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Empirically Promising Psychosocial Treatments

Recent, systematic reviews of the literature on the treatment of youth suicidal behaviour suggest that due to methodological limitations, no one treatment approach can be said to be “well-established.” 56 57 At the same time, some therapeutic approaches appear to be more promising than others.

For example, a recent Canadian review 58 systematically examined the evidence on treatments for suicidal children and adolescents and found that:

Dialectical behavior therapy (DBT) is helpful when available…and fluoxetine combined with cognitive behavior therapy (CBT) has been helpful for suicidal ideation as well as depressed mood… Interpersonal therapy (IPT) is useful for depressed adolescents but has not yet been shown to benefit suicidal ideation or behaviour. There is a small amount of evidence that family therapy is beneficial in reducing suicidal ideation in teenagers without major depressive illness (p. 40S).

In another review 59 , both developmental group psychotherapy and family communication and problem-solving, while limited, did lead to statistically significant differences between treatment and comparison groups. Other promising psychosocial approaches that led to observed reductions in suicide attempts or deliberate self-harm (even though they were not statistically significant) were characterized by the following features:

  • Short-term interventions in outpatient settings
  • Involved family members in treatment
  • Involved some form of cognitive behavioural therapy (CBT)

According to this reviewer eight tentative statements (based on promising, not efficacious research), with implications for reducing suicide attempts and indirect markers of suicidality (i.e. threats, ideation) among youth can be made:60

  1. Developmental group psychotherapy (which included elements of problem-solving, cognitive behavioural therapy, dialectical behavioural therapy, and psycho dynamic group psychotherapy) was superior to the comparison group in reducing self-harm.
  2. Family communication and problem-solving were more likely to reduce suicide ideation than were the comparison conditions, but only among those without major depression.
  3. Family interventions (i.e. brief 5-session intervention) did not reduce suicidality among youth with major depression.
  4. Short-term, outpatient treatments were effective in reducing suicide attempts or deliberate self-harm among suicide attempters.
  5. Outpatient treatment was an effective alternative to hospitalization in two studies.
  6. CBT and problem solving were included in many of the interventions that reduced the direct and indirect markers of suicidality.
  7. Dialectical behavioural therapy (DBT) was helpful in reducing a number of indirect markers of suicidality among youth who were diagnosed with borderline personality disorder.
  8. Short-term interventions that involved families increased youth’s compliance with treatment recommendations.

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