Motivational interviewing intervention feasible, acceptable for youths at risk for suicide

A safety planning intervention that incorporated motivational interviewing appeared feasible and acceptable for youths at risk for suicide, according to a presentation at the Anxiety and Depression Association of America annual conference.

“Youth suicide has been notably rising in recent years, along with an increase in certain psychiatric hospitalizations and emergency department visits for suicide risk concerns,” Ewa Czyz, PhD, research assistant professor in the department of psychiatry at the University of Michigan, said during a presentation. “[This research] is on psychiatric and hospitalized youth, who represent an especially high-risk group. We know that many of these youth are at a high risk for experiencing a suicide-related event, such as suicide attempt or hospitalization in the weeks after discharge.”

Few randomized controlled trials have focused on this high-risk transition period, which underscores a “critical need” to develop approaches that target suicide risk in the post-discharge period, according to Czyz. In the current pilot randomized controlled trial, Czyz and colleagues sought to assess a safety planning intervention for at-risk youths that featured motivational interviewing and post-discharge contacts. They randomly assigned 36 adolescents aged 13 to 17 years, of whom 79% were girls and 86% were white, to either treatment as usual or to the motivational interviewing safety plan condition, which included a 1-hour individual in-person meeting and a 30-minute family session. Those in the intervention group and their parents received booster phone calls 2 weeks after discharge to further adjust the safety plan to better meet participants’ post-discharge needs. Further, all study participants completed daily surveys that were texted to their phones for 4 weeks and assessed mechanisms of change, response to the intervention and risk indicators.

Results showed a study consent rate of 77% and retention rates in the high 80s across the study period. Although approximately 24% of youths disclosed thoughts of suicide across the study period, less than 1% of these disclosures met the study’s risk threshold for having a counselor call the youth and their family. Thus, the researchers concluded that the risk monitoring was feasible but required robust resources, since someone had to be on call each day of the study. Youth and parent satisfaction ratings after both the in-person meetings and booster calls were high. Parents tended to rate helpfulness of the intervention as higher than did the youths. Youths in the motivational interviewing safety plan condition reported higher self-efficacy for refraining from suicidal action, greater use of coping/relying on self and greater use of the safety plan.

“Motivational interviewing strategies appear to be promising in terms of maintaining safety plan use, although both groups showed a drop in safety plan use over time,” Czyz said. “Additional context may be needed to sustain post-discharge safety plan use and coping.”

Reference:

Czyz E, et al. Building resilience to prevent suicide: New interventions. Presented at: The Anxiety and Depression Association of America Annual Conference; Mar. 18-19, 2021 (virtual meeting).