Moa Karemyr, Martin Bellander, Moa Pontén, Anna Ohlis, Oskar Flygare, Ylva Walldén, Ralf Kuja-Halkola, Gergö Hadlaczky, David Mataix-Cols, Joan Rosenbaum Asarnow, Clara Hellner, Jennifer L Hughes, Johan Bjureberg
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Effective treatments targeting suicide attempts are scarce.</p><p><strong>Objective: </strong>To assess the feasibility and preliminary efficacy of a family-based cognitive behavioural treatment relative to an active control for youth with suicidal behaviour.</p><p><strong>Methods: </strong>30 youths (93% female; mean (SD) age=14.6 (1.5) years) residing in Sweden with recent suicidal behaviour (last 3 months) and at least one available parent were randomised to 12 weeks of the family-based cognitive behavioural treatment Safe Alternatives for Teens and Youths (SAFETY) or supportive therapy, an active control treatment. Primary endpoint was 3-month post-treatment. Feasibility outcomes included treatment and assessment compliance, adverse events, treatment credibility and treatment satisfaction. Secondary outcomes included suicide attempt, non-suicidal self-injury, anxiety, depression, quality of life and emotion dysregulation.</p><p><strong>Findings: </strong>Both treatments showed high compliance, satisfaction, credibility and session completion, with few adverse events and dropouts as well as low attrition (7% at primary endpoint). At the primary endpoint, two (14%) participants in SAFETY and four (27%) in supportive therapy had attempted suicide. Non-suicidal self-injury was reduced by 95% (incidence rate ratio=0.05 (95% CI 0.01 to 0.20)) in SAFETY and 69% (incidence rate ratio=0.31 (0.11 to 0.83)) in supportive therapy. Participation in SAFETY, but not in supportive therapy, was associated with moderate-to-large within-group improvements in anxiety and depression (Cohen's d=0.85 [0.33 to 1.40]), quality of life (d<i>=</i>1.01 [0.48 to 1.56]) and emotion dysregulation (d=1.22 [0.45 to 2.03]).</p><p><strong>Conclusions: </strong>The results suggest that SAFETY is feasible and promising for youth with suicidal behaviour.</p><p><strong>Clinical implications: </strong>A large randomised controlled trial is warranted to further examine the efficacy of SAFETY.</p><p><strong>Trial registration number: </strong>NCT05537623.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"28 1","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049871/pdf/","citationCount":"0","resultStr":"{\"title\":\"Preventing suicide with Safe Alternatives for Teens and Youths (SAFETY): a randomised feasibility trial.\",\"authors\":\"Moa Karemyr, Martin Bellander, Moa Pontén, Anna Ohlis, Oskar Flygare, Ylva Walldén, Ralf Kuja-Halkola, Gergö Hadlaczky, David Mataix-Cols, Joan Rosenbaum Asarnow, Clara Hellner, Jennifer L Hughes, Johan Bjureberg\",\"doi\":\"10.1136/bmjment-2025-301575\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Suicide attempts are common in youth and have potentially lethal outcomes. 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Secondary outcomes included suicide attempt, non-suicidal self-injury, anxiety, depression, quality of life and emotion dysregulation.</p><p><strong>Findings: </strong>Both treatments showed high compliance, satisfaction, credibility and session completion, with few adverse events and dropouts as well as low attrition (7% at primary endpoint). At the primary endpoint, two (14%) participants in SAFETY and four (27%) in supportive therapy had attempted suicide. Non-suicidal self-injury was reduced by 95% (incidence rate ratio=0.05 (95% CI 0.01 to 0.20)) in SAFETY and 69% (incidence rate ratio=0.31 (0.11 to 0.83)) in supportive therapy. 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引用次数: 0
摘要
背景：自杀企图在青少年中很常见，并且具有潜在的致命后果。针对自杀企图的有效治疗方法很少。目的：评估以家庭为基础的认知行为治疗相对于主动控制青少年自杀行为的可行性和初步效果。方法：30名青年（93%为女性）；平均（SD）年龄=14.6（1.5）岁，居住在瑞典，最近有自杀行为（最近3个月），并且至少有一位家长被随机分配到12周的以家庭为基础的认知行为治疗青少年安全替代方案（SAFETY）或支持性治疗，一种积极的对照治疗。主要终点为治疗后3个月。可行性结局包括治疗和评估依从性、不良事件、治疗可信度和治疗满意度。次要结果包括自杀企图、非自杀性自残、焦虑、抑郁、生活质量和情绪失调。结果：两种治疗均表现出较高的依从性、满意度、可信度和疗程完成度，几乎没有不良事件和退出，并且损失率低（主要终点为7%）。在主要终点，安全组有2名（14%）参与者和支持治疗组有4名（27%）参与者曾试图自杀。非自杀性自我伤害在安全组减少95%（发生率比=0.05 (95% CI 0.01 ~ 0.20)），在支持治疗组减少69%（发生率比=0.31(0.11 ~ 0.83)）。参与SAFETY，而非支持治疗，与焦虑和抑郁（Cohen’s d=0.85[0.33至1.40]）、生活质量（d=1.01[0.48至1.56]）和情绪失调（d=1.22[0.45至2.03]）的组内中度至重度改善相关。结论：结果表明，SAFETY对于有自杀行为的青少年是可行的和有希望的。临床意义：需要一项大型随机对照试验来进一步检验SAFETY的疗效。试验注册号：NCT05537623。
Preventing suicide with Safe Alternatives for Teens and Youths (SAFETY): a randomised feasibility trial.
Background: Suicide attempts are common in youth and have potentially lethal outcomes. Effective treatments targeting suicide attempts are scarce.
Objective: To assess the feasibility and preliminary efficacy of a family-based cognitive behavioural treatment relative to an active control for youth with suicidal behaviour.
Methods: 30 youths (93% female; mean (SD) age=14.6 (1.5) years) residing in Sweden with recent suicidal behaviour (last 3 months) and at least one available parent were randomised to 12 weeks of the family-based cognitive behavioural treatment Safe Alternatives for Teens and Youths (SAFETY) or supportive therapy, an active control treatment. Primary endpoint was 3-month post-treatment. Feasibility outcomes included treatment and assessment compliance, adverse events, treatment credibility and treatment satisfaction. Secondary outcomes included suicide attempt, non-suicidal self-injury, anxiety, depression, quality of life and emotion dysregulation.
Findings: Both treatments showed high compliance, satisfaction, credibility and session completion, with few adverse events and dropouts as well as low attrition (7% at primary endpoint). At the primary endpoint, two (14%) participants in SAFETY and four (27%) in supportive therapy had attempted suicide. Non-suicidal self-injury was reduced by 95% (incidence rate ratio=0.05 (95% CI 0.01 to 0.20)) in SAFETY and 69% (incidence rate ratio=0.31 (0.11 to 0.83)) in supportive therapy. Participation in SAFETY, but not in supportive therapy, was associated with moderate-to-large within-group improvements in anxiety and depression (Cohen's d=0.85 [0.33 to 1.40]), quality of life (d=1.01 [0.48 to 1.56]) and emotion dysregulation (d=1.22 [0.45 to 2.03]).
Conclusions: The results suggest that SAFETY is feasible and promising for youth with suicidal behaviour.
Clinical implications: A large randomised controlled trial is warranted to further examine the efficacy of SAFETY.
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