Cognitive Therapy for Suicide Prevention in Homeless Youth

Overseen By Natasha Slesnick, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Psychiatric hospitalization

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

Compensation: Varies

Number of Visits: 13

Duration: 6 months

300 Participants Needed

Trial Summary

What is the purpose of this trial?

Suicide is the leading cause of death among YEH and most youth do not access services that may be available to them. Therefore, this study seeks to address this gap in the research literature with the goal to identify an effective intervention that can be readily adopted by communities that serve these youth. We will test the effects of outreach-worker delivered Cognitive Therapy for Suicide Prevention (CTSP)+Services as Usual (SAU) versus SAU alone on suicidal ideation (primary outcome), substance use and depressive symptoms (secondary outcomes) at 3, 6, 9 and 12- months.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Cognitive Therapy for Suicide Prevention (CTSP) in homeless youth?

Research shows that Cognitive Therapy for Suicide Prevention (CTSP) can help reduce suicidal thoughts in homeless youth by improving their problem-solving skills and reducing feelings of being a burden to others. This treatment has been found to enhance protective factors against suicide, making it a promising option for this high-risk group. ^{1 2 3 4 5}

Is Cognitive Therapy for Suicide Prevention (CTSP) safe for use in humans?

Research suggests that Cognitive Therapy for Suicide Prevention (CTSP) is safe for use in humans, as it has been shown to reduce risks associated with suicidal ideation and illicit drug use among homeless youth without reported adverse effects. ^{4 6 7 8 9}

How is the treatment Cognitive Therapy for Suicide Prevention (CTSP) unique for preventing suicide in homeless youth?

Cognitive Therapy for Suicide Prevention (CTSP) is unique because it specifically addresses cognitive distortions (inaccurate thoughts) and enhances social problem-solving skills, which are protective factors against suicidal thoughts. Unlike other treatments, CTSP has shown effectiveness in reducing the impact of illicit drug use on suicidal ideation and improving feelings of belongingness and reducing perceived burdensomeness among homeless youth. ^{4 5 7 10 11}

Research Team

Natasha Slesnick, Ph.D.

Principal Investigator

Ohio State University

Eligibility Criteria

This trial is for young people aged 15-24 who are experiencing homelessness, have a history of substance use, and show signs of suicidal behavior or have attempted suicide in the past year. They must be actively using alcohol or drugs.

Inclusion Criteria

SSI-W score > 4 or at least one suicide attempt in prior 12 months

I am between 15 and 24 years old.

Meets criteria for homelessness

Exclusion Criteria

Youth requires psychiatric hospitalization

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) or SAU alone over 6 months

6 months

10 sessions of CTSP with 9 optional booster sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Assessments at 3, 6, 9, and 12 months post-baseline

Treatment Details

Interventions

• Cognitive Therapy for Suicide Prevention

Trial Overview The study compares two approaches: usual support services alone versus those services plus Cognitive Therapy for Suicide Prevention (CTSP), delivered by outreach workers. The goal is to see which method better reduces suicidal thoughts, substance use, and depression over time.

Participant Groups

Group I: Cognitive Therapy for Suicide Prevention + Services as Usual Experimental Treatment 2 Interventions

10 sessions of Cognitive Therapy for Suicide Prevention (CTSP) provided over 6 months, with 9 optional booster sessions + services as usual (SAU) received by the community.

Group II: Services as Usual Active Control 1 Intervention

Services as Usual involves utilizing Strengths-Based Outreach and Advocacy to link youth to community services for a period of 6 months.

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

Findings from Research

Cognitive-behavioral therapies (CBTs) significantly reduce suicide behavior, as shown in a systematic review of 28 studies, indicating their efficacy in addressing this serious clinical issue.

The effectiveness of CBT was particularly notable in adult populations and individual treatment formats, but not in adolescents or group settings, suggesting that treatment approaches may need to be tailored for different age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Tarrier, N., Taylor, K., Gooding, P.[2022]

Cognitive-Behavioral Therapy (CBT) significantly reduced suicidal ideation and hopelessness in depressed adolescents aged 12 to 18 who had attempted suicide, with a 54% to 77% decrease in scores after 12 weeks of treatment.

In a clinical trial involving 30 participants, those receiving CBT showed marked improvements compared to a control group that did not receive the intervention, highlighting the efficacy of CBT in this high-risk population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts. Alavi, A., Sharifi, B., Ghanizadeh, A., et al.[2022]

In a study of 120 individuals with recent suicide attempts, those receiving cognitive therapy showed a significantly faster improvement in their problem-solving skills, particularly in reducing negative views and impulsive behaviors, compared to a control group.

Cognitive therapy not only helps decrease the recurrence of suicide attempts but also leads to rapid changes in problem-solving appraisal within 6 months, which is crucial during the high-risk period following a suicide attempt.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Ghahramanlou-Holloway, M., Bhar, SS., Brown, GK., et al.[2022]

Cognitive Therapy for Suicide Prevention (CTSP) significantly enhances the protective effects of social problem-solving on suicidal ideation among homeless youth, as shown in a study with 150 participants over 9 months.

The study found that perceived burdensomeness acted as a mediator in the relationship between social problem-solving and suicidal ideation, indicating that CTSP can effectively reduce suicidal thoughts by addressing feelings of being a burden.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Problem-Solving and Suicidal Ideation Among Homeless Youth Receiving a Cognitive Therapy Intervention: A Moderated Mediation Analysis. Zhang, J., Wu, Q., Slesnick, N.[2022]

Cognitive therapy effectively addresses key issues in suicidal patients, such as perfectionism, social sensitivity, and hopelessness, by helping them develop constructive thinking patterns.

The therapy involves planning activities and tracking negative thoughts, which can lead to a decrease in feelings of hopelessness and improve overall mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive therapy for the suicidal patient: a case study. Reilly, CE.[2019]

A manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) was developed and tested on 110 adolescents aged 13 to 19 who recently attempted suicide, focusing on risk reduction and relapse prevention.

The therapy was well-received, with 72.4% of participants completing 12 or more sessions, indicating its feasibility for preventing recurrence of suicidal behavior in this high-risk group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. Stanley, B., Brown, G., Brent, DA., et al.[2022]

Cognitive Therapy for Suicide Prevention (CTSP) combined with Treatment as Usual (TAU) significantly interrupts the link between illicit drug use and suicidal ideation in homeless youth, suggesting it can effectively reduce suicide risk in this vulnerable group.

In a study of 150 homeless youth aged 18 to 24, those receiving CTSP + TAU showed a greater reduction in cognitive distortions and suicidal thoughts compared to those receiving only TAU, highlighting the importance of targeted interventions in addressing mental health challenges associated with drug use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Illicit Drug Use, Cognitive Distortions, and Suicidal Ideation Among Homeless Youth: Results From a Randomized Controlled Trial. Wu, Q., Zhang, J., Walsh, L., et al.[2023]

The Safety Planning Intervention (SPI) is effective in reducing suicidal ideation and behavior, as well as improving depression and treatment engagement among adults experiencing suicide-related distress, based on a systematic review of 26 studies.

The SPI is adaptable and can be delivered in various formats (in-person or online) and as a standalone or combined intervention, making it a flexible tool in suicide prevention practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Ferguson, M., Rhodes, K., Loughhead, M., et al.[2022]

In a study involving 418 adults with suicidal ideation, the internet-based cognitive behavioral therapy (CBT) intervention 'Living with Deadly Thoughts' showed a lower rate of reliable deterioration (7%) compared to an attention control group (14%), indicating it is a safer option for suicide prevention.

The analysis found that initial severity of suicidal thinking was linked to lower odds of deterioration, while other psychological and demographic factors did not significantly affect deterioration rates, reinforcing the safety of internet-based CBT interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rates and Predictors of Deterioration in a Trial of Internet-Delivered Cognitive Behavioral Therapy for Reducing Suicidal Thoughts. Batterham, PJ., Christensen, H., Calear, AL., et al.[2022]

In a study of 150 homeless youth aged 18-24, those who had experienced intimate partner violence were less likely to attend treatment sessions when assigned to Cognitive Therapy for Suicide Prevention plus treatment as usual (CTSP+TAU).

Conversely, youth with higher scores for acquired capability for suicide and those identifying as Black were more likely to engage in treatment, highlighting the importance of considering trauma history and demographic factors in treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of Treatment Engagement Among Suicidal Youth Experiencing Homelessness. Walsh, L., Luthy, E., Feng, X., et al.[2022]

In a study of 150 homeless youth over 9 months, three distinct trajectories of suicidal ideation were identified: Fast Declining (74.7%), Chronic (19.3%), and Steadily Declining (6.0%), highlighting the varied responses to intervention.

Youth in the Chronic group, who had higher substance use and a greater risk for future suicide, attended more therapy sessions, suggesting that tailored interventions may be necessary to address the unique needs of different subgroups within this high-risk population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Heterogeneous trajectories of suicidal ideation among homeless youth: predictors and suicide-related outcomes. Wu, Q., Zhang, J., Walsh, L., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Social Problem-Solving and Suicidal Ideation Among Homeless Youth Receiving a Cognitive Therapy Intervention: A Moderated Mediation Analysis. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Cognitive therapy for the suicidal patient: a case study. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Illicit Drug Use, Cognitive Distortions, and Suicidal Ideation Among Homeless Youth: Results From a Randomized Controlled Trial. [2023]

8. England pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Rates and Predictors of Deterioration in a Trial of Internet-Delivered Cognitive Behavioral Therapy for Reducing Suicidal Thoughts. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Predictors of Treatment Engagement Among Suicidal Youth Experiencing Homelessness. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Heterogeneous trajectories of suicidal ideation among homeless youth: predictors and suicide-related outcomes. [2023]