Project Summary

What is the research about?

Suicide is the second leading cause of death among teens. One treatment to prevent suicide is known as dialectical behavior therapy, or DBT. DBT helps people learn to manage intense emotions and hard relationships. Research shows that DBT helps prevent suicide. But questions remain about how well it works for teens who are at moderate or high risk for suicide.

In this study, the research team is comparing two prevention programs for teens at risk for suicide. The first program, Stepped Care, uses strategies tailored to teens’ suicide risk, including DBT, to help them learn to manage stress and change unhelpful behaviors. The second program, Zero Suicide, aims to improve suicide care in health systems and can include therapy, medicine, or both.

Who can this research help?

Results may help health system administrators when considering ways to treat teens at moderate to high risk for suicide. Also, results may help teens and their families decide what kind of suicide prevention care to receive.

What is the research team doing?

The research team is using electronic health records at four sites in Oregon, Washington State, Minnesota, and Georgia to identify 9,800 teens. The teens are ages 13–17 and are at moderate or high risk for suicide. The team is assigning teens by chance to receive Stepped Care or Zero Suicide.

Teens in the Stepped Care group receive treatment tailored to their level of suicide risk. Teens at highest risk and their parents or caregivers receive weekly group DBT for six months. Groups of up to six teens plus parents learn skills to change unhelpful thoughts and behaviors. Skills include how to meditate and ways to manage emotions and tolerate stress.

For teens at medium risk for suicide, study care managers offer one-on-one phone sessions every one to four weeks. At the sessions, teens and care managers assess risk for self-harm and create and use a safety plan. Safety plans are action plans teens can use if they have suicidal thoughts. The plans help teens identify the warning signs of suicide and define ways to help. For example, safety plans may include sources of professional help and how to stay safe at home, such as by safely storing firearms or medicines. Care managers also help teens obtain services, medicine, and mental health appointments as needed.

Teens in the Zero Suicide group receive standard mental health services, which may include risk assessment, treatment, and counseling.

For one year, the research team is monitoring the rate of suicide attempts and self-harm. The team is also looking at the use of mental health services. These services may include a stay in a mental health unit, an emergency room visit, or a prescription for medicine. The team is looking to see how well the programs work based on a teen’s race, gender, and level of risk for suicide.

Teens who have lived with suicidal behavior and their parents, doctors, and therapists are helping to plan and conduct this study.

Research methods at a glance

Design Element Description
Design Randomized controlled trial
Population 9,800 youth ages 13–17 who were enrolled at one of four study sites in Oregon, Minnesota, Washington State and Georgia for more than 3 years and 3 months and were at moderate to high risk for suicide
  • Stepped Care
  • Zero Suicide

Primary: fatal/nonfatal suicide attempts and intentional self-injury

Secondary: healthcare utilization, including psychiatric hospitalization, emergency department use, and use of psychotherapeutic medication

Timeframe Timeframe Length of follow-up for collecting data on primary outcomes. View Glossary 1-year follow-up for primary outcomes

Project Information

Gregory Clarke, PhD
Courtney McCracken, PhD
Kaiser Foundation Research Institute
Large Pragmatic Trial to Prevent Suicide Attempts, Deaths in Moderate-to-High Risk Youth

Key Dates

July 2021
June 2028


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 15, 2024