Implementing and Adapting the SAFETY Treatment for Suicidal Youth: The Incubator Model,Telehealth, and the Covid-19 Pandemic

The Safe Alternatives for Teens and Youth (SAFETY) treatment was developed to decrease the risk of repeat suicidal and self-harm behavior in youth presenting with elevated suicide risk. This paper uses case illustrations to demonstrate the SAFETY treatment, building upon the companion paper describing our “incubator” treatment development model and process (Asarnow et al., 2022). As illustrated in the second case illustration, the incubator model approach was particularly useful during the COVID-19 pandemic switch to telehealth. SAFETY specifically targets suicide and self-harm risk reduction using an individually tailored principle-guided approach, grounded in a case conceptualization that identifies cognitive-behavioral processes and reactions that contribute to increased suicide attempt risk and explains the youth’s suicidal/self-harm behavior within the context of his or her broader social systems. The SAFETY treatment has been tested in two treatment development trials, and results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm.     

Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

The Incubator Treatment Development Model: The SAFETY Treatment for Suicidal/Self-Harming Youth

Youths who make suicide attempts or engage in repetitive self-harm are at risk for future suicide attempts and death by suicide or self-harm. This treatment development report focuses on the Safe Alternatives for Teens and Youth (SAFETY) treatment. SAFETY is a 12-week outpatient child and family-centered cognitive-behavioral treatment, informed by dialectical-behavior therapy, and designed to promote safety following a suicide attempt or repeated episodes of self-harm. Previous reports have described results of small open and randomized treatment development trials. Here, we describe our “incubator” treatment development model. Combining scientific rigor with attention to the community context in which treatment is delivered, the incubator model emphasizes laboratory-based treatment development trials and quantitative and qualitative data generated through partnerships with community treatment sites and youth and parent consumers of care. Aims of this approach are to: (1) integrate information from our partners throughout the treatment development process; (2) create a more feasible and easily transportable “youth” and “family” centered treatment; and (3) accelerate the pace with which laboratory-based treatment advances can be incorporated into improvements in community care. We describe our incubator treatment development model and how data generated through our treatment development process and interactions between the laboratory and community teams contributed to the development of the SAFETY treatment.     

“八胞胎”事件引发的伦理思考

震惊全国的广州“八胞胎”事件逐渐淡出公众的视野,但它带给我们的思考并未结束.从伦理视角对该事件中暴露出的亲子关系的界定、“子宫”商品化、公平公正、多胎妊娠、代际伦理等问题进行了深入思考,并针对ART技术自身特点,从强化医疗机构和ART技术从业人员的职业道德和法律意识;加强卫生行政部门的监管;加强顶层设计,完善ART技术的法律法规;提高不孕症患者对辅助生殖知识的认知,加强生殖伦理教育等方面提出了探讨性建议.     

Preferences for suicide prevention strategies among university students in Japan: a cross-sectional study using full-profile conjoint analysis

In Japan, implementation of suicide prevention policies is mainly supported by public funds. However, it is unclear what kinds of suicide prevention strategies people prefer. We conducted a survey to clarify people’s preferences regarding suicide prevention strategies adopted in Japan. This was a cross-sectional self-administered questionnaire survey. Participants were recruited through a lecture held by the first author at their university. We distributed questionnaires to 324 people present at the lecture; 249 completed questionnaires were included in the final analysis. We estimated suicide prevention strategy preferences using full profile conjoint analysis. For all six prevention strategies, the inclusion of each strategy in the policy profile was statistically significantly related to the positive evaluation of the overall policy profile. Marginal Willingness to Pay (MWTP) for restriction of access to means showed the highest value of the six suicide prevention strategies. MWTP was the lowest for public awareness activities. Preferred suicide prevention strategies in Japan are restriction of access to means and enhancement of psychiatric services. The results of this study indicate the strategies that are preferred have a high level of evidence of suicide prevention and do not directly intervene in a person’s free will to die by suicide.     

Self-Criticism,Neediness, and Distress in the Prediction of Suicide Ideation: Results from Cross-Sectional and Longitudinal Studies

The aim of the present study was to test whether the maladaptive personality traits of self-criticism and neediness predict suicide ideation when controlling for general distress. Further, potential interactive effects on suicide ideation of the two traits and distress were also evaluated. Two studies with nonclinical samples were conducted. The first investigation was cross-sectional and involved a final sample of 202 community adults while the second study was longitudinal with a final sample of 207 college students. Results of Study 1 demonstrated that self-criticism, but not neediness, associated with suicide ideation and, in doing so, also interacted with distress. Neediness also tended to interact with self-criticism in the prediction of suicide ideation. Results from Study 2 were similar and confirmed the Study 1 results. Changes in self-criticism, but not changes in neediness, predicted changes in suicide ideation after statistically controlling for changes in distress. Changes in the interaction between self-criticism and distress predicted changes in suicide ideation and changes in the interaction between self-criticism and neediness tended to predict changes in suicide ideation. Results are discussed with regard to their implications for psychological intervention.     

大学生的冲动性特质与自杀意念的关系:一个有调节的中介模型

以应激-易感模型为依据考察冲动性特质与自杀意念的关系,并在此基础上提出一个有调节的中介模型,探讨负性生活事件影响的中介作用以及家庭环境的调节作用。采用巴瑞特冲动性量表、青少年生活事件量表、家庭环境量表、贝克自杀意念量表对902名大学生进行集体施测,旨在考察负性生活事件的影响对大学生冲动性特质与自杀意念的中介作用以及家庭环境的调节作用,结果表明:(1)冲动性特质和负性生活事件的影响能正向预测大学生的自杀意念;(2)负性生活事件的影响在冲动性特质和自杀意念之间起中介作用;(3)负性生活事件影响的中介作用和冲动性特质的直接作用受家庭环境的调节。这些结果对于综合解释环境与个体因素对自杀意念的作用与机制具有重要意义。     

Suicidal Adolescents' Social Support from Family and Peers: Gender-Specific Associations with Psychopathology

Perceptions of social support from family, non-family adults, and peers were examined in relation to the psychopathology reported by 220 suicidal adolescents (152 females) during a psychiatric hospitalization. Results of regression analyses showed that, among females, family support was negatively related to hopelessness, depressive symptoms, and suicidal ideation. Among males, peer support was positively associated with depressive symptoms and suicidal ideation. Across gender, more peer support was associated with more externalizing behavior problems; whereas, family support was negatively related to these problems and to alcohol/substance abuse. Paralleling normative findings, age was positively associated with peer support, and females perceived more peer support than did males. Findings extend previous research on social support to suicidal adolescents, and broaden the literature by examining extrafamilial support and a broader range of relevant psychopathology. That is, perceived social support relates to psychiatric impairment differentially by gender, and normative, age-related variations in perceptions of social support are detected even among highly impaired adolescents. Clinical implications and directions for future research are discussed.