Adapting Youth-Nominated Support Teams to Prevent Suicide Among Youth with Emerging Psychosis

Background and Purpose: An estimated 5% of people with schizophrenia die by suicide, giving this diagnosis one of the highest suicide rates of any mental health condition. Suicide risk appears to be highest early in the course of illness and may be particularly elevated for individuals at clinical high risk for psychosis (CHR). Despite the CHR population’s high risk of suicidality, current standards of treatment inadequately address suicide risk among youth in the early stages of psychosis. The Youth-Nominated Support Team (YST) is a brief intervention based on social support and health behavior models, developed to reduce suicide risk among adolescents with recent suicidal ideation and/or suicide attempts, and is the first intervention with demonstrated efficacy in reducing mortality among suicidal adolescents. We used qualitative methodology to adapt the YST intervention for youth receiving services through CHR services in preparation for a randomized trial of the adapted intervention.

Methods: We conducted a series of focus groups with clients at CHR, their family members, and clinicians who worked in CHR clinics (N=30), to discuss the adaptation of the YST intervention. A framework analysis was conducted using Dedoose software. The coding framework was developed in accordance with the a priori themes of the focus group, which were further refined as additional concepts were identified in the transcripts. This established a set of emergent themes related to potential adaptations. Following the steps from the Delphi method, the identified themes were presented to a team of study investigators and outside consultants to rank and discuss the feasibility of the adaptations.

Results. Focus group participants identified several key methodological innovations that may improve the acceptability and potential effectiveness of the YST intervention for the CHR population (YST-CHR). Recommended adaptations include greater involvement of the client in the psychoeducational sessions between the clinician and support persons, integration of web-based and telehealth methods, and incorporation of a support-person role for individuals with lived experience of psychosis, among others. The final adapted YST-CHR approach will be presented in the context of these and other consensus meeting recommendations.

Conclusions and Implications. Youth receiving services for CHR and psychosis spectrum diagnoses are at elevated risk for suicide yet have rarely benefited from targeted interventions intended to meet their unique clinical needs. The adaptation of YST, one of relatively few evidence-based interventions for suicidal behavior among youth, provides an important new clinical tool to help alleviate this risk. The adapted YST-CHR will be examined in a small feasibility trial followed by a larger multi-site randomized clinical trial to determine its efficacy.