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Stratified Care Intervention for Suicidal Ideation, Depression, and Non-Suicidal Self-Injury in Adolescents (Reframe-IT+ & CARIBOU)

2026년 8월 18일 업데이트: Jorge Gaete, Universidad de los Andes, Chile

Acceptability, Feasibility, Fidelity, and Exploration of the Efficacy of a Stratified Care Intervention for the Prevention of Suicidal Ideation, Depression, and Non-Suicidal Self-Injury: Reframe-IT+ & CARIBOU

The aim of this study is to evaluate the acceptability, feasibility, and fidelity of implementing a stratified care intervention for adolescents with suicidal ideation and depressive symptoms, and to preliminarily explore its effectiveness in reducing suicidal ideation and depression in educational institutions with high socioeconomic vulnerability in the Metropolitan Region.

Specific Objectives

  1. To determine the feasibility of implementing a stratified care plan tailored to the needs of adolescents with suicidal ideation.
  2. To determine the fidelity of the implementation of Reframe-IT+ and CARIBOU-CBT, with the addition of the initial CARIBOU-SITB component, among participating facilitators following the intervention.
  3. To determine the acceptability of the initial CARIBOU-SITB component among participating students and facilitators, as measured after the intervention.
  4. To explore the efficacy of Reframe-IT+ and CARIBOU-CBT, with the addition of the initial CARIBOU-SITB component, in reducing suicidal ideation, depressive symptoms, anxiety, hopelessness, and non-suicidal self-injury (NSSI) immediately following the intervention, and at 3, 6, 9, and 12 months post-intervention.
  5. To explore the efficacy of Reframe-IT+ and CARIBOU-CBT, with the addition of the initial CARIBOU-SITB component, in improving general functioning, quality of life, cognitive-behavioral skills related to behavioral activation, emotional regulation, and problem-solving immediately after the intervention, and at 3, 6, 9, and 12 months post-intervention.

Participants will:

  1. Complete a battery of self-report questionnaires before the intervention, immediately after, and at 3, 6, 9, and 12 months of follow-up.
  2. Receive CARIBOU-SITB, a four-session intervention focused on safety planning and reducing the risk of self-harm.
  3. Then receive either Reframe-IT+ (13 sessions) or CARIBOU-CBT (16 sessions), individual cognitive-behavioral interventions delivered at their school by a trained psychologist, depending on the severity of their depressive symptoms.

Hypotheses or research assumptions

This study proposes the following hypotheses regarding the feasibility of the study using Reframe-IT+ and CARIBOU-CBT with the addition of the initial CARIBOU-SITB component (H1), the fidelity of the intervention (H2), the acceptability of the initial CARIBOU-SITB component (H3)and the expected effects of the intervention (H4 and H5):

H1: We will be able to recruit 21 educational institutions, screen 70% of the students who consent to participate in this project, and ensure the participation of 100 students, all of whom will be offered CARIBOU-SITB and then, based on depressive symptoms, will be assigned to Reframe-IT+ (47 students) or CARIBOU-CBT (53 students).

H2: Facilitators of the Reframe-IT+ and CARIBOU-CBT programs, incorporating the initial CARIBOU-SITB component, will demonstrate 80% adherence to the manual-as a measure of fidelity-based on self-reports regarding the implementation of each session.

H3: After adapting the material for the initial CARIBOU-SITB component to Chilean culture, a high level of acceptability (over 70% positive ratings) is expected from participating students and facilitators following the intervention.

H4: Reframe-IT+ and CARIBOU-CBT, with the addition of the initial CARIBOU-SITB component, will reduce suicidal ideation, depressive and anxiety symptoms, hopelessness, and non-suicidal self-injury (NSSI) among participating students at the end of the intervention and at 3, 6, 9, and 12 months post-intervention.

H5: Reframe-IT+ and CARIBOU-CBT, with the addition of the initial CARIBOU-SITB component, will improve overall functioning, quality of life, cognitive-behavioral skills, behavioral activation, emotional regulation, and problem-solving skills in participating students at the end of the intervention and at 3, 6, 9, and 12 months post-intervention.

연구 개요

상태

모집하지 않고 적극적으로

정황

개입 / 치료

상세 설명

This is a quasi-experimental study without a control group, using a pre-post design with follow-up assessments at 3, 6, 9, and 12 months post-intervention. The study targets 10th, 11th, and 12th-grade students attending secondary schools with high socioeconomic vulnerability (≥50% on the School Vulnerability Index, IVE-SINAE) in the Metropolitan Region of Chile.

The intervention comprises two sequential components. First, all eligible students with suicidal ideation (C-SSRS score ≥3) receive CARIBOU-SITB, a four-session individual intervention based on dialectical behavior therapy and motivational interviewing, focused on safety planning and reducing the risk of self-harm. Following this component, students are stratified according to their depressive symptom severity on the PHQ-9: those with mild or moderate symptoms (PHQ-9 <20) are offered Reframe-IT+, a 13-session individual cognitive-behavioral intervention combining in-person and digital delivery; those with severe symptoms (PHQ-9 ≥20) are offered CARIBOU-CBT, a 16-session individual cognitive-behavioral intervention. Both programs are delivered at the schools by trained psychologists and target behavioral activation, cognitive restructuring, emotional regulation, and problem-solving skills, with CARIBOU-CBT additionally addressing communication skills.

The study is conducted in two phases. A preparatory phase includes translation and cultural adaptation of the CARIBOU-SITB manual, preparation of intervention and assessment materials, facilitator training, and development of protocols for managing critical risk situations. An implementation phase follows, encompassing school recruitment, parental informed consent, student screening and informed consent/assent, invitation interviews to confirm eligibility, program delivery, and post-intervention and follow-up assessments.

Primary outcomes includes the feasibility of implementing the stratified care plan (recruitment, attendance, response, and retention rates), the fidelity of implementation by facilitators (self-reported adherence to session protocols), and the acceptability of the CARIBOU-SITB component (assessed via acceptability questionnaires and the Client Satisfaction Questionnaire, CSQ-8). Secondary outcomes explore the preliminary efficacy of the interventions in reducing suicidal ideation (C-SSRS, SIQ-JR), non-suicidal self-injury, depressive symptoms (PHQ-9), anxiety (GAD-7), and hopelessness (BHS), as well as their efficacy in improving general functioning, quality of life, and cognitive-behavioral skills related to behavioral activation, emotional regulation, and problem-solving, assessed immediately post-intervention and at 3, 6, 9, and 12 months.

연구 유형

중재적

등록 (실제)

90

단계

  • 해당 없음

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 장소

  • 칠레
      • Santiago, 칠레
        • Universidad De Los Andes

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

  • 어린이
  • 성인

건강한 자원 봉사자를 받아들입니다

아니

설명

Inclusion Criteria:

  1. Schools

    • Located in Santiago, Chile
    • Secondary school (1st through 4th year of secondary school)
    • At least two classes per grade level
    • At least 30 students per class
    • High vulnerability index (≥50%) as measured by the School Vulnerability Index - National Allocation System for Equality (IVE-SINAE)

  2. Students

    • Students in grades 9, 10, and 11
    • Suicidal ideation reported in the past month, defined as a score ≥3 on the Columbia Suicide Severity Rating Scale (C-SSRS)
    • For the Reframe-IT+ Program: mild or moderate depressive symptoms, defined as a score <20 on the PHQ-9
    • For the CARIBOU-CBT Program: severe depressive symptoms, defined as a score ≥20 on the PHQ-9

Exclusion Criteria:

  • Participation in a manualized suicide prevention program (Reframe-IT+/CARIBOU) in 2025
  • Severe psychotic symptoms, defined as clear perceptual disturbances and delusions identified during the invitation interview
  • Suicide attempt(s) in the past 3 months, or active suicidal ideation requiring hospitalization, as determined during the screening interview
  • History of a prior medical diagnosis of Bipolar Disorder I or II
  • History of a prior medical diagnosis of a Severe Eating Disorder (e.g., Anorexia Nervosa or Bulimia)
  • Severe substance use disorder, meeting any of the following patterns: daily cannabis use throughout the day; excessive alcohol or benzodiazepine use ≥3 times per week; cocaine or opioid use several days per month or more, as determined during the screening interview
  • Intellectual disability
  • Inability to speak, read, or write in Spanish

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 방지
  • 할당: 해당 없음
  • 중재 모델: 순차적 할당
  • 마스킹: 없음(오픈 라벨)

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Reframe-IT+ and CARIBOU

All participants first will receive the CARIBOU-SITB component. Then students with severe depressive symptoms (PHQ-9 score ≥ 20) will receive CARIBOU-CBT: a cognitive-behavioral therapy intervention.

Students with mild or moderate depressive symptoms (PHQ-9 score < 20) will receive Reframe-IT+: a cognitive-behavioral therapy intervention. All interventions will be delivered individually at the educational institution by a trained psychologist.
행동: Reframe-IT and CARIBOU
All participants first will receive the CARIBOU-SITB component (4 weekly sessions, 45 minutes each). Then students with severe depressive symptoms (PHQ-9 score ≥ 20) will receive CARIBOU-CBT: a cognitive-behavioral therapy intervention consisting of 16 weekly sessions of 45 minutes each, targeting behavioral activation, cognitive restructuring, problem-solving, and communication skills. Students with mild or moderate depressive symptoms (PHQ-9 score < 20) will receive Reframe-IT+: a cognitive-behavioral therapy intervention consisting of 13 weekly sessions of 45 minutes each (5 in-person and 8 combining in-person and digital delivery), targeting behavioral activation, cognitive restructuring, emotional regulation, stress tolerance, and problem-solving. All interventions will be delivered individually at the educational institution by a trained psychologist.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Feasibility of Implementing the Stratified Care Plan
기간: Throughout the implementation phase (approximately 5 months)
Feasibility will be assessed through recruitment and sample characteristics, attendance at invitation interviews, questionnaire response rates, participant attendance and progress in sessions, and retention/dropout rates, reported as percentages with 95% confidence intervals.
Throughout the implementation phase (approximately 5 months)
Fidelity of Implementation of Reframe-IT+ and CARIBOU-CBT
기간: After each session, throughout the implementation phase (approximately 5 months)
Fidelity will be assessed via facilitator self-report session-monitoring questionnaires completed after each session with each participating student, measuring adherence to the intervention manuals. Adequate fidelity is defined as ≥80% adherence.
After each session, throughout the implementation phase (approximately 5 months)
Acceptability of the CARIBOU-SITB Component - CSQ-8
기간: Immediately after completion of the CARIBOU-SITB component (approximately 4 weeks)
Acceptability will be assessed among using the Client Satisfaction Questionnaire (CSQ-8), an 8-item instrument measuring overall satisfaction with the intervention received (score range 8-32). A high level of acceptability is defined over 70% of participant with score ≥ 24
Immediately after completion of the CARIBOU-SITB component (approximately 4 weeks)
Acceptability of the CARIBOU-SITB Component - Students
기간: Immediately after completion of the CARIBOU-SITB component (approximately 4 weeks)
Acceptability will be assessed among students using in-house general and module-specific acceptability questionnaires.
Immediately after completion of the CARIBOU-SITB component (approximately 4 weeks)
Acceptability of the CARIBOU-SITB Component - Facilitators
기간: Immediately after completion of the CARIBOU-SITB component (approximately 4 weeks)
Acceptability will be assessed among facilitators using in-house general and module-specific acceptability questionnaires.
Immediately after completion of the CARIBOU-SITB component (approximately 4 weeks)

2차 결과 측정

결과 측정
측정값 설명
기간
Change in Suicidal Ideation Severity
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Columbia Suicide Severity Rating Scale (C-SSRS), a 6-item self-report instrument assessing the severity of suicidal ideation and behavior (score range 0-6).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Frequency of Suicidal Ideation
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Suicidal Ideation Questionnaire-Junior (SIQ-JR), a 15-item self-report instrument (score range 0-90).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Non-Suicidal Self-Injury (NSSI)
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using a self-report assessment of non-suicidal self-injurious behavior frequency and severity.
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Depressive Symptoms
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Patient Health Questionnaire (PHQ-9), a 9-item self-report instrument (score range 0-27).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Anxiety Symptoms
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Generalized Anxiety Disorder scale (GAD-7), a 7-item self-report instrument (score range 0-21).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Hopelessness
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Beck Hopelessness Scale (BHS), a 20-item self-report instrument (score range 0-20).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Psychotic Symptoms
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Community Assessment of Psychic Experiences-Positive (CAPE-P15), a 15-item self-report instrument (score range 15-60).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Mood Intensity
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Mood and Feelings Questionnaire-Short Form (MFQ), a 13-item self-report instrument (score range 0-26).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in General Functional Impairment
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Columbia Impairment Scale (CIS), Youth Version, a 13-item self-report instrument assessing functional impairment.
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Behavioral Activation Skills
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Behavioral Activation for Depression Scale (BADS).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Problem-Solving Skills
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Social Problem-Solving Inventory-Revised (SPSI-R).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Emotional Regulation Skills
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA).
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Change in Quality of Life
기간: Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.
Measured using the KIDSCREEN instrument, assessing health-related quality of life.
Baseline, Immediately after completion of the intervention (approximately 20 weeks), and 3, 6, 9, and 12 months after completion of the intervention.

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

Universidad de los Andes, Chile

협력자

Fundación Crecer y Sanar

수사관

  • 수석 연구원: Jorge Gaete, PhD, Centro de Investigación de Salud Mental Estudiantil (ISME)

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (실제)

2026년 6월 9일

기본 완료 (추정된)

2027년 11월 30일

연구 완료 (추정된)

2027년 12월 31일

연구 등록 날짜

최초 제출

2026년 8월 5일

QC 기준을 충족하는 최초 제출

2026년 8월 18일

처음 게시됨 (실제)

2026년 8월 21일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2026년 8월 21일

QC 기준을 충족하는 마지막 업데이트 제출

2026년 8월 18일

마지막으로 확인됨

2026년 8월 1일

추가 정보

이 연구와 관련된 용어

키워드

추가 관련 MeSH 약관

기타 연구 ID 번호

  • FCS2026

개별 참가자 데이터(IPD) 계획

개별 참가자 데이터(IPD)를 공유할 계획입니까?

예

IPD 계획 설명

The datasets used and/or analysed during the current study will be available from the corresponding author on reasonable request.

IPD 공유 기간

It is planned to submit the study protocol to a journal around September 2026

IPD 공유 액세스 기준

It is planned to submit the study protocol a journal around September 2026

IPD 공유 지원 정보 유형

  • 연구_프로토콜
  • 수액

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

아니

미국 FDA 규제 기기 제품 연구

아니

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

구독하다