Centre for Youth Mental Health - Research Publications
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ItemNo Preview AvailableInternet-based cognitive behavioural therapy for young people with suicide-related behaviour (Reframe-IT): a randomised controlled trial(BMJ PUBLISHING GROUP, 2017-08)BACKGROUND: Suicide-related behaviours are common in young people and associated with a range of negative outcomes. There are few evidence-based interventions; however, cognitive behavioural therapy (CBT) shows promise. Internet delivery of CBT is popular, with potential to increase reach and accessibility. OBJECTIVE: To test the effectiveness of an internet-based CBT program (Reframe-IT) in reducing suicide-related behaviours, depression, anxiety, hopelessness and improving problem solving and cognitive and behavioural skills in school students with suicide-related behaviours. METHODS: A parallel randomised controlled trial testing the effectiveness of Reframe-IT plus treatment as usual (TAU) compared with TAU alone in reducing suicidal ideation, suicide attempts, depression, hopelessness, symptoms of anxiety, negative problem orientation and cognitive and behavioural skill acquisition was undertaken. We recruited students experiencing suicidal ideation from 18 schools in Melbourne, Australia, between August 2013 and December 2016. The intervention comprised eight modules of CBT delivered online over 10 weeks with assessments conducted at baseline, 10 weeks and 22 weeks. FINDINGS: Only 50 of the planned 169 participants were recruited. There were larger improvements in the Reframe-IT group compared with the TAU group for the primary outcome of suicidal ideation (intervention -61.6, SD 41.6; control -47.1, SD 42.3, from baseline to 22-week follow-up intervention); however, differences were non-significant (p=0.593). There were no increases in distress in the majority of participants (91.1%) after completion of each module. Changes in depression and hopelessness partly mediated the effect of acquisition of CBT skills on suicidal ideation. CONCLUSIONS: The trial was underpowered due to difficulties recruiting participants as a result of the complex recruitment procedures that were used to ensure safety of participants. Although there were no significant differences between groups, young people were safely and generally well engaged in Reframe-IT and experienced decreases in suicidal ideation and other symptoms as well as improvements in CBT skills. The study is the first online intervention trial internationally to include young people demonstrating all levels of suicide risk. CLINICAL IMPLICATIONS: Integration of internet-delivered interventions for young people with suicide-related behaviour may result in reductions in these behaviours. Further research is needed, but researchers should feel more confident about being able to safely undertake research with young people who experience these behaviours. TRIAL REGISTRATION NUMBER: ACTRN12613000864729.
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ItemOnline and Social Media Suicide Prevention Interventions for Young People: A Focus on Implementation and Moderation(CANADIAN ACAD CHILD & ADOLESCENT PSYCHIATRY, 2016)OBJECTIVE: Suicide remains a major global public health issue for young people. The reach and accessibility of online and social media-based interventions herald a unique opportunity for suicide prevention. To date, the large body of research into suicide prevention has been undertaken atheoretically. This paper provides a rationale and theoretical framework (based on the interpersonal theory of suicide), and draws on our experiences of developing and testing online and social media-based interventions. METHOD: The implementation of three distinct online and social media-based intervention studies, undertaken with young people at risk of suicide, are discussed. We highlight the ways that these interventions can serve to bolster social connectedness in young people, and outline key aspects of intervention implementation and moderation. RESULTS: Insights regarding the implementation of these studies include careful protocol development mindful of risk and ethical issues, establishment of suitably qualified teams to oversee development and delivery of the intervention, and utilisation of key aspects of human support (i.e., moderation) to encourage longer-term intervention engagement. CONCLUSIONS: Online and social media-based interventions provide an opportunity to enhance feelings of connectedness in young people, a key component of the interpersonal theory of suicide. Our experience has shown that such interventions can be feasibly and safely conducted with young people at risk of suicide. Further studies, with controlled designs, are required to demonstrate intervention efficacy.
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ItemThe safety and acceptability of delivering an online intervention to secondary students at risk of suicide: findings from a pilot study(WILEY, 2015-12)BACKGROUND: Suicide-related behaviour is a major problem among adolescents. Yet relatively few studies have tested the efficacy, acceptability and safety of interventions for this population. We developed and pilot tested an online intervention for at-risk school students, which has led to reduced suicidal ideation, hopelessness and depressive symptoms. The aims of this study were to examine the safety and acceptability of the programme, and to determine which components were found to be most helpful and enjoyable. METHODS: This pilot study employed a pre-test/post-test design, with an 8-week intervention phase. Participants were assessed immediately before, and immediately after the intervention. Participants were also asked to complete a weekly questionnaire immediately after the intervention, and again 2 days later assessing suicidal ideation and distress. RESULTS: Twenty-one young people completed the intervention. Overall, the intervention did not lead to increases in suicidal ideation or distress. Participants reported enjoying the programme, in particular watching the video diaries and completing the activities, and said they would recommend the programme to a friend. Overall, the cognitive components of the programme were found to be most helpful. CONCLUSIONS: Overall, the programme appeared to be a safe and acceptable intervention for at-risk adolescents. This was a small, pilot study so we need to interpret the results with caution. However, the findings are promising and suggest that young people at risk of suicide can safely be included in trials as long as adequate safety procedures are in place. The programme is now being tested in a randomized controlled trial.
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ItemCan an Internet-based intervention reduce suicidal ideation, depression and hopelessness among secondary school students: results from a pilot study(WILEY, 2016-02)AIM: Little evidence exists regarding the efficacy of suicide prevention programmes among the youth. This pilot study aimed to test the effects of a specifically designed, eight-module Internet-based programme on suicidal ideation among secondary school students. METHODS: The study employed a pre-test/post-test design. Outcomes of interest were suicidal ideation, depression and hopelessness. Participants were recruited via the school well-being team, were assessed at baseline and immediately post-intervention. The intervention was delivered weekly at the young persons' school. RESULTS: Twenty-one students completed all eight modules and a post-intervention assessment, and constitute the observed case sample used for the analysis. Overall levels of suicidal ideation, depressive symptoms and hopelessness decreased significantly over the course of the study. CONCLUSIONS: This was a small pilot study with no control group. However, significant reductions were seen in suicidal ideation, depressive symptoms and hopelessness, indicating that Internet-based interventions may hold promise when it comes to reducing suicide risk among youth. Further investigation is warranted.
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ItemHetrick SH, Yuen HP, Cox G, Bendall A, Pirkis J, Robinson J. (2014) Does cognitive behavioural therapy have a role in improving problem solving and coping in adolescents with suicidal ideation? . 7:e13(Cambridge Journals, 2014)Abstract Problem-solving and coping skills deficits have been shown in adolescents who experience suicide-related behaviours, including suicidal ideation. Little evidence exists about effective interventions for this population. We undertook a pilot study of an Internet-based CBT programme that included problem-solving skills training to investigate its impact on skills deficits. The study employed a pre-test/post-test design. Outcomes of interest were negative problem orientation, emotion- and task-focused coping, and adolescents’ perception of helpfulness of the intervention. Participants, recruited via the school wellbeing team, were assessed at baseline, at weekly intervention sessions and immediately post-intervention. Twenty-one adolescents completed the intervention. Over the course of the intervention, negative problem-solving orientation improved and students relied less on emotion-focused coping strategies. Because there was no control group, we cannot be certain that the changes seen between baseline and post-intervention can be attributed to the intervention. Adolescents rated the problem-solving and cognitive restructuring modules as particularly helpful. Interventions that include enhancement of problem-solving skills, as well as cognitive restructuring to address adolescents’ appraisal of problems and their ability to solve them appear promising for adolescents with suicidal ideation. Further investigation is warranted.
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ItemThe development of a randomised controlled trial testing the effects of an online intervention among school students at risk of suicide(BMC, 2014-05-27)BACKGROUND: Suicide-related behaviour among young people is of significant concern, yet little is known regarding the effectiveness of interventions designed to reduce risk among this population. Of those interventions that have been tested, cognitive-behavioural therapy appears to show some promise among young people with suicidal ideation. Internet-based interventions are becoming increasingly popular and have shown some effect in preventing and treating depression and anxiety in young people. However, to date there are no randomised controlled trials examining the impact of Internet-based Cognitive Behavioural Therapy among suicidal youth. METHODS/DESIGN: This is a randomised controlled trial testing the effects of Internet-based cognitive-behavioural therapy among suicidal high school students who have sought help from the school wellbeing team. The intervention comprises 8 modules of Cognitive Behavioural Therapy delivered online. The study has a staggered, two-year recruitment phase and participants are assessed at baseline, post intervention and 12 weeks later. DISCUSSION: If effective the program has the ability to be readily adapted and delivered to a range of populations in a range of settings, at relatively little cost. It can also be adapted for mobile applications. TRIAL REGISTRATION: ACTRN12613000864729. Date registered: 05/08/2013.