Developing Adaptive Treatment Strategies to Address Suicidal Risk in College Students: A Pilot Sequential, Multiple Assignment, Randomized Trial (SMART)

Abstract

This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4-8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions-both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4-16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.

Collaborative assessment and management of suicidality for teens: A promising frontline intervention for addressing adolescent suicidality.

“…In addition to implementation outcomes, there were promising outcomes related to STB. The majority of youth resolved, according to CAMS criteria, demonstrating four consecutive weeks of no STB, management of urges, and low self-reported suicide risk, similar to the response rates obtained in adult populations (Pistorello et al, 2018) as well as other well-established interventions for selfinjury (i.e., in the CARES DBT trial 54.2% of youth had no injury at the end of the intervention; McCauley et al, 2018). When the severity of suicidal ideation was used as the primary outcome, a moderate effect size was observed in reduction of suicidal ideation, on par with other brief programs but smaller in impact than the CAMS trial with adults (Ellis et al, 2017;Jobes et al, 2017) and other more comprehensive programs for youth (i. e., DBT;McCauley et al, 2018).…”

Borderline and schizotypal traits in college students: Relationship and personality profiles

“…Dissociation has been shown to predict poor response to dialectical behavioral therapy (DBT) in female patients with BPD (Kleindienst et al, 2011). As DBT is the most evaluated and recommended psychotherapy for college students with BPD (Meaney-Tavares and Hasking, 2013;Lin et al, 2018;Pistorello et al, 2012Pistorello et al, , 2017Uliaszek et al, 2016), future studies on DBT in college students or application of DBT to college students should consider the frequent association of borderline, schizotypal symptoms and dissociation.…”

Adaptive Interventions in Child and Adolescent Mental Health

“…Based on a search of studies identified in early August 2015 via the www.clinicaltrials.gov website (search terms [“adaptive treatment” or “adaptive intervention” or “adaptive strategy” or “sequential treatment”] crossed with [“children”, “child”, “adolescent” or “youth”], or with the terms [“sequential multiple assignment randomized trial” or “sequential, multiple assignment, randomized trial”]), we wish to note that there is other exciting work on adaptive interventions being done in the areas of adolescent marijuana use (Budney, Stanger, & colleagues, 2014; Kaminer & colleagues, 2012), prevention of oppositional behavior (Dishion et al, 2014), child depression (Eckshtain, 2013), autism (Kasari & colleagues, 2012), college student suicide prevention (Pistorello & colleagues, 2015), child trauma (Salloum, Robst, et al, 2014; Salloum, Scheeringa, Cohen, & Storch, 2014), and child and adolescent obsessive-compulsive disorder (Shavitt & colleagues, 2010). 1 …”