combines three components: (1) universal screening using the Computerized Adaptive Screen for Suicidal Youth (CASSY), (2) a brief intervention designed for Black youth with elevated suicide risk in for ED settings, Connections for Safety (CFS), that combines safety planning and strategies to support linkage to outpatient mental health services, and (3) supportive text messages to youth and parent/caregivers for six weeks following the youth's ED visit. Study objectives are (1) to integrate input from multiple stakeholders to inform and facilitate WeCare implementation, and (2) to use a hybrid one effectiveness-implementation design to evaluate its effectiveness.
Detailed description
From 1991 through 2017, suicide attempts increased by 73% among Black high school-aged youth, and suicide attempts requiring hospitalization increased by 122% for Black high school-aged boys. These alarming findings, in part, led to the creation of the Emergency Taskforce on Black Youth Suicide and Mental Health and their subsequent report, Ring the Alarm: The Crisis of Black Youth Suicide in America, and passage of the Pursuing Equity in Mental Act. These all highlight the urgent need to improve suicide risk detection, treatment, and prevention among Black youth. We propose to respond to these challenges and the urgent need for an effective suicide prevention strategy for Black youth by examining the effectiveness of an "easily implementable," "systems-level" strategy to recognize and respond to suicide risk among Black youth who present to EDs. WeCare combines (1) CASSY, a universal screening; (2) CFS, an intervention with elements from SAFETY-Acute (SAFETY-A), an evidence-based, family-centered intervention to safety planning for children and adolescents; (3) Safety Planning Intervention (SPI), a brief ED-based intervention of a written list prioritizing coping strategies and sources of support to alleviate a suicidal crisis; (3) Making Connections Intervention (MCI), a mental health engagement intervention for Black adolescents and their parents; and (4) a follow-up text messaging support system for youth and parents will be introduced for enhanced feasibility. This study is a randomized clinical effectiveness trial with 2,200 Black youth at risk for suicide to examine the effectiveness of WeCare. Youth, ages 12 to 19 years, enrolled from two hospital EDs in New York City, will be assessed on enrollment for risks associated with suicide. Moderate/high-risk youth will be randomly assigned to WeCare vs. usual services. Survey assessments will be conducted at 3- and 6-month follow-up, with medical record review through 12 months to examine the effectiveness of WeCare and mediators of WeCare effects. The objective is to increase risk identification, treatment referral and engagement, and, in turn, reduce suicidal ideation and behavior among Black youth.
Interventions
BEHAVIORALWeCare
WeCare combines two evidence-based strategies -- universal screening using the Computerized Adaptive Screen for Suicidal Youth and an adapted version of the SAFETY-ACUTE, which incorporates PI Lindsey's extensive work with Black youth, their families, and community stakeholders to develop culturally tailored strategies for addressing treatment barriers.
Sponsors
New York University
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
12 Years to 19 Years
Healthy volunteers
Yes
Inclusion criteria
adolescent and parent/guardians: * Adolescents aged 12-17 years and their parents or guardians, and adolescents 18-19 years who have the option for their parent or guardian to participate * Having a parent/caregiver present in the ED to consent or available to consent remotely (12-17 year olds, only) * Having a cellular phone with text messaging capacity * Adolescent able to speak English, and understand study questions * Parents able to consent in English, Spanish, French or Creole * Meet screening criteria
Exclusion criteria
adolescent and parent/guardians: * Adolescent is medically unstable * Adolescent present with severe cognitive impairment * Parents are not present in the ED, unable to consent remotely, and not able to give consent in either English, Spanish, French or Creole (12-17 year olds, only) * Adolescent does not have access to cellular phone * Adolescents active in mental health treatment (e.g., seen a therapist, social worker, or mental health provider in the last week)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mental Health Outpatient Visits (Electronic Medical Record) | Baseline, Months 3 and 6 | This measure assesses mental health service utilization from 50 patient care locations in New York City via electronic medical records. |
| Columbia-Suicide Severity Rating Scale | Baseline, Months 3 and 6 | This measure is a semi structured interview to assess suicidal ideation and attempt This measure is a semi structured interview to assess suicidal ideation and attempt behavior (actual, interrupted, aborted suicide attempts; preparatory behavior). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Attitudes Toward Psychological Help Scale | Baseline, Months 3 and 6 | This measure assesses psychological factors, including stigma, perceived relevance of treatment, etc. that impact one's perceptions and attitudes about using formal mental health treatment services. |
| Barriers | Baseline, Months 3 and 6 | This 5-item measure captures barriers to MH treatment participation identified in PI Lindsey's prior work with Black youth and families. A higher score indicates a perception of more barriers to treatment (Minimum score: 5; Maximum score: 15). |
| Caregiver Knowledge of Mental Health Services (Therapy Survey) | Baseline, Months 3 and 6 | This measures expectations about treatment at a children's psychiatric clinic (caregiver). |
| ED STARS Mental Health Service Use | Baseline, Months 3 and 6 | This measure assesses mental health service utilization, efforts to link to services, linkage, and engagement with outpatient MH services (caregiver). |
| Hopelessness | Baseline, Months 3 and 6 | This measure targets recent feelings of hopelessness and hope. |
| Parent-Family Connectedness Scale | Baseline, Months 3 and 6 | This measure assesses familial connectedness. |
| How I Feel about Friends | Baseline, Months 3 and 6 | This 2-ite, measure assesses peer connectedness. Higher scores indicate greater peer connectedness (Minimum score: 2; Maximum score: 10). |
| Peer Victimization and Perpetration | Baseline, Months 3 and 6 | This measure assesses bullying. |
| Urgency Premeditated Perseverance Sensation Seeking Subscale | Baseline, Months 3 and 6 | This measure assesses impulsivity. |
| Mental Health Service Use | Baseline, Months 3 and 6 | This measure assesses lifetime mental health service use (caregiver). |
| Stages of Change | Baseline, Months 3 and 6 | This 8-item measure assesses adolescents' willingness to change (Minimum score: 8; Maximum score: 32). |
| Barriers to Treatment Participation Scale | Baseline, Months 3 and 6 | This measure assesses barriers to treatment (caregiver). |
Countries
United States
Contacts
CONTACTMichael A Lindsey, PhD
CONTACTJacqueline Holloway, PhD
PRINCIPAL_INVESTIGATORMichael A Lindsey, PhD
New York University
Outcome results
None listed