Concurrent Treatment for Parents and Adolescents Who Attempt Suicide

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DESCRIPTION (provided by applicant): Approximately 2 million adolescents attempt suicide each year and 700,000 receive emergency medical treatment each year (Shaffer & Pfeffer, 2001). Treatment of adolescent suicide attempters is complicated by parental psychopathology, which has been found to be significantly elevated in this group compared to normal controls. There are several pathways by which all parents' psychopathology may be related to their adolescent's suicidality. First, genetic transmission of either suicidal behavior and/or more general psychopathology, such as an affective disorder, may be the mechanism by which parent functioning affects adolescent suicidal behavior. Indeed, a number of studies have found high rates of parental suicidal behavior among adolescents who attempt suicide. Second, parents with a history of past or current suicidality may model suicidal behavior for their adolescent. Third, family processes in these families may be especially sensitive to suicidality. For example, these families may inadvertently reinforce suicidal behavior via attention, or adolescents may use suicidal behavior to terminate aversive family relationship patterns. Fourth, parental psychiatric disorders may lead to aversive parenting in such a way that it may lead to an adolescent's suicidal thinking or behavior (Downey & Coyne, 1990). Finally, parental functioning may affect a parent's ability to follow through with their adolescent's treatment attendance, which in turn can affect progress made in therapy. The purpose of this application is to develop a treatment protocol that simultaneously treats the adolescent who attempts suicide and his/her parent, most typically a mother, if the parent is diagnosed with major depressive disorder. A two-step sequence of treatment development is proposed. Phase I includes therapist training, pilot testing, and protocol revisions as well as a small open trial. The concurrent treatment protocol will include both individual sessions for adolescents and parents but also parenting and family sessions. In Phase II we will conduct a small randomized trial and compare the experimental concurrent treatment protocol to treatment of the adolescent alone. Adolescents hospitalized on a psychiatric inpatient unit or treated in the Emergency Department following a suicide attempt will be recruited to participate in the study. Outcome will be assessed at the end of treatment and 6 months post-treatment. By integrating the treatment of these adolescents with that of their parents and using the same treatment principles for both, we hypothesize that the experimental protocol will lead to greater improvements in suicidal ideation and treatment success (i.e., no repeat suicide attempts, no repeat hospitalizations) than that typically found when an adolescent is treated individually. Adolescent suicide is the third leading cause of death during adolescence. This application tests an integrated protocol for suicidal adolescents and a depressed parent. Reducing the incidence of injurious suicide attempts among adolescents 14 to 17 years old and completed suicide among youth 15 to 19 years old are Year 2010 objectives addressed in this application.