Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD

Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression, including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed adolescents. Sixty adolescents (86.7% girls), aged 13 to 18 years (M = 14.9), with major depressive disorder referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16 weeks. Linear mixed models were fitted to test our hypothesis, time was the only factor to have a significant effect on suicidal ideation t(31.05) = −3.32, p < .01. Participants in both treatment groups reported significantly reduced suicidal ideation, but the majority were still in the clinical range after 16 weeks of treatment. ABFT was not associated with more favorable outcomes than TAU. Findings must be interpreted with caution given the study limitations.

[1]  L. Mehlum,et al.  Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics , 2020, Child and Adolescent Psychiatry and Mental Health.

[2]  Andrew C. Porter,et al.  Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents. , 2019, Journal of child psychology and psychiatry, and allied disciplines.

[3]  B. Larsson,et al.  Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior. , 2019, Journal of child psychology and psychiatry, and allied disciplines.

[4]  M. Pompili.  Critical appraisal of major depression with suicidal ideation , 2019, Annals of General Psychiatry.

[5]  Andrew C. Porter,et al.  Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth , 2019, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[6]  J. Weisz,et al.  Meta-Analysis: 13-Year Follow-Up of Psychotherapy Effects on Youth Depression. , 2019, Journal of the American Academy of Child and Adolescent Psychiatry.

[7]  R. Gallop,et al.  Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial , 2018, JAMA psychiatry.

[8]  Quintin A. Hunt,et al.  Attachment-Based Family Therapy with Suicidal Adolescents: An Overview , 2017 .

[9]  V. R. Weersing,et al.  Evidence Base Update of Psychosocial Treatments for Child and Adolescent Depression , 2017, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[10]  L. Diep,et al.  Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up. , 2016, Journal of the American Academy of Child and Adolescent Psychiatry.

[11]  Sabrina Eberhart,et al.  Applied Missing Data Analysis , 2016 .

[12]  B. Larsson,et al.  Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. , 2014, Journal of the American Academy of Child and Adolescent Psychiatry.

[13]  S. Hollon,et al.  Do depression treatments reduce suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on suicidality. , 2014, Journal of affective disorders.

[14]  Paul Vedder,et al.  Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. , 2014, JAMA pediatrics.

[15]  J. Rosenbaum,et al.  Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review , 2013, Neuropsychiatric disease and treatment.

[16]  Matthew K Nock,et al.  Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. , 2013, JAMA psychiatry.

[17]  G. Andersson,et al.  The effects of psychotherapy for adult depression on suicidality and hopelessness: a systematic review and meta-analysis. , 2013, Journal of affective disorders.

[18]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[19]  R. Gallop,et al.  Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. , 2010, Journal of the American Academy of Child and Adolescent Psychiatry.

[20]  M. Oquendo,et al.  Can novel nosological strategies aid in the identification of risk for suicidal behavior? , 2009, Crisis.

[21]  J. Bridge,et al.  Epidemiology of youth suicide and suicidal behavior , 2009, Current opinion in pediatrics.

[22]  David R. Williams,et al.  Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys , 2009, PLoS medicine.

[23]  J. Olin,et al.  The GRID-HAMD: standardization of the Hamilton Depression Rating Scale , 2008, International clinical psychopharmacology.

[24]  C. Dowrick,et al.  The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study , 2008, Social Psychiatry and Psychiatric Epidemiology.

[25]  Alec L. Miller,et al.  Dialectical behavior therapy adapted for suicidal adolescents. , 1997, Suicide & life-threatening behavior.

[26]  T. Little,et al.  Peer Functioning, Family Dysfunction, and Psychological Symptoms in a Risk Factor Model for Adolescent Inpatients' Suicidal Ideation Severity , 2000, Journal of clinical child psychology.

[27]  N. Ryan,et al.  Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.