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Predicting Patterns of Treatment Response and Outcome for Suicidal and Depressed Adolescents.

OBJECTIVE: Although several treatments have been shown to be effective in treatment of youth suicidal thoughts and behaviors (STBs), there is a pressing need to account for the substantial variation in adolescents' response to and outcomes from these treatments.

METHOD: Secondary analyses of data from a sixteen-week randomized trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced Non-Directive Supportive Therapy (FE-NST) identified distinct classes of adolescents' treatment response. Established risk factors for STBs, along with treatment condition and sociodemographic variables, were then tested as predictors of class membership.

RESULTS: Three patterns of adolescents' treatment response and outcome were identified: a) Non-Responders (15.8%), b) Good Responders (57.5%), and c) Partial Responders (26.7%). After controlling for initial symptom severity, Non-Responders were more likely to have higher levels of non-suicidal self-injury and pessimism and were more likely to meet diagnostic criteria for Major Depressive Disorder than Good or Partial Responders. Partial Responders were more likely than Good Responders to meet criteria for MDD and to have higher perceived burdensomeness.

CONCLUSION: Although most adolescents showed significant symptom reductions in both treatments, adolescents with higher pre-treatment levels of pessimism, MDD, NSSI and perceived burdensomeness were less likely to show an optimal pattern of treatment benefit. The findings point to heterogeneity in treatment response that may require adapting treatments for adolescents with these pre-treatment profiles.

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