Remission, Recovery, Relapse, and Recurrence Rates for Suicide Attempts and Nonsuicidal Self-Injury for Suicidal Youth Treated With Dialectical Behavior Therapy or Supportive Therapy.

OBJECTIVE: To evaluate rates of remission, recovery, relapse, and recurrence in suicidal youth who participated in a clinical trial comparing Dialectical Behavior Therapy (DBT) and Individual and Group Supportive Therapy (IGST). METHOD: Participants were 173 youth, aged 12 to 18 years, with repetitive self-harm (including at least 1 prior suicide attempt [SA]) and elevated suicidal ideation (SI). Participants received 6 months of DBT or IGST and were followed for 6 months post-treatment. The sample was 95% female, 56.4% White, and 27.49% Latina. Remission was defined as absence of SA or nonsuicidal self-injury (NSSI) across one 3-month interval; recovery was defined across 2 or more consecutive intervals. Relapse and recurrence were defined as SA or NSSI following remission or recovery. Cross-tabulation with χ2 was used for between-group contrasts. RESULTS: Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA in DBT than for IGST. Across treatments and time points, SA had higher remission and recovery rates and lower relapse and recurrence rates than NSSI. There were no significant differences in NSSI remission between conditions; however, participants receiving DBT had significantly higher NSSI recovery rates than those receiving IGST for the 3- to 9-month, 3- to 12-month, and 6- to 12-month intervals. CONCLUSION: Results showed higher percentages of SA remission and recovery for DBT as compared to IGST. NSSI was less likely to remit than SA. DIVERSITY & INCLUSION STATEMENT: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. CLINICAL TRIAL REGISTRATION INFORMATION: Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www. CLINICALTRIALS: gov/; NCT01528020.

Suicide in young people: screening, risk assessment, and intervention.

Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.

Mechanisms of Change in the Prevention of Depression: An Indicated School-Based Prevention Trial at the Transition to High School.

OBJECTIVE: Depression represents a major public health concern, and prevalence increases significantly during adolescence. The high school transition may exacerbate the risk of depression for youth with pre-existing vulnerability. The High School Transition Program (HSTP) is a brief, skills-based intervention that has demonstrated efficacy in preventing depression in adolescents. The current study aimed to evaluate the theorized mechanisms of change of the HSTP intervention by testing a multiple mediation model including school attachment (SA) and self-esteem (SE) as two mediators of treatment outcomes. METHOD: Students (N= 497; 61.5% girls) with elevated depressive symptoms, identified for the intervention program via an eighth-grade screening, were randomized to a brief intervention (n = 247) or the HSTP (n = 233) from 2003 to 2008. Participants completed measures at five time points. The first assessment occurred at the start of the second semester of eighth grade and the last assessment occurred at the end of ninth grade. A multiple mediation model tested whether SA and SE contributed to changes in depression for youth in the HSTP. RESULTS: The mediation model, including contemporaneously assessed SE and SA, was not supported. There was evidence of sequential mediation, such that students who participated in the HSTP intervention reported higher SA, which in turn predicted improved SE, and in turn contributed to amelioration of depressive symptoms. CONCLUSION: The HSTP intervention ameliorated depressive symptoms by targeting factors specific to the school transition (ie, SA). Results suggest youth at risk for depression may benefit from prevention efforts that enhance students' capacity to effectively manage identified environmental stressors, such as school transitions. CLINICAL TRIAL REGISTRATION INFORMATION: Middle School to High School Transition Project: Depression and Substance Abuse Prevention; https://clinicaltrials.gov/; NCT00071513.

Is Treatment Working? Detecting Real Change in the Treatment of Child and Adolescent Depression.

OBJECTIVE: Despite advances in evidence-based treatments for youth depression in recent decades, overall treatment effects are modest at best, with 30% to 50% of youth being nonresponders. Practice parameters consistently recommend systematic assessment and routine monitoring of depressive symptoms, or measurement-based care (MBC), to enhance youth depression treatment. However, the literature offers few guidelines on how to use assessment results to inform care decisions or to detect real and clinically meaningful change. Thus the current study produced reliable change indices (RCIs) per Jacobson and Truax for two commonly used standardized assessments of youth depression (ie, Patient Health Questionnaire-9 items, Modified for Adolescents [PHQ-9A], the Short Moods and Feelings Questionnaire [SMFQ]). METHOD: The study sample (N = 1,738) consisted of youths 6 to 18 years old seen in a child and adolescent psychiatry clinic of a regional pediatric medical center who completed at least one of the target depression measures. We examined the factor structure and internal reliability for the PHQ-9A, and calculated RCIs for patients with a depression-related diagnosis for both measures. RESULTS: Analyses confirmed a one-factor solution and adequate internal consistency (α = .86) for the PHQ-9A. All measures yielded acceptable test-retest reliabilities (r > 0.75) and RCIs that equate to clinical practice recommendations of using reliable changes scores of 7, 6, and 8 for the PHQ-9A, the SMFQ-Child Report, and the SMFQ-Parent Report, respectively. CONCLUSION: Psychometric validation of the PHQ-9A and these RCIs are timely and significant contributions to the treatment of youth depression, by facilitating effective use of MBC-a critical evidence-based strategy for improving treatment outcomes.

Identifying comorbid depression and disruptive behavior disorders: comparison of two approaches used in adolescent studies.

Interest in commonly co-occurring depression and disruptive behavior disorders in children has yielded a small body of research that estimates the prevalence of this comorbid condition and compares children with the comorbid condition and children with depression or disruptive behavior disorders alone with respect to antecedents and outcomes. Prior studies have used one of two different approaches to measure comorbid disorders: (1) meeting criteria for two DSM or ICD diagnoses or (2) scoring .5 SD above the mean or higher on two dimensional scales. This study compares two snapshots of comorbidity taken simultaneously in the same sample with each of the measurement approaches. The Developmental Pathways Project administered structured diagnostic interviews as well as dimensional scales to a community-based sample of 521 11-12 year olds to assess depression and disruptive behavior disorders. Clinical caseness indicators of children identified as "comorbid" by each method were examined concurrently and 3-years later. Cross-classification of adolescents via the two approaches revealed low agreement. When other indicators of caseness, including functional impairment, need for services, and clinical elevations on other symptom scales were examined, adolescents identified as comorbid via dimensional scales only were similar to those who were identified as comorbid via DSM-IV diagnostic criteria. Findings suggest that when relying solely on DSM diagnostic criteria for comorbid depression and disruptive behavior disorders, many adolescents with significant impairment will be overlooked. Findings also suggest that lower dimensional scale thresholds can be set when comorbid conditions, rather than single forms of psychopathology, are being identified.