Academic Journal
Stratified Stepped-Care for Reducing Suicide Attempts and Self-Harm in Youth: A Randomized Clinical Trial.
| Τίτλος: | Stratified Stepped-Care for Reducing Suicide Attempts and Self-Harm in Youth: A Randomized Clinical Trial. |
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| Συγγραφείς: | Asarnow JR; University of California, Los Angeles, California. Electronic address: jasarnow@ucla.edu., Clarke GN; Kaiser Permanente, Center for Health Research, Portland, Oregon., Firemark AJ; Kaiser Permanente, Center for Health Research, Portland, Oregon., Bedics J; University of California, Los Angeles, California; California Lutheran University, Thousand Oaks, California., Miranda J; University of California, Los Angeles, California., Zhang L; University of California, Los Angeles, California., Duan N; Columbia University, New York, New York., Comulada WS; University of California, Los Angeles, California. |
| Πηγή: | Journal of the American Academy of Child and Adolescent Psychiatry [J Am Acad Child Adolesc Psychiatry] 2026 Sep; Vol. 65 (9), pp. 1133-1145. Date of Electronic Publication: 2025 Dec 23. |
| Τύπος έκδοσης: | Journal Article; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: United States NLM ID: 8704565 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-5418 (Electronic) Linking ISSN: 08908567 NLM ISO Abbreviation: J Am Acad Child Adolesc Psychiatry Subsets: MEDLINE |
| Imprint Name(s): | Publication: Jan. 2010- : New York : Elsevier Original Publication: [Baltimore, Md.] : The Academy, [1987- |
| Ιατρικοί όροι (MeSH): | Self-Injurious Behavior*/prevention & control , Suicide, Attempted*/psychology , Cognitive Behavioral Therapy*/methods , Dialectical Behavior Therapy*/methods , Suicide Prevention*, Humans ; Adolescent ; Child ; Female ; Male ; Young Adult ; Quality Improvement |
| Περίληψη: | Objective: Identifying effective approaches for reducing suicide attempts and self-harm is critical for preventing suicide deaths and self-harm-related morbidity. This study evaluated whether suicide attempts (SAs), self-harm, and related suicide-risk indicators are reduced when a stratified stepped-care for suicide prevention (SC-SP) intervention is added to health system quality improvement. Method: Youth selected for past-year suicidal behavior, active suicidal ideation, or previous suicide attempt and/or ≥3 non-suicidal self-injury (NSSI) episodes plus past-year depression (N = 301, ages 12-24 years) were randomized to one of the following: (1) health system Zero Suicide quality improvement (ZSQI) featuring system-level initiatives to improve suicide-risk screening and treatment access; or (2) ZSQI plus SC-SP, which triaged youths to suicide-specific treatments using care-stratification algorithms and a dialectical behavior therapy (DBT)-informed cognitive behavioral therapy (CBT) model, allowing for more intense care with higher and/or increased risk levels. Interviewers blinded to treatment assignment assessed outcomes at 3, 6, and 12-month follow-ups. Results: Intent-to-treat (ITT) analyses included all randomized participants (95% with ≥1 follow-up assessment). Within SC-SP, 95% received ≥1 intervention contact; 90% were assigned a care level; and 96% received care in their original assigned care level. No significant between-group differences were found in 12-month SA rates (primary outcome) (SC-SP 8.09%; ZSQI 9.59%). Compared to ZSQI, at 12 months SC-SP youths showed significantly less total self-harm (relative risk = 0.46, 95% CI = 0.26, 0.79, p = .006, number needed to treat = 10.2) and depression (secondary outcomes), and greater satisfaction with care. No deaths were detected. Conclusion: Despite negative results for the primary outcome of SAs, results suggest the promise of SC-SP for reducing youth self-harm and depression and improving patient satisfaction with care. Plain Language Summary: This randomized trial of 301 youth aged 12 to 24 at risk for suicide compared standard Zero Suicide quality improvement (ZSQI) care with an added program, stratified stepped-care for suicide prevention (SC-SP), to evaluate its effectiveness in reducing suicide attempt and self-harm risk. SC-SP used structured risk assessments to match patients to appropriate treatments, including dialectical behavioral therapy. While groups did not differ significantly in suicide attempts, the SC-CP intervention was associated with significantly less total self-harm (a combination of suicide attempts and non-suicidal self-injury) and depression, and reported greater patient satisfaction with care. Clinical Trial Registration Information: Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults (Step2Health); https://www. Clinicaltrials: gov/study/NCT03092271. (Copyright © 2025 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.) |
| Grant Information: | R01 MH112147 United States MH NIMH NIH HHS |
| Contributed Indexing: | Keywords: adolescents; intervention; quality improvement; self-harm; suicide |
| Molecular Sequence: | ClinicalTrials.gov NCT03092271 |
| Entry Date(s): | Date Created: 20251225 Date Completed: 20260826 Latest Revision: 20261015 |
| Update Code: | 20261015 |
| DOI: | 10.1016/j.jaac.2025.12.008 |
| PMID: | 41448486 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1527-5418 |
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| DOI: | 10.1016/j.jaac.2025.12.008 |