Development of a treatment protocol for Puerto Rican adolescents with suicidal behaviors.

Abstract

Adolescents in Puerto Rico are at an increased risk for suicide attempts, though evidence-based treatments specifically for this group have not been tested. The current study was designed to develop and pilot test a culturally sensitive, manualized outpatient treatment for Puerto Rican adolescents who have experienced a suicidal crisis. The study was divided into phases. Phase 1 consisted of developing a socio-cognitive behavioral treatment for suicidal behavior. Phase 2 tested the treatment protocol in an open trial with 11 (6 male and 5 female) Puerto Rican adolescents. Active treatment had an approximate duration of 3-6 months. An initial assessment, process measures, and posttreatment assessment were completed with each participant to measure treatment feasibility as well as suicidality, symptoms, and risk factors. Participants were very satisfied with treatment and reported relevant clinical benefits. The retention rate was 73% (8 out of 11). For those who completed the treatment protocol, the goal of reducing further suicide risk was achieved; 2 showed reliable clinical changes in suicidal ideation, while 6 maintained low levels during treatment. All treatment completers had either a partial or total remission of their pretreatment diagnosis and half had reliable improvements in at least 1 risk factor. A theory-driven treatment protocol was developed according to patient's needs, but further research is needed to continue its development and to explore its efficacy.

Can Cognitive‐Behavioral Therapy Be Optimized With Parent Psychoeducation? A Randomized Effectiveness Trial of Adolescents With Major Depression in Puerto Rico

“…It may be that parents in CBT-alone may have relied more on the adolescents' therapist for specific recommendations than what caregivers would have received from the facilitators in the CBT + TEPSI condition. These hypotheses are consistent with findings that adapting treatments to specific family needs is associated with reducing depression symptoms and suicidal ideation (Diamond et al, 2012;Duart e-V elez et al, 2016).…”

Socio-Cognitive Behavioral Therapy for Suicidal Behavior With a Puerto Rican Male Adolescent

“…migration and immigration history, national background, documentation status, language use) (Duarté-Vélez & Bernal, 2007). However, Duarté-Vélez and colleagues (Duarté-Vélez, Torres-Dávila, Spirito, Polanco, & Bernal, 2016) argue that shared core cultural values among this group make it possible to develop a culturally informed intervention for suicidal behavior that can be individually tailored to Latinx adolescents and their families from various Latinx ethnicities. This can be accomplished by developing a strong case conceptualization and making the treatment plan relevant to their particular socio-cultural contextual experiences and clinical presentation.…”

“…This can be accomplished by developing a strong case conceptualization and making the treatment plan relevant to their particular socio-cultural contextual experiences and clinical presentation. Accordingly, Duarte-Velez et al (2016) developed a theoretically derived Socio-cognitive Behavioral Treatment protocol for suicidal behavior (SCBT-SB) for Latinx adolescents living in Puerto Rico, informed by empirical evidence.…”

“…The development of this treatment protocol was informed by studies focusing on Latinx populations, and two evidence based CBT protocols: one for teens with suicidal behavior and substance use problems with a predominantly White population in United States (Esposito-Smythers, Spirito, Hunt, Kahler, & Monti, 2011) and a CBT culturally adapted intervention for depressed Latinx teens living in PR (Rosselló & Bernal, 1999; Rosselló, Bernal, & Rivera-Medina, 2008). Outcomes of a small open pilot using the SCBT-SB showed that treatment completers had clinically significant positive changes and reductions in suicide risk as well as positive treatment satisfaction (Duarté-Vélez et al, 2016).…”

“…The socio-cognitive behavioral therapy for suicidal behavior (SCBT-SB) is informed by Cognitive Behavioral Therapy (CBT) (Dieserud, Roysamb, Ekeberg, & Kraft, 2001; Wenzel & Beck, 2008) and is embedded within an ecological framework (Ayyash, 2002). SCBT-SB emphasizes the contextual and social circumstances that influence adolescents’ suicidal behavior (Duarté-Vélez et al, 2016). This approach is different from traditional CBT in that it moves away from an individual conceptualization focusing on psychopathology, to a multidimensional and multi-faceted understanding of suicidal behavior.…”