This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

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