Psychoeducational Social Support Intervention Reduces Mortality In Suicidal Adolescents

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A psychoeducational social support intervention involving youth-nominated caring adults, was associated with reduced mortality in suicidal adolescents.

The Youth-Nominated Support Team intervention for Suicidal Adolescents-Version II (YST) reduced mortality in suicidal adolescents, according to the results of a trial published in JAMA Psychiatry.

Cheryl A. King, PhD, of the Department of Psychiatry, University of Michigan, Ann Arbor, and colleagues conducted a post hoc secondary analysis of a randomized clinical trial using National Death Index (NDI) data from adolescent psychiatric inpatients from 2 psychiatric hospitals enrolled in the trial from November 10, 2002, to October 26, 2005. Study participants had suicidal ideation, which was either frequent or involved having a plan; a suicide attempt; or both, within 4 weeks of enrollment. The participants were randomly assigned to either treatment as usual (TAU) or YST plus TAU (YST).

YST is a psychoeducational social support intervention. Participants nominated caring adults from family, school, and community to support them following hospitalization. Support individuals attended a psychoeducational session to learn about the adolescent’s problem list and treatment plan, suicide warning signs, how to communicate with adolescents, and how to support treatment adherence and appropriate behavioral choices. Adult volunteers received weekly support calls from YST staff for 3 months.

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The length of NDI follow-up ranged from 11.2 to 14.1 years. The analysis included 448 adolescents. During the 12 months after the index psychiatric hospitalization, supportive adults reported that adolescents in the YST group attended more outpatient psychotherapy sessions than adolescents in the TAU group (mean [SD], 26.2 [25.7] vs 22.5 [18.3]; P =.04) and medication follow-up sessions (mean [SD], 9.4 [10.5] vs 8.5 [9.8], P =.03). Youth in the YST group were also more likely to participate in outpatient substance use treatment (20 of 165 [12.1%] vs 10 of 166 [6.0%]; P =.03). There was no between-group difference for inpatient alcohol or drug treatment.

Over the 11- to 14-year follow-up, 2 deaths occurred in the YST group compared with 13 in the TAU group (hazard ratio, 6.62; P < 0.01); only 9 were death by suicide or drug-related with unknown intent (8 TAU, 1 YST). More participants died of drug overdose (accidental or unknown intent) than suicide during follow-up. Researchers pointed out that the line between intentional and accidental drug overdose can be difficult to determine.

Researchers noted that the study was limited by the small sample size for a mortality outcomes study. In addition, NDI data may have been incomplete.

Researchers recommended additional research to replicate these study findings and evaluate hypothesized mechanisms of action.


King CA, Arango A, Kramer A, et al. Association of the youth-nominated support team intervention for suicidal adolescents with 11- to 14-year mortality outcomes. Secondary analysis of a randomized clinical trial [published online February 6, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.4358.