Abstract
Young adult suicidality is worldwide a prevalent mental health problem and the number one cause of death, with devastating consequences for individuals and their families, and substantial economic costs. However, psychological and pharmacological treatments currently recommended in guidelines for treatment of high-risk youth for fatal suicide have limited effect. In line with the WHO’s recommendation to involve the family in treatment of these youth, Attachment Based Family Therapy (ABFT) was developed; a 16-week attachment and emotion-focused treatment, implemented in mental health care settings across various European countries in the past years, and is becoming increasingly popular among therapists. However, the (cost-)effectiveness of ABFT has not been studied in emerging adults. In the proposed pragmatic RCT we aim to evaluate the effectiveness and cost-effectiveness of ABFT compared to Treatment As Usual (TAU) on suicidality, as delivered in daily practice. This pragmatic multicenter study in the Netherlands and Belgium includes 12 participating sites. Participants are suicidal young adults (≥ 31 SIQ-JR score) between 18 and 25 years old who seek mental health treatment (n = 142) and their caregivers. The primary outcome is suicidality (SIQ-JR), with assessments at baseline, post-intervention (five months after baseline), three, six and twelve months after intervention. We predict that, compared to TAU, ABFT will lead to a stronger reduction in suicidality and will be more cost-effective, over the course of all timepoints. We also expect stronger decreases in depressive symptoms, given that suicidality is very common in individuals with depressive disorder, as well as more improvement in family functioning, autonomy, entrapment, and young adult attachment, in the ABFT condition. This study can contribute to improving the care for suicidal youngsters with high mortality risk. Treatment of suicidal emerging adults is understudied. The results will inform clinical guidelines and policy makers and improve treatment of suicidal emerging adults.