Support Team Selected by Suicidal Teens May Curb Mortality

By Marilynn Larkin

February 15, 2019

NEW YORK (Reuters Health) - The Youth Support Team (YST) intervention for suicidal adolescents is associated with reduced mortality for up to 14 years, according to a post hoc analysis of the treatment program.

In YST, adolescents nominate caring adults who learn about their problems, treatment plans and how to support them. The randomized controlled trial of version II showed that YST plus treatment-as-usual (TAU), compared to TAU only, was associated with a greater reduction in the severity of suicidal thoughts at six-weeks followup.

However, according to Dr. Cheryl King of the University of Michigan in Ann Arbor and colleagues, the YST had other "promising indicators," including no suicide (vs. one for TAU), fewer suicide attempts, and a modest positive effect for functional impairment at one year.

For the current study, Dr. King and colleagues investigated the impact of YST version II on mortality 11 to 14 years after hospitalization among 448 adolescents (mean age, 15.6; 71% female; 84% white) who were hospitalized with suicidal ideation, a suicide attempt or both within the four weeks prior to enrollment.

Participants' diagnoses included depressive disorder (87.9%), posttraumatic stress disorder or acute stress disorder (25.2%), other anxiety disorder (28.7%), disruptive behavior disorder (41.5%), and alcohol or substance use disorder (20.8%).

As reported online February 6 in JAMA Psychiatry, there were 13 deaths in the TAU group and two deaths in the YST group (hazard ratio, 6.62). Causes of death included suicide (four patients total; one in YST); drug overdose, accidental or undetermined (eight); traffic fatality (one); homicide (one in YST); and infective endocarditis secondary to drug use (one).

"Taken together... this secondary analysis of mortality outcomes indicates that YST may be associated with positive youth trajectories and reduced mortality," the authors state. "To our knowledge, no other intervention for suicidal adolescents has been associated with reduced mortality."

"Because this was a secondary analysis," they note, "results warrant replication with examination of mechanisms."

"The YST may have had an initially small yet cascading positive impact on the lives of the young people who participated, leading to a lower risk of dying over time," Dr. King told Reuters Health by email.

"Although further studies are needed to replicate findings and understand exactly how YST is helping," she said, "results suggest that caring adults in the lives of at-risk adolescents can make a difference and that this is probably facilitated by providing these adults with tailored education and support."

"One very positive aspect of YST is that it has the potential to be scaled up," she noted. "Although we have not conducted cost analyses and the intervention does require the involvement of a mental health professional, I believe these costs would be seen as reasonable by many."

Dr. Cynthia Fontanella, Associate Professor in the Department of Psychiatry and Behavioral Health at Ohio State University Wexner Medical Center in Columbus, said the study findings are "exciting," but pointed to caveats - i.e., the fact that it was a post-hoc, secondary analysis with a relatively small sample size, and "complexities related to classification, given that only four of 15 cases were definitively classified as suicide."

"Caveats aside, the findings are certainly compelling and suggest the need for additional research," she told Reuters Health by email. "While the mechanism is not clear, the findings are in keeping with previous literature suggesting that interventions relying on social support - such as safety planning and social contacts such as postcards and telephone calls, etc. - may reduce the risk of subsequent completed suicide and suicide attempts."

"Engaging supportive adults in the life of an at-risk adolescent seems to be a good idea," she added. "Why wouldn't we want to take these findings seriously, given what seems to be considerable face validity? Given the existing state of knowledge of suicide risk subsequent to inpatient hospitalization, why wouldn't reputable inpatient psychiatric facilities incorporate this relatively straightforward intervention into standard practice?"


JAMA Psychiatry 2019.