Efficacy of a brief psychological intervention for adolescents with recent suicide attempt : A randomized clinical trial

Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents. A randomized clinical trial was conducted across nine Spanish hospitals (January 2021-March 2024) with 261 adolescents (12-17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors. After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321-1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390-1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004-1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814-0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009-1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039-1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677-0.996), p=0.045]. While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.