Skills to Enhance Positivity in Suicidal Adolescents: Results From an Open Development Trial

Abstract

"Skills to Enhance Positivity" (STEP) is a two-part positive affect program designed to decrease recurrent suicidal behavior in adolescents hospitalized due to suicide risk. Here, we describe the initial pilot phase in which the intervention was developed and modified based on a sample of 20 adolescent participants, aged 12 to 18 years old ( M = 15.9, SD = 1.5). STEP consisted of an in-person phase (four sessions) and a remote delivery phase (text messaging and phone calls). The inpatient sessions focused on psychoeducation of positive affect, mindfulness meditation, gratitude, and savoring. The remote delivery phase comprised of weekly phone calls and daily text messages to enhance mood monitoring and skills practice reminders. Average session attendance was 81%, and mean daily response rate to text messages was 73.6%, demonstrating high engagement. STEP was described as good or excellent by over 90% of parents and 100% of adolescents. Only one participant had a suicide attempt, and five were readmitted for suicidality in the following 6 months, fewer than comparable naturalistic studies. Although preliminary results are promising, larger randomized trials are needed to determine the efficacy of STEP in reducing suicidal behaviors.

Interventions to reduce self-harm on in-patient wards: systematic review

“…Interventions were conducted on both adult wards 49 , 50 , 54 , 56 , 58 – 70 and adolescent in-patient wards. 43 , 51 – 53 , 55 , 57 Many wards did not have any gender restrictions ( n = 10), 49 , 50 , 53 – 56 , 58 , 60 , 69 , 70 but a few studies conducted interventions on female-only ( n = 3) 62 , 65 , 66 or male-only psychiatric ward ( n = 1), 63 or did not report the gender of the ward ( n = 7). 52 , 57 , 59 , 61 , 64 , 67 , 68 In total, 62 in-patient psychiatric wards were included in the present review.…”

“… 43 , 51 – 53 , 55 , 57 Many wards did not have any gender restrictions ( n = 10), 49 , 50 , 53 – 56 , 58 , 60 , 69 , 70 but a few studies conducted interventions on female-only ( n = 3) 62 , 65 , 66 or male-only psychiatric ward ( n = 1), 63 or did not report the gender of the ward ( n = 7). 52 , 57 , 59 , 61 , 64 , 67 , 68 In total, 62 in-patient psychiatric wards were included in the present review. Many of these were acute psychiatric wards ( n = 41), 49 , 54 , 56 , 58 – 63 , 65 – 70 followed by forensic ( n = 6), 64 child and adolescent wards ( n = 7), 43 , 51 – 53 , 55 , 57 PICU ( n = 4) 60 and triage/assessment units ( n = 3).…”

“… 52 , 57 , 59 , 61 , 64 , 67 , 68 In total, 62 in-patient psychiatric wards were included in the present review. Many of these were acute psychiatric wards ( n = 41), 49 , 54 , 56 , 58 – 63 , 65 – 70 followed by forensic ( n = 6), 64 child and adolescent wards ( n = 7), 43 , 51 – 53 , 55 , 57 PICU ( n = 4) 60 and triage/assessment units ( n = 3). 60 One study did not report the number or type of wards.…”

“…The study designs varied with the majority using a pre and post design ( n = 14), 49 , 51 – 53 , 55 , 57 – 59 , 61 – 63 , 65 , 66 , 69 followed by randomised controlled trials ( n = 6), 50 , 54 , 56 , 60 , 68 , 70 non-randomised controlled trials ( n = 2) 64 , 67 and interrupted time series ( n = 1). 43 The majority of the studies had control groups except five.…”

“… 43 The majority of the studies had control groups except five. 57 , 59 , 61 – 63 All interventions aimed to reduce the frequency of self-harm, although many also monitored depression, anxiety, suicidal ideation and other indices.…”