Salloum Alison, Boedeker Peter, Morris Cleo, Storch Eric A
School of Social Work, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, MHC 1400, USA.
Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA.
Res Child Adolesc Psychopathol. 2025 May;53(5):687-700. doi: 10.1007/s10802-024-01242-5. Epub 2024 Sep 26.
Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.
关于儿童创伤认知行为疗法（CBT）期间有自杀意念（SI）和临床恶化（CW）儿童的临床轨迹研究有限。本研究利用一项随机临床试验的二次数据，比较创伤聚焦CBT与阶梯式护理CBT，以检验：（1）有SI、反复出现死亡/濒死想法和既往自杀未遂儿童的临床特征及结局；（2）治疗期间的临床恶化情况及结局差异。儿童（4至12岁）及其父母（N = 183）参与研究，132人完成治疗。对7至12岁儿童及其父母进行访谈，评估SI、死亡/濒死想法、既往自杀未遂情况以及创伤的数量/类型。父母完成的结局测量指标（基线和治疗后）包括儿童创伤后应激症状、功能损害以及内化和外化问题，由一名独立评估者对总体严重程度进行评分。7至12岁儿童、父母和治疗师在治疗期间完成了表明CW的评分。结果在治疗组间无差异；因此，使用合并样本。基线时有SI的儿童比没有SI的儿童严重程度更高。对于完成治疗者，基线时有SI的儿童（n = 14）在治疗后均无SI。儿童（n = 3）和治疗师（n = 5）对CW的评分较低。18名儿童（13.64%）被父母评为CW。大多数评分出现在治疗开始时。治疗师评分为CW的儿童内化问题更多。研究结果表明，有SI和CW的儿童可通过创伤聚焦CBT得到改善。需要对有SI和创伤儿童的临床轨迹以及监测CW的临床工具开展更多研究。临床试验注册信息：https://clinicaltrials.gov ：NCT02537678 。
