Building Resilience and Attachment in Vulnerable Adolescents (BRAVA)

Brief Group Intervention for Adolescents With Mild to Moderate Suicidal Ideation and Their Caregivers: Preliminary Investigation for a Novel Treatment Approach

Suicide is the second leading cause of mortality for Canadian adolescents. Mental health complaints are one of the leading reasons for an emergency department visit at the Children's Hospital of Eastern Ontario and 60% of adolescents report suicidal ideation. The goal of the present investigation is to test the efficacy of a brief group intervention for adolescents with passive suicidal ideation and their caregivers that will focus on coping, familial support, and emotional regulation. The investigators hypothesize that a brief group intervention, delivered in the weeks following presentation for crisis services, will reduce suicidal ideation and improve coping and familial support.

Study Overview

• Status: Completed
• Conditions: Suicidal Ideation
• Intervention / Treatment: Behavioral: Group Intervention

• Study Type: Interventional
• Enrollment (Actual): 76
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada, K1H8L1
      • Children's Hospital of Eastern Ontario

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Mild to moderate suicidal ideation
• Recently presented for services in response to a psycho-social crisis (Emergency Department, MH Urgent Care)
• One or two caregiver(s) committed to attending the majority of sessions

Exclusion Criteria:

• Presence of a suicidal plan and/or recent gesture/attempt
• Psychosis
• Schizophrenia
• Dual diagnosis
• Developmental disability or delay
• "Behavioural problem" as primary concern
• Major substance abuse
• Currently receiving mental health services (once every two weeks or more frequently)
• Inability to commit to majority of sessions (minimum 4 of 6 sessions)
• Children's aid society involvement
• Inability of at least one caregiver to commit to attending the majority of sessions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Group Intervention; The intervention will consist of 6 psycho-educational group sessions for caregivers and 6 psycho-educational group sessions for adolescents. Adolescent and caregiver sessions will be held separately and will focus on different issues. For adolescents, the group sessions will focus on coping strategies and emotional regulation. For caregivers, the group sessions will be focused on attachment, family environment, and validation.

Behavioral: Group Intervention; The intervention will consist of 6 psycho-educational group sessions for caregivers and 6 psycho-educational group sessions for adolescents. Adolescent and caregiver sessions will be held separately and will focus on different issues. For adolescents, the group sessions will focus on coping strategies and emotional regulation. For caregivers, the group sessions will be focused on attachment, family environment, and validation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Suicidal Ideation	Suicidal ideation will be measured using the Suicidal Ideation Questionnaire Junior (SIQ-JR; Reynolds, 1988). Repeated Measures ANOVA or ANCOVA will be used to compare differences in suicidal ideation within groups (pre-post changes). Further comparisons using clinical cut-off will be conducted via McNemar test for matched pairs.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Familial Support	Familial support will be measured using questionnaires for both caregivers and youth. Youth will respond to the Family Environment Scale (Koren, DeChillo, & Friesen, 1992) and the Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987). Caregivers will respond to the Family Environment Scale and and Relationship Scale Questionnaire (Griffine & Gartholomew, 1994). Repeated Measures ANOVA or ANCOVA will be used to compare differences within groups (pre-post changes).	6 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Coping Strategies	Youth coping strategies will be measured using the Youth Stress and Coping Questionnaire (Cloutier et al., 2008). Repeated Measures ANOVA or ANCOVA will be used to compare differences within groups (pre-post changes).	6 weeks
Depression	Youth depression will be measured using the Children's Depression Inventory-2 Self report (CDI-2; Kovaks, 2010). Repeated Measures ANOVA or ANCOVA will be used to compare differences within groups (pre-post changes).	6 weeks
Anxiety	Youth anxiety symptoms will be measured using the Multidimensional Anxiety Scale for Children (MASC-2; March, 1997). Repeated Measures ANOVA or ANCOVA will be used to compare differences within groups (pre-post changes).	6 weeks

Collaborators and Investigators

• Sponsor: Allison Kennedy
• Collaborators: AFP Innovation Fund; Mach Gaensslen Foundation
• Investigators: Principal Investigator: Allison Kennedy, Ph.D., Children's Hospital of Eastern Ontario

Publications and helpful links

General Publications

• Rathus JH, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life Threat Behav. 2002 Summer;32(2):146-57. doi: 10.1521/suli.32.2.146.24399.
• Diamond GS, Wintersteen MB, Brown GK, Diamond GM, Gallop R, Shelef K, Levy S. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2010 Feb;49(2):122-31. doi: 10.1097/00004583-201002000-00006.
• Armsden GC, Greenberg MT. The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc. 1987 Oct;16(5):427-54. doi: 10.1007/BF02202939.
• Cloutier, P. F., Kennedy, A., & Glennie, E. (2008, June). Coping behaviors and intensity of non-suicidal self-harm in Canadian adolescents presenting to emergency mental health services. Poster presented at the third annual meeting of the International Society for the Study of Self-Injury (ISSS), Harvard University, Cambridge, MA.
• Kovacs, M. (2010). Children's Depression Inventory Manual. Toronto, ON: Multi-Health Systems Inc.
• March, J.S. (2013). Manual for the Multidimensional Anxiety Scale for Children - 2nd Edition (MASC-2). Toronto, ON: MHS Inc.
• Moos, R. H., & Moos, B. S. (1981). Family environment scale manual
• Reynolds, W. M. (1988). Suicidal Ideation Questionnaire Professional Manual (p. 47).
• Griffine, D. W., & Garthholomew, K. (1994). The metaphysics of measurement: The case of adult attachment. (pp. 17-52).

Study record dates

Study Major Dates

• Study Start: February 1, 2014
• Primary Completion (Actual): May 1, 2017
• Study Completion (Actual): May 1, 2017

Study Registration Dates

• First Submitted: August 14, 2013
• First Submitted That Met QC Criteria: August 16, 2013
• First Posted (Estimate): August 20, 2013

Study Record Updates

• Last Update Posted (Actual): August 14, 2017
• Last Update Submitted That Met QC Criteria: August 10, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Keywords: Adolescent; Emergency Department; Coping; Suicidal Ideation; Attachment; Crisis
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide; Suicidal Ideation
• Other Study ID Numbers: CHAMO_SI_Group_001