Suicidal Teenagers’ Hospitalization Risk Reduced by Crisis Intervention

Use of a family-based crisis intervention in the emergency department for suicidal teenagers led to higher levels of satisfaction and greater feelings of family empowerment, found a recent study. Family-based crisis intervention is an emergency psychiatric intervention aimed at stabilizing a suicidal teenager during their emergency department visit, enabling them to go back home the same day.

“Family-based crisis intervention is a model of care for suicidal adolescents that may be a viable alternative to traditional [emergency department] care that presumes inpatient care as an end point,” wrote Elizabeth A. Wharff, PhD, and colleagues at the Boston Children’s Hospital in Massachusetts. “This intervention successfully allowed for some adolescents to circumnavigate the traditional inpatient psychiatric route and receive treatment in their home and community setting.”

The researchers randomly assigned 142 teenagers, aged 13 to 18 years, to receive family-based crisis intervention or treatment as usual when they arrived at a large emergency department for suicidality. To qualify as suicidal, the teenager, within the previous 3 days, had to have attempted suicide, identified themselves as suicidal, or been observed by an adult behaving in a way that indicated suicidality.

Teenagers receiving family-based crisis intervention first underwent a standard psychiatric evaluation. Then, licensed psychiatric social workers with intervention training worked with the teenager and their family and teenager for 60 to 90 minutes. The session involved the family and teenager coming up with a crisis narrative together and then learning “cognitive behavioral skill building, therapeutic readiness, psycho-education about depression, and safety planning,” the authors described.

Usual care, meanwhile, consisted of a standard psychiatric evaluation with a discharge (if no imminent suicide risk was present) and clinical recommendations.

In both groups, the adolescents and their caregivers filled out questionnaires about the teenager’s level of suicidality and the family’s sense of empowerment. Both the adolescent and their caregivers also rated their satisfaction with the care the teenager received before the intervention, after the intervention, and 3 more times during the following month.

No teenagers in either group died by suicide during the study period, and no differences in levels of suicidality existed between the 2 groups over time. However, adolescents were more likely to be discharged if they received the family-based crisis intervention instead of usual care. Although 68% of teenagers receiving usual care were hospitalized, only 38% of teenagers receiving the intervention were hospitalized.

Families in both groups reported an increase in family empowerment over time, but the families whose teenagers received family-based crisis intervention had a greater increase and also rated their satisfaction with care higher. These sentiments persisted during the follow-up assessments.

“Avoidance of inpatient psychiatric admission for suicidal adolescents has several benefits for the adolescent, family, and the health care system,” the authors wrote. “An inpatient admission separates the adolescent from her primary support system and may negatively impact an individual or family’s beliefs about recovery, the capacity to be safe in the world, or the family’s ability to provide a safe and containing environment for their child.”

Reference

Wharff EA, Ginnis KB, Ross AM, et al. Family-based crisis intervention with suicidal adolescents: a randomized clinical trial [published online Febraury 28, 2017]. Pediatr Emerg Care. doi: 10.1097/PEC.0000000000001076