Psychoeducation for Suicidal Youth

(STEP Trial)

Recruiting at 2 trial locations

Overseen By Shirley Yen, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Brown University

Disqualifiers: Active psychotic disorder, cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 4 weeks

216 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if the STEP program (Skills to Enhance Positivity) can reduce suicidal thoughts and actions in teenagers hospitalized for suicide risk. STEP includes sessions on mindfulness, gratitude, and positive thinking, along with daily reminders after hospital discharge. Participants will either receive the STEP program or use a safety resource app. Teens hospitalized for suicide risk and who have experienced suicidal thoughts or attempts in the past month might be suitable for this trial. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could improve mental health support for teens.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the Skills to Enhance Positivity (STEP) program improves mental health in teens at risk for suicide. In similar programs, supportive messages have helped teens feel safer and more confident in avoiding harmful actions. These programs aim to increase positive feelings and coping skills.

The STEP program includes sessions on mindfulness, gratitude, and enjoying positive experiences. It does not use medication, reducing concerns about physical side effects. Safety reports from related studies suggest that focusing on positive thinking and mindfulness is generally well-received. Teens often find these techniques helpful and easy to follow.

Overall, this type of treatment is considered safe and supportive for young people dealing with difficult emotions. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the STEP program for suicidal youth because it adds an innovative twist to traditional care. Unlike standard treatments that often focus on managing negative thoughts and behaviors, STEP emphasizes enhancing positivity by increasing attention to positive emotions and experiences. This approach is delivered through in-person sessions during a hospital stay and continues with mood monitoring and skill-building messages via a smartphone app after discharge. This blend of in-person and app-based methods aims to boost emotional resilience in a more engaging and accessible way, potentially reducing the risk of future suicidal behavior.

What evidence suggests that this trial's treatments could be effective for reducing suicidal events and ideation in adolescents?

Research has shown that the STEP program, one of the treatments in this trial, may help reduce suicidal behavior in teenagers. In earlier studies, only one participant in the STEP program attempted suicide, and five were hospitalized again for suicidal thoughts over six months. These numbers were lower than those in similar studies without STEP. The program enhances positive thinking through sessions on mindfulness and gratitude, which can improve problem-solving and social support. Additionally, more than 90% of parents and all teenagers rated the program as good or excellent. This suggests that STEP could effectively lower the risk of suicidal thoughts and actions in young people. Meanwhile, the Enhanced TAU, another treatment arm in this trial, includes regular programming of the inpatient psychiatric unit, followed by a safety plan and resources accessible via an app post-discharge. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adolescents and adults aged 12-60 who are hospitalized for suicide risk, have had recent suicidal thoughts or attempts, and can use a smartphone. They must understand English or Spanish. Stakeholders working with these individuals can also participate.

Inclusion Criteria

I am proficient in English or Spanish.

Patients with access to a smart phone

I am between 12 and 60 years old and hospitalized for suicide risk.

Exclusion Criteria

Patients being discharged to a residential facility.

Patients with active psychotic disorder

Patients with significant cognitive impairment or deficits

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either STEP or ETAU intervention during inpatient psychiatric admission, including 4 in-person sessions for STEP

4 weeks

4 in-person sessions

Post-discharge Monitoring

Mood monitoring and skill reminders sent daily for the first month post-discharge and three times a week for the following two months

3 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 3, 6, and 12 months

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Enhanced TAU
• STEP

Trial Overview

The study compares STEP—a program with in-person sessions on positive thinking skills and mood monitoring—to Enhanced TAU (usual care plus safety app reminders). Participants will be randomly assigned to one of the two groups to assess effectiveness.

How Is the Trial Designed?

Group I: STEP: Positivity skill enhancement Experimental Treatment 1 Intervention

This intervention includes the Enhanced TAU described below plus it entails 4 in-person sessions delivered during an inpatient psychiatric admission, followed by mood monitoring and skills messages delivered post-discharge via app, to promote the practice of increasing attention to positive affect and experiences as a means of reducing risk for suicidal behavior.

Group II: Enhanced TAU Active Control 1 Intervention

his comparison intervention involves regular programming of the inpatient psychiatric unit, followed by safety plan and resources loaded onto an app that the participant has access to post-discharge.

Who Is Running the Clinical Trial?

Brown University

Lead Sponsor

Trials

480

Recruited

724,000+

Published Research Related to This Trial

The Skills to Enhance Positivity (STEP) intervention aims to increase positive affect in adolescents at risk of suicide and has shown promise in a pilot study by reducing suicidal events and ideation.

The ongoing randomized controlled trial will compare STEP to Enhanced Treatment as Usual (ETAU) to determine its effectiveness in decreasing suicidal behaviors and improving positive emotional experiences over a 6-month follow-up period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Skills to Enhance Positivity in adolescents at risk for suicide: Protocol for a randomized controlled trial. Yen, S., Suazo, N., Doerr, J., et al.[2023]

The LINC to LIFE Safety Planning (L2L SP) training program, which lasts 150 minutes, significantly improved mental health providers' knowledge, perceived behavioral control (PBC), and intentions regarding safety planning for suicidal clients immediately after the training.

At a six-month follow-up, improvements in attitudes, PBC, and emotional responses were noted, suggesting that the training has lasting benefits, although declines in knowledge indicate a need for refresher sessions to maintain effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

LINC to Life: Evaluation of a Safety Planning Training Program with Clinicians and Mental Health Staff. Bender, AM., Schuck, A., Peterson, AL., et al.[2022]

A quality improvement project involving 134 veterans hospitalized for suicidal thoughts showed that a new single-session suicide-focused psychoeducation group was highly acceptable and perceived as useful by participants.

After attending the group, veterans reported increased hope and motivation to learn coping skills for their suicidal thoughts, indicating the potential effectiveness of this intervention in an inpatient setting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding suicide: Development and pilot evaluation of a single-session inpatient psychoeducation group. Gebhardt, HM., Ammerman, BA., Carter, SP., et al.[2022]

The 'Skills to Enhance Positivity' (STEP) program, which includes both in-person and remote sessions, showed high engagement among adolescents at risk for suicide, with an 81% attendance rate and a 73.6% response rate to text messages.

In the 6 months following the intervention, only one participant attempted suicide and five were readmitted for suicidality, suggesting that STEP may effectively reduce suicidal behaviors, although further research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Skills to Enhance Positivity in Suicidal Adolescents: Results From an Open Development Trial. Yen, S., Ranney, ML., Tezanos, KM., et al.[2020]

The Skills to Enhance Positivity (STEP) intervention, which includes in-person sessions and ongoing support through text messages, was well-received by adolescents, with 83% session completion and high satisfaction ratings.

Participants in the STEP program experienced significantly fewer suicide events (6) compared to those receiving enhanced treatment as usual (ETAU) (13) over a six-month follow-up, suggesting its potential effectiveness in reducing suicidal behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Skills to Enhance Positivity in Suicidal Adolescents: Results from a Pilot Randomized Clinical Trial. Yen, S., Ranney, ML., Krek, M., et al.[2021]

Proactive suicide risk screening and psychoeducation have made significant strides in helping to identify at-risk youth, which is crucial since suicide is the second leading cause of death among this age group in the U.S.

While there is still limited empirical support for specific interventions targeting youth suicide risk, promising psychotherapeutic approaches are being developed, emphasizing the need for continued research and improvement in these areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Saving Lives: Recognizing and Intervening with Youth at Risk for Suicide. Arango, A., Gipson, PY., Votta, JG., et al.[2022]

Psycho-educational programs for suicide prevention in students aged 14 to 18 significantly improved knowledge about suicide and positively influenced attitudes towards suicidal individuals.

However, these programs did not have an impact on coping styles or levels of hopelessness, indicating that while they can enhance understanding and attitudes, they may not address all aspects of mental health related to suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide prevention in adolescents: a controlled study of the effectiveness of a school-based psycho-educational program. Portzky, G., van Heeringen, K.[2015]

A psychoeducational suicide prevention group for 250 psychiatrically hospitalized adolescents was effective, with nearly all participants reporting they learned helpful strategies to prevent future suicide attempts.

The creation of a 'Reasons To Live List' was particularly beneficial for participants, while a 'Safety List' was considered less helpful, indicating that different therapeutic tools may have varying impacts based on individual experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adolescent perceptions of a suicide prevention group on an inpatient unit. Esposito-Smythers, C., McClung, TJ., Fairlie, AM.[2022]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC5984182/

Skills to Enhance Positivity in Suicidal Adolescents (STEP)

Only one participant had a suicide attempt, and five were readmitted for suicidality in the following six months, fewer than comparable naturalistic studies.

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC7461700/

Skills to Enhance Positivity in Suicidal Adolescents

Laboratory studies have shown that inducing positive emotions results in improved problem solving and increased social support (Fredrickson et al., 2003); both ...

3.

journals.plos.org

journals.plos.org/plosone/article?id=10.1371/journal.pone.0287285

Skills to Enhance Positivity in adolescents at risk for suicide

We hypothesize that those randomized to STEP, compared to ETAU, will have lower rates of suicide events, active suicidal ideation (SI), and ...

4.

journals.sagepub.com

journals.sagepub.com/doi/abs/10.1177/0145445517748559

Skills to Enhance Positivity in Suicidal Adolescents

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 ...

5.

ctv.veeva.com

ctv.veeva.com/study/skills-to-enhance-positivity-in-suicidal-youth

Skills to Enhance Positivity in Suicidal Youth (STEP)

Specifically, this study proposes to test the effectiveness of STEP in reducing suicidal events and ideation in 216 adolescents, admitted to ...

6.

reporter.nih.gov

reporter.nih.gov/search/ZmGiYVB0BUmDW5_pBgkDZA/project-details/10683179

Project Details - NIH RePORTER

PROJECT NARRATIVE SKILLS TO ENHANCE POSITIVITY IN ADOLESCENTS AT RISK FOR SUICIDE The rates of suicidal behaviors in youth remain unacceptably high, and the ...

7.

link.springer.com

link.springer.com/article/10.1007/s11920-025-01620-w

Suicide Prevention in Youth | Current Psychiatry Reports

Adolescents who received supportive text messages showed improved safety plan use, self-efficacy to refrain from suicidal action, and coping by ...

8.

publications.aap.org

publications.aap.org/pediatrics/article/153/1/e2023064800/196189/Suicide-and-Suicide-Risk-in-Adolescents

Suicide and Suicide Risk in Adolescents | Pediatrics

Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and ...