SPECIALIZED FAMILY ER PROGRAM WITH SUICIDE ATTEMPTERS

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Suicide attempts reach a peak incidence in mid to late adolescence. Suicide attempters constitute a significant proportion of all adolescent psychiatric emergencies and a history of attempted suicide constitutes a highly significant risk factor for later suicide. Family factors are of critical importance in this disorder; studies indicate that a majority od adolescent suicide attempts are preceded by intrafamilial disputes and that family characteristics are also important determinants of compliance with recommended treatment. However, the literature in this area is sparse and no controlled study has evaluated family-based interventions. However, the literature in this area is sparse and no controlled study has evaluated family-based interventions with attempters. Our goal is to evaluate the effectiveness of a specialized emergency room (ER) family intervention for a consecutive series of 200 female suicide attempters aged 12 - 18 who are predominantly Black and Hispanic who will be followed longitudinally over 18 months. Female suicide attempters and their families will be assigned in a systematic block design as follows: 1) 100 will receive a specialized ER program and brief (6 session) family therapy; and 2) 100 will receive standard ER care (medical treatment and an outpatient appointment for the next day) and brief family therapy. The specialized ER program, aimed at addressing family conflict and treatment compliance, will have three major components: 1) a 1 1/2 hour crises family intervention will be conducted by a bilingual therapist who will also serve as the liaison to follow-up brief family therapy in an outpatient clinic; 2) the family's expectations regarding therapy will be provided to staff in the ER, and pediatric, adult, and child psychiatry. Since the specialized ER program will involve all staff,k it is not possible to randomly assign individual suicide attempters to condition, but attempters will be assigned systematically to condition in six month blocks that control for seasonal variations in suicidality. This program is aimed at reducing the number of suicide reattempts and suicide-related risk factors (family conflict and parental symptomatology, individual psychiatric diagnosis, substance abuse, trouble at school and with the law_. These factors will be assessed at 3, 6, 12, and 18 months following the attempt. We anticipate that two factors will intervene to mediate the impact of the specialized ER program first,k compliance with brief family therapy will be significantly higher among those receiving the specialized ER program, associated with greater acquisition of coping skills (interpersonal problem solving, positive events, and attributions), fewer symptoms during the course of therapy, and greater satisfaction with health care services by suicide attempters and their families; second, stressful events in the families lives and parental substance abuse and psychiatric symptoms will disrupt the maintenance of positive treatment gains and outcomes.