February 8, 2010 — Adolescents with suicidal thoughts and elevated depression had stronger and faster reduction of symptoms when treated with family therapy than with standard treatment in the community. Researchers from The Children's Hospital of Philadelphia reported these findings this month in the Journal of the American Academy of Child and Adolescent Psychiatry.
Suicide is the third leading cause of death in American adolescents, accounting for more than 1,300 deaths in youths between the ages of 12 and 18 in 2005. An additional one million teens attempt suicide each year, leading to high emotional and financial costs to families and the healthcare system. Unfortunately, very few treatment studies have focused on this vulnerable age group or identified treatments with proven results.
Family involvement has a strong impact on reducing suicidal thinking
In this study, Attachment-based Family Therapy (ABFT), found that patients with severe suicidal thinking were at least four times more likely to have no suicide thinking at the end of the treatment or three months after treatment, than patients treated in the community.
Patients in ABFT also showed a more rapid decrease in depression symptoms and were retained in treatment longer than in community care, even with additional supports provided by the study. This is the first treatment study for teen suicidal ideation to show robust and statistically significant improvement over treatment as usual.
Working with families and teens — a different treatment approach
"Most treatment models mainly work with the adolescents alone, helping them to learn new coping and problem solving strategies," says study leader Guy S. Diamond, PhD, director of the Center for Family Intervention Science at the Children's Hospital of Philadelphia. "But adolescents are highly influenced by their parents. Family conflict, chaos, and strife can contribute to youth suicide, while at the same time family love, trust, and communication can buffer against it. This therapy aims to resolve family conflicts and promote family strengths so that the appropriate bond of attachment can protect youth from self harm."
The researchers studied 66 children between the ages of 12 and 17 who presented in primary care or emergency rooms with severe suicidal thinking and depressive symptoms. The average age was 15, about three quarters were African American and 83 percent were female. Parent participation was required.
"Parents are not viewed as the problem, but as the curative medicine," Diamond says. "They are the key to keeping lines of communication open in order to monitor against suicidal behavioral. And while no treatment is perfect for all patients, helping any family through a youth's suicide crisis is important."
Future research directions
Diamond says his team's future studies will focus on a broader population of patients, stronger comparison treatments, and long term outcomes to better assess treatment benefits.
About the study's funding and authors
A grant from the Centers for Disease Control and Prevention supported this research. Diamond's co-authors were Gregory Brown, PhD from the University of Pennsylvania; Matthew B. Wintersteen, PhD, from Thomas Jefferson University; Robert Gallop, PhD, from West Chester University; and Gary M. Diamond, PhD, from Ben-Gurion University of Negev, Israel; Karni Shelef, PhD, of Achva Academic College of Israel; and Suzanne Levy, PhD, from Children's Hospital.