Stratified Stepped-Care for Reducing Suicide Attempts and Self-Harm in Youth: A Randomized Clinical Trial.
Joan R Asarnow, Greg N Clarke, Alison J Firemark et al.
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In 30 seconds
This randomized clinical trial evaluated whether adding stratified stepped-care for suicide prevention (SC-SP) to Zero Suicide quality improvement (ZSQI) reduced suicidal behavior among 301 youth aged 12–24 selected for recent suicidal behavior, suicidal ideation, or specified histories of suicide attempt, self-injury, and depression. At 12 months, suicide-attempt rates did not differ significantly between groups (SC-SP 8.09%; ZSQI 9.59%). Compared with ZSQI alone, SC-SP was associated with significantly less total self-harm (relative risk = 0.46, 95% CI = 0.26, 0.79, p = .006) and depression, and greater satisfaction with care.
Key findings
- At 12 months, suicide-attempt rates were 8.09% with SC-SP and 9.59% with ZSQI, with no significant between-group difference.
- SC-SP was associated with less total self-harm than ZSQI at 12 months (relative risk = 0.46, 95% CI = 0.26, 0.79, p = .006; number needed to treat = 10.2).
- The SC-SP group had less depression and greater satisfaction with care than the ZSQI group at 12 months.
Why it matters
The trial distinguishes effects on suicide attempts from effects on broader self-harm outcomes: the added stepped-care program did not significantly reduce the primary outcome, but was associated with less total self-harm and depression. These findings suggest that structured, risk-matched care may improve some clinically important outcomes for youth at elevated suicide risk, while leaving its effect on suicide attempts uncertain.
What to keep in mind
The primary outcome, suicide attempts, showed no significant between-group difference. Follow-up was limited to 12 months, and no deaths were detected.