ARTICLES
Multisystemic Therapy Effects on Attempted Suicide by Youths Presenting Psychiatric Emergencies

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ABSTRACT

Objective

To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization.

Method

Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1-year posttreatment follow-up.

Results

Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST. Also, treatment differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age. Moreover, treatment effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation.

Conclusions

Results generally support MST's effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization varied based on informant and youth demographic characteristics.

Section snippets

Participants

Participants were 156 youths who were approved for emergency psychiatric hospitalization at the Medical University of South Carolina because of suicidal ideation/planning or attempted suicide, homicidal ideation or behavior, psychosis, or other threat of harm to self or others. Youths were included if they were (1) aged 10 to 17, (2) Medicaid-funded or without health insurance, and (3) residing in a noninstitutional environment such as the home of a family member or relative, foster home, or

Outcomes

Table 1 presents the percentage of youths who were suicide attempters or ideators before treatment, after treatment, and at the 1-year follow-up for both the MST and hospital conditions. Also included are means and standard deviations for continuous variables, as well as significance tests for time and treatment effects. Significant linear time effects were found for caregiver- and youth-rated attempted suicide, youth-rated suicidal ideation, caregiver-rated anxious/depressed, youth-rated

DISCUSSION

This report presents the first examination of MST for suicidal behavior in children and adolescents. Importantly, the results support the efficacy of MST relative to inpatient psychiatric hospitalization in reducing the frequency of attempted suicide. In addition, analysis of quadratic effects suggests that MST may contribute to more rapid symptom relief compared to hospitalization. Although several clinical trials with suicidal youths have been conducted (Harrington et al., 1998;

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  • Cited by (0)

    The research reported in this article was supported by NIMH grants R01MH51852 and R01MH51852 , and AHRQ grant PO1 HS1087 . Special thanks go to Sonja Schoenwald for her comments on an earlier draft of this manuscript.

    Disclosure: Drs. Henggeler and Rowland are stockholders in MST Services Inc., which has the exclusive licensing agreement through the Medical University of South Carolina for the dissemination of MST technology and intellectual property.

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