认知行为家庭治疗预防自杀未遂：一项随机对照试验。
Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial.
作者信息
Asarnow Joan Rosenbaum, Hughes Jennifer L, Babeva Kalina N, Sugar Catherine A
机构信息
University of California Los Angeles, David Geffen School of Medicine.
Center for Depression Research and Clinical Care (CDRCC), University of Texas Southwestern Medical School, Dallas.
出版信息
J Am Acad Child Adolesc Psychiatry. 2017 Jun;56(6):506-514. doi: 10.1016/j.jaac.2017.03.015. Epub 2017 Apr 5.
OBJECTIVE
Suicide is a leading cause of death. New data indicate alarming increases in suicide death rates, yet no treatments with replicated efficacy or effectiveness exist for youths with self-harm presentations, a high-risk group for both fatal and nonfatal suicide attempts. We addressed this gap by evaluating Safe Alternatives for Teens and Youths (SAFETY), a cognitive-behavioral, dialectical behavior therapy-informed family treatment designed to promote safety.
METHOD
Randomized controlled trial for adolescents (12-18 years of age) with recent (past 3 months) suicide attempts or other self-harm. Youth were randomized either to SAFETY or to treatment as usual enhanced by parent education and support accessing community treatment (E-TAU). Outcomes were evaluated at baseline, 3 months, or end of treatment period, and were followed up through 6 to 12 months. The primary outcome was youth-reported incident suicide attempts through the 3-month follow-up.
RESULTS
Survival analyses indicated a significantly higher probability of survival without a suicide attempt by the 3-month follow-up point among SAFETY youths (cumulative estimated probability of survival without suicide attempt = 1.00, standard error = 0), compared to E-TAU youths (cumulative estimated probability of survival without suicide attempt = 0.67, standard error = 0.14; z = 2.45, p = .02, number needed to treat = 3) and for the overall survival curves (Wilcoxon χ = 5.81, p = .02). Sensitivity analyses using parent report when youth report was unavailable and conservative assumptions regarding missing data yielded similar results for 3-month outcomes.
CONCLUSION
Results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm. This is the second randomized trial to demonstrate that treatment including cognitive-behavioral and family components can provide some protection from suicide attempt risk in these high-risk youths. Clinical trial registration information-Effectiveness of a Family-Based Intervention for Adolescent Suicide Attempters (The SAFETY Study); http://clinicaltrials.gov/; NCT00692302.
目的
自杀是主要的死亡原因。新数据显示自杀死亡率惊人上升，但对于有自伤表现的青少年（这是致命和非致命自杀未遂的高危群体），尚无经重复验证有效或有效果的治疗方法。我们通过评估青少年安全替代方案（SAFETY）来填补这一空白，这是一种认知行为、受辩证行为疗法启发的家庭治疗方法，旨在促进安全。
方法
对近期（过去3个月）有自杀未遂或其他自伤行为的青少年（12 - 18岁）进行随机对照试验。青少年被随机分为接受SAFETY治疗组或通过家长教育和支持获取社区治疗强化的常规治疗组（E - TAU）。在基线、3个月或治疗期结束时评估结果，并随访6至12个月。主要结局是青少年报告的至3个月随访期内的自杀未遂事件。
结果
生存分析表明，与E - TAU组青少年（无自杀未遂的累积生存估计概率 = 0.67，标准误 = 0.14；z = 2.45，p = 0.02，需治疗人数 = 3）相比，SAFETY组青少年在3个月随访点无自杀未遂的生存概率显著更高（无自杀未遂的累积生存估计概率 = 1.00，标准误 = 0），对于总体生存曲线也是如此（Wilcoxon χ = 5.81，p = 0.02）。当青少年报告不可用时使用家长报告进行的敏感性分析以及关于缺失数据的保守假设，得出的3个月结局结果相似。
结论
结果支持SAFETY对预防近期有自伤行为的青少年自杀未遂的疗效。这是第二项随机试验，证明包括认知行为和家庭成分的治疗可以为这些高危青少年提供一定程度的预防自杀未遂风险的保护。临床试验注册信息 - 基于家庭的青少年自杀未遂干预措施的有效性（SAFETY研究）；http://clinicaltrials.gov/；NCT00692302。
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