The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial.

Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Cost-Benefit Analysis* ; Suicidal Ideation* ; Family Therapy*/methods ; Family Therapy*/economics ; Multicenter Studies as Topic* ; Pragmatic Clinical Trials as Topic*; Humans ; Young Adult ; Adolescent ; Adult ; Female ; Treatment Outcome ; Male ; Belgium ; Object Attachment ; Netherlands ; Health Care Costs ; Suicide Prevention ; Time Factors

Background: Young adult suicidality is worldwide a prevalent mental health problem and the number one cause of death, with devastating consequences for individuals and their families, and substantial economic costs. However, psychological and pharmacological treatments currently recommended in guidelines for treatment of high-risk youth for fatal suicide have limited effect. In line with the World Health Organization's (WHO) recommendation to involve the family in treatment of these youth, attachment-based family therapy (ABFT) was developed, a 16-week attachment and emotion-focused treatment, implemented in mental health care settings across various European countries in the past years, and becoming increasingly popular among therapists. However, the (cost-)effectiveness of ABFT has not been studied in emerging adults. In the proposed pragmatic randomized controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of ABFT compared to treatment as usual (TAU) on suicidality, as delivered in daily practice.
Methods: This pragmatic multicenter study in the Netherlands and Belgium includes 13 participating sites. Participants are suicidal young adults (≥ 31 SIQ-JR score) between 16 and 30 years old who seek mental health treatment (n = 142) and their caregivers. The primary outcome is suicidality (SIQ-JR), with assessments at baseline, post-intervention (5 months after baseline), 3, 6, and 12 months after intervention. We predict that, compared to TAU, ABFT will lead to a stronger reduction in suicidality and will be more cost-effective, over the course of all time points. We also expect stronger decreases in depressive symptoms, given that suicidality is very common in individuals with depressive disorder, as well as more improvement in family functioning, autonomy, entrapment, and young adult attachment, in the ABFT condition.
Discussion: This study can contribute to improving the care for suicidal youngsters with high mortality risk. Treatment of suicidal emerging adults is understudied. The results will inform clinical guidelines and policy makers and improve treatment of suicidal emerging adults.
Trial Registration: This trial is registered on ClinicalTrials.gov (NCT05965622, first posted on July 28, 2023).
(© 2024. The Author(s).)

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Keywords: Attachment-based family therapy; Cost-effectiveness; Psychotherapy; Randomized controlled trial; Suicidal ideation; Suicidality; Suicide prevention; Young adult

ClinicalTrials.gov NCT05965622

Date Created: 20241016 Date Completed: 20241016 Latest Revision: 20241019

20250114

PMC11484370

10.1186/s13063-024-08499-7

39415182