Suicide and attempted suicide among young adults is a common and serious mental health problem worldwide, and certainly in Belgium and the Netherlands. Fatal suicide is a leading cause of death among young people. Suicide attempts, whether fatal or not, also have devastating consequences for these youngsters’ families and come with substantial economic costs.
However, research on the treatment of suicidality among young adults remains scarce. The current psychological therapy approaches and drug treatments for young adults at very high risk of fatal suicide attempts have only limited success. Increasing evidence points to the importance of involving their family in their treatment.. The WHO recommends involving loved ones in the treatment of suicidal young adults. Attachment-Based Family Therapy, or ABFT, was shown to work well in several studies in the US. ABFT is also used to treat suicidal young adults in Belgium and the Netherlands, but remains poorly investigated.
The purpose of the REPAIR study is to test whether ABFT is effective in reducing suicidal thoughts and could have an add-on effect on standard treatment, in a real-life situation, and whether it provides good value for money – two questions which have never been investigated in young adults. This study is a Dutch-Belgian collaboration, with 6 or 7 participating sites in each country. Sites are hospitals, mental health centers, student health centers or private practices. Participants (142 individuals) are older adolescents and young adults between 16 and 30 years old who have frequent suicidal thoughts, and who seek mental health treatment. Initially, the study was open to young adults only (18 – 25 years old). However, as recruitment progressed, the research team was faced with a lot of older adolescents who also wanted to apply. Furthermore, research suggests that the age range of young adulthood extends into the late twenties. Therefore, the age range was expanded to 16 – 30 years old, to include both older adolescents and young adults.
We predict that ABFT will reduce suicidal thoughts and suicide attempts compared to current treatment, that this improvement will be maintained over time, and that this approach will provide better value for money. The project will contribute to improving care for suicidal older adolescents and young adults with high suicide risk. Results will inform clinical guidelines and policymakers, and improve the treatment of older adolescents and young adults with a high risk for fatal suicide and of their families.
| Title | Targeting suicidality in young adults: a randomized controlled, pragmatic, multicentre trial evaluating the (cost)-effectiveness of Attachment Based Family Therapy compared to Treatment as Usual - REPAIR |
| Participants (P) | Suicidal young adults and their families. The young adults are 16-30 years, seek mental health treatment, have a score above 31 on the SIQ-JR (cut-off for suicidality) and have at least one primary parent or caregiver that participates in the assessment and treatment. |
| Intervention (I) | Attachment Based Family Therapy (ABFT): ABFT is a manualized treatment, that emerges from interpersonal theories that suggest suicide can be precipitated, exacerbated, or buffered against by the quality of family relationships. Therefore, ABFT focuses on strengthening parent-child attachment bonds to create a protective and secure base for young adult development. Sessions are scheduled weekly, and the intervention lasts on average 16 weeks. |
| Control (C) | Treatment as usual (TAU): Most treatment centres’ clinical practices rely heavily on the use of antidepressants and/or CBT or DBT. All regular interventions are allowed in TAU, except for systemic family therapy of more than 4 sessions in total. Parents are allowed to be involved in the treatment, which is part of treatment as usual, and can comprise for instance psycho-education or parental support or skill training. |
| Outcome (O) | Change suicidality as measured with the SIQ-JR, prepost at 5 months after baseline. |
| Trial Design | A randomized, controlled, pragmatic, multicentre, trial with 13 participating sites in the Netherlands and Belgium, in which suicidal young adults will be randomized (1:1) to 1. ABFT with TAU or 2. TAU. After inclusion, duration of study participation, including follow-up, will be 17 months total. |
| Sample Size | 142 participants randomised |
| Trial duration | 47 months from FPI to CSR |
| Budget | 993,500 € of which 544,760 € in The Netherlands and 448,740 € in Belgium |
| Sponsor | Academic Medical Center, Amsterdam, The Netherlands |
| Chief Investigator | Prof. Claudi Bockting |
| BCC and National Coordinator | Universitaire Ziekenhuizen Leuven - Katholieke Universiteit Leuven, Leuven, Belgium Prof. Guy Bosmans |
| Number of participating sites | Netherlands 7 sites and Belgium 6 sites Belgian sites: UPC KU Leuven |
