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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial seeks an effective therapy to assist homeless youth dealing with suicidal thoughts, substance use, and depression. It compares a combination of Cognitive Therapy for Suicide Prevention (a type of talk therapy) with regular community services against community services alone. The goal is to determine if adding this therapy more effectively reduces suicidal thoughts. Youth who are homeless, have recently used alcohol or drugs, and have attempted suicide in the past year might be suitable candidates for this trial. As an unphased trial, this study provides a unique opportunity for participants to contribute to groundbreaking research that could enhance support for vulnerable youth.

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 prior data suggests that Cognitive Therapy for Suicide Prevention is safe for homeless youth?

Research has shown that Cognitive Therapy for Suicide Prevention (CTSP) is generally manageable for participants. In studies with homeless youth, CTSP greatly reduced suicidal thoughts and feelings of hopelessness. These studies did not report any serious negative effects from the therapy.

CTSP involves talk therapy sessions, which are safe as they do not involve medication. Participants in earlier trials found the therapy helpful and supportive. Overall, CTSP appears to be a safe option for those seeking to reduce suicidal thoughts. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Cognitive Therapy for Suicide Prevention (CTSP) because it offers a tailored approach specifically designed to address suicidal thoughts and behaviors in homeless youth, a group with unique challenges. Unlike standard care options that might focus broadly on mental health through general counseling or medication, CTSP provides targeted therapy sessions aimed at understanding and altering the thoughts and behaviors that contribute to suicidal feelings. Additionally, the integration of booster sessions allows for ongoing support and reinforces the skills learned, potentially leading to more sustainable positive outcomes. This targeted and continuous approach could make a significant difference in preventing suicide in this vulnerable population.

What evidence suggests that Cognitive Therapy for Suicide Prevention might be an effective treatment for suicidal ideation in homeless youth?

Research has shown that Cognitive Therapy for Suicide Prevention (CTSP), which participants in this trial may receive, can greatly reduce suicidal thoughts in homeless youth. Studies have found that CTSP lowers both suicidal thoughts and feelings of hopelessness. Specifically, one study found that CTSP effectively reduced suicidal thoughts among homeless youth, who are often at high risk. The therapy includes structured sessions that aim to change negative thinking patterns and addresses related issues like substance use and depression. This makes CTSP a promising option for tackling the challenges faced by homeless youth. ^{2 3 4 6 7}

Who Is on the Research Team?

Natasha Slesnick, Ph.D.

Principal Investigator

Ohio State University

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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 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]

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]

Citations

1. researchgate.net researchgate.net/publication/337616180_Cognitive_Therapy_for_Suicide_Prevention_A_Randomized_Pilot_with_Suicidal_Youth_Experiencing_Homelessness

(PDF) Cognitive Therapy for Suicide Prevention Homeless youth have extremely high rates of suicidal ideation and attempts, but limited research has evaluated the efficacy of suicide ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9582044/

Heterogeneous Trajectories of Suicidal Ideation among ... Cognitive therapy for suicide prevention: A randomized pilot with suicidal youth experiencing homelessness. Cognitive Therapy and Research, 44, 402–411.

3. trialsjournal.biomedcentral.com trialsjournal.biomedcentral.com/articles/10.1186/s13063-024-07997-y

Suicide prevention for substance using youth experiencing ... Through this study, we will test our strategy for significantly reducing suicidal ideation (primary outcome), substance use, and depressive ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8416804/

Predictors of Treatment Engagement among Suicidal ... Data from a larger randomized clinical trial testing Cognitive Therapy for Suicide Prevention among homeless youth were used (Slesnick et al., 2019). As youth ...

5. withpower.com withpower.com/trial/phase-suicide-8-2023-27611

Cognitive Therapy for Suicide Prevention in Homeless Youth Cognitive-Behavioral Therapy (CBT) significantly reduced suicidal ideation and hopelessness in depressed adolescents aged 12 to 18 who had attempted suicide, ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12482997/

Qualitative experiences with a suicide prevention intervention This study presents the adaptation of Cognitive Therapy for Suicide Prevention (CTSP) within a supportive housing randomized trial for YEH (18 ...

7. reporter.nih.gov reporter.nih.gov/search/p5tH503IrkK7faoHaNh3Iw/project-details/8880370

Suicide Prevention Among Substance Abusing Homeless ... Safety Planning and Cognitive Behavioral Therapy for Adolescent Suicide Prevention in Mozambique: A Hybrid Effectiveness/Implementation Cluster Randomized Trial.