SickKids study seeks evidence-based intervention for youth suicide prevention

TORONTO - In a Canadian first, clinician-scientists from The Hospital for Sick Children (SickKids) are testing a suicide prevention strategy in a clinical trial to find an effective intervention for the country’s second leading cause of death among adolescents. The trial is testing a six-week patient and family-centered treatment program for children and youth who present to the SickKids emergency department (ED) with acute suicidality.

There is an urgent, unmet need for effective suicide prevention strategies for high-risk adolescents. Over the past two years, SickKids has seen a 66 per cent increase in youth presenting to the ED for a mental health concern. The latest literature using data from the Canadian Institute for Health Information (CIHI), reports adolescent visits to EDs across Ontario for self-harm have more than doubled over the past 10 years. The ED is often a point of contact with the mental health care system, yet previous research from SickKids looking at data across Ontario has shown adolescents presenting to an ED following a suicide attempt are at increased risk of completed suicide after discharge from hospital.

SickKids Drs. Daphne Korczak, Child and Adolescent Psychiatrist, and Yaron Finkelstein, Staff Physician in Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology, have been working together and with other scientists to test the potential effectiveness of a treatment program in the ED derived from a version that Korczak had previously piloted in the SickKids inpatient mental health unit.

“We found the patients who received this program in the inpatient setting were improving but we know only a small proportion of kids with suicidality are admitted to hospital,” says Korczak, who is also an Associate Scientist in the Neuroscience and Mental Health program at SickKids and an Associate Professor in the Department of Psychiatry at the University of Toronto. “Youth and families who come to the ED in crisis need care; we need to be able to offer them a treatment that we know works, using the same rigour as we would to test any other treatment. Our aim is to find an evidence-based treatment program that works.”

The six-week treatment program for adolescents and their families is aimed at addressing the most common thoughts, feelings and sources of distress that suicidal adolescents experience. It consists of weekly individual and family therapy, which is believed to be key in successful intervention programs.

“This study is the first step in what we hope will be an effective suicide prevention program that could be used throughout Canada to increase access to immediate help and treatment for adolescents at high risk of suicide, regardless of where they live,” says Finkelstein, who is also a Senior Associate Scientist in the Child Health Evaluative Sciences program at SickKids and a Professor in the Departments of Paediatrics and Pharmacology and Toxicology at the University of Toronto.

The study is a randomized controlled trial which will include 128 participants and their families. Recruitment began in 2018 and the study will soon reach the halfway mark. Youth presenting to the SickKids ED with acute suicide risk behaviour or ideation may be eligible for the trial if they meet certain study criteria.

“Through ongoing research over the past decade, we’ve identified the concern for subsequent self-harm and high suicide risk after these patients who presented to the ED have been discharged. As clinicians and researchers, we feel the need and an obligation to develop and offer an effective evidence-based intervention. If we are able to accomplish this, it would be important progress towards establishing a national suicide prevention program,” says Finkelstein.

The next steps for this research will be to expand the trial to multiple centres across the country.

This study is funded by the Capitalize for Kids Grant from the Centre for Brain and Mental Health at SickKids, the Cundill Centre for Child and Youth Depression at the Centre for Addictions and Mental Health (CAMH) and SickKids Foundation.

If you are a young person experiencing thoughts of self-harm or suicide, please reach out to speak with a trusted adult, seek help from a community mental health centre or contact Kids Help Phone at 1-800-668-6868 or text TALK to 686868 to chat with a volunteer Crisis Responder 24/7. If you feel acutely unsafe due to thoughts of ending your life, please immediately visit your local emergency department or call 911.

For more resources on youth suicide please go to AboutKidsHealth.ca.