Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
J Am Acad Child Adolesc Psychiatry. 2010 Feb;49(2):122-31. doi: 10.1097/00004583-201002000-00006.
To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents.
This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms.
Using intent to treat, patients in ABFT demonstrated significantly greater rates of change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size (ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6-99.6) than patients in EUC (51.7%; 95% CI = 32.4-54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI = 52.6-87.4; EUC 34.6%; 95% CI = 15.6-54.2; odds ratio = 4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus 2.9).
ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study).Clinical Trial Registry Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097.
评估依附家庭治疗（ABFT）是否比增强常规护理（EUC）更能有效减少青少年的自杀意念和抑郁症状。
这是一项针对在初级保健和急诊部门中筛选出的 12 至 17 岁自杀青少年的随机对照试验。在 341 名接受筛查的青少年中，有 66 名（70%为非裔美国人）进入了为期 3 个月的治疗研究。评估在基线、6 周、12 周和 24 周进行。ABFT 包括个体和家庭会议，而 EUC 包括促进转介给其他提供者。所有参与者都接受每周监测和 24 小时危机热线的帮助。测量自杀意念和抑郁症状的变化轨迹和临床康复情况。
采用意向治疗，ABFT 组患者在治疗后评估的自我报告自杀意念变化率显著更高，且在随访中仍保持获益，具有很强的总体效果量（ES = 0.97）。在临床医生评估方面，两组之间的差异相似。在治疗后，ABFT 组达到临床康复标准的自杀意念患者比例显著高于 EUC 组（87%；95%置信区间[CI] = 74.6-99.6）（51.7%；95% CI = 32.4-54.32）。在随访中仍保持获益（ABFT，70%；95% CI = 52.6-87.4；EUC，34.6%；95% CI = 15.6-54.2；比值比= 4.41）。随着时间的推移，抑郁症状的模式相似，在有诊断为抑郁症的青少年亚组中也是如此。ABFT 的保留率高于 EUC（平均= 9.7 比 2.9）。
ABFT 在减少青少年自杀意念和抑郁症状方面比 EUC 更有效。需要进一步的研究来确认治疗效果，并测试拟议的变化机制（家庭安全网研究）。
初级保健中的预防青少年自杀：家庭模式，网址：http://www.clinicaltrials.gov，唯一标识符：NCT00604097。
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