Tailored treatment approach shows promise for reducing suicide and self-harm risk in teens and young adults – Psychiatry

A new approach to mental healthcare for young people at risk of self-harm and suicide is showing promising results. A study demonstrates that tailoring the intensity of treatment to an individual’s level of risk can significantly reduce self-harm and depression, while also increasing patient satisfaction.

A Growing Crisis in Youth Mental Health

Suicide remains a leading cause of death among young people in the United States. Even more prevalent is self-harm – encompassing suicide attempts and self-injury – which represents the leading cause of morbidity worldwide for those aged 10-24. Recognizing self-harm as a strong predictor of future suicide attempts underscores the critical need for early intervention.

The Study Design

Researchers from UCLA and Kaiser Permanente Northwest’s Center for Health Research conducted a randomized clinical trial, the largest of its kind to date, evaluating a “stratified stepped-care” model. The study enrolled 301 youth between the ages of 12 and 24 who were identified as being at elevated risk for suicide or self-harm.

Participants were divided into two groups. The first group received Zero Suicide Quality Improvement (ZSQI), a system-wide initiative focused on improved screening, access to treatment, and safety planning. The second group, ZSQI Plus Stratified Stepped-Care for Suicide Prevention, built upon ZSQI by triaging youth to different levels of care based on their assessed risk.

Key Findings and Outcomes

Over a 12-month period, the study revealed a 54% reduction in self-harm risk among those receiving the stepped-care approach compared to those receiving standard quality improvement alone. Researchers also observed a significant reduction in depression severity within the stepped-care group, alongside higher levels of patient satisfaction with their mental health care.

Notably, there were no deaths in either group during the study. Suicide attempt rates were also lower than expected in both groups, supporting existing research suggesting that health system quality improvement initiatives can contribute to suicide prevention.

What Could Happen Next

The findings suggest that health systems could increasingly adopt stratified stepped-care models. This may involve further refinement of risk assessment tools and the development of more accessible digital mental health resources for lower-risk youth. It is also possible that other institutions may seek to replicate this study to determine if similar results are observed in different populations or healthcare settings. Further research, as noted by Dr. Joan Asarnow, is needed to optimize suicide and self-harm prevention strategies within healthcare systems.

Frequently Asked Questions

What is “stratified stepped-care”?

Stratified stepped-care involves triaging youth to different levels of care based on their assessed risk. Lower-risk youth receive care management, monitoring, and digital mental health tools, while higher-risk youth are offered more intensive services like DBT skills groups and individual therapy.

What is Zero Suicide Quality Improvement (ZSQI)?

ZSQI is a health system-wide initiative featuring improved suicide-risk screening, treatment access, electronic health record safety planning templates, and continuous quality improvement.

Does this study indicate a reduction in suicide attempts?

While the study did not find significant differences in suicide attempts between groups, lower-than-expected attempt rates were observed in both conditions, supporting other research indicating that health system quality improvement can lead to reductions in suicide attempts.

How might healthcare systems adapt to better support at-risk youth?