What can Attachment Based Family Therapy Offer Depressed and Suicidal Youth?

Throughout the world suicide is the third leading cause of death among 10–19 year olds and a major public concern. In Norway, 69 people aged 15–24 died by suicide in 2009 (The Norwegian Institute of Public Health, 2010). Internationally, 20% of teenagers seriously consider killing themselves and 5% to 8% attempt suicide (AACAP, 2001; Grunbaum et al., 2002). Surprisingly, there are few well done intervention studies for youth suicidal behavior, and in most of these studies, the experimental treatment has not been much better than control (Spirto et al., 2002). In fact, a recent meta-analysis of Cognitive Behavioral Therapy (CBT) for youth suicide found no significant effect of CBT for suicide in this age group (Tarrier et al., 2008). Clearly, there is a need to consider alternative interventions. Surprisingly, few treatment studies have examined family interventions for this population (see Harrington et al., 1998 and Huey et al., 2004). Yet, research on youth suicide consistently identifies family factors as an important risk and protective factor for suicidal ideation and behavior (henceforth called suicidal behavior). Unlike adults, the family context is highly influential and inescapable. Youth suicidal ideation and attempts are more frequent in families characterized as low in cohesion and parental responsiveness and high in conflict (Beautrais et al., 1996; Brent et al., 1994; Fergusson et al., 2000; Kurtz & Derevensky, 1993). Prospective and cross-sectional studies of both community and clinical samples also have linked parental criticism, emotional unresponsiveness, lack of care and support, rejection and control to youth suicidal ideation and attempts (Connor & Rueter, 2006; Kerr et .al., 2006; see Wagner et al, 2003 for review). Brent and colleagues (1988) found that 20% of youth suicides and 50% of non-fatal suicide attempts were directly preceded by conflict with parents. For some youth, these negative family factors may be the cause of suicide or merely provide the unstable and unsupportive context to fuel youth suicide. But in either case, interventions that impove this development cocoon, might be a promising means of reducing this serious public heath problem.