A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal

Abstract

Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents' suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12-to 18-years-old (49% were African American) were randomized to ABFT (n ¼ 66) or FE-NST (n ¼ 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F 1,127 ¼ 181, p ¼ .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t 127 ¼ 12.61, p < .0001; effect size, d ¼ 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t 127 ¼ 10.88, p < .0001; effect size, d ¼ 1.93). Response rates (ie, !50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.

Effectiveness of Attachment-Based Family Therapy compared to Treatment as Usual for Depressed Adolescents in Community Mental Health Clinics

“…The lack of differences between ABFT and TAU is consistent with ndings by Diamond and colleges (31,33) who reported no differences between ABFT and EUC or non-directive supportive treatment in terms for remission rate, clinical response or reduction of depressive symptom at the end of treatment. However, in their studies, the adolescents' reduction in depressive symptoms was clinically signi cant.…”

“…Actually, the failure to nd any statistically or clinically signi cant change in the investigated treatments, may indicate that both of the treatments might not be e cient in reducing depressive symptoms. Our sample was comparable to samples in other trials in terms of severity of depressive symptoms, comorbidity or on any other important factors (11,31,33). Severity of depressive symptoms going in to treatment cannot, therefore, explain the lack of improvement at the end of treatment.…”

“…Given the large number of adolescents with depression who do not respond su ciently to a rst-line treatment, it is necessary with continued efforts to identify factors that may moderate the treatment effects. Another factor that may explain the lack of treatment response to ABFT in our study may be the differences in sample characteristics.Earlier evaluations of ABFT have relied on samples consisting of adolescents from ethnic minorities, many living in one parent households, and one third of the parents had income below the powerty line (31,33). These factors differentiate perviously studied populations from the present study in important ways.…”

“…Participants who received ABFT exhibited greater and faster reduction in suicidal ideation, but ABFT was no more effective in reducing symptoms of depression compared to enhanced usual care. In a more recent study comparing the e cacy of ABFT to a family-enhanced nondirective supportive therapy (FE-NST), both treatments produced substantial reductions in depressive symptoms, but ABFT did not outperform FE-NST in reducing suicidal ideation, which was the primary outcome in the study (31). Furthermore, there was a substantial number adolescents in both treatment groups who did not achieve remission.…”

“…The empirical support for ABFT is emerging (31)(32)(33)(34)(35) and ABFT has been designated as a probably e cacious treatment for adolescents with suicidal ideation based on a study from 2010 (Diamond et al, 2010; Glenn, Franklin, & Nock, 2015). Nevertheless, the evidence is still limited and inconclusive.…”