Open Trial and Pilot Randomized Controlled Trial of a Novel Program to Reduce Perceived Burdensomeness

We have read this dissertation and recommend that it be approved. iv ACKNOWLEDGMENTS To the mentors who have provided guidance and support, the instructors who have opened doors and showed me new possibilities, and to the friends and colleagues who have encouraged, put up with, and artfully distracted me: You each have my profound thanks. This work would not have been possible, first and foremost, without the support of my faculty advisor, Dr. Jeremy Pettit, my dissertation committee members, and the faculty who have provided support, both formal and informal, along the way. Nor would this work have been completed without the assistance of my fellow graduate students and a dedicated team of research assistants. To date, suicide prevention programs for adolescents have not demonstrated sustained reductions in suicide-related behaviors and further program development is called for, particularly for the prevention of non-clinical suicide risk. This research utilizes the Interpersonal-Psychological Theory of Suicide in the development of the LEAP Program, a novel, web-based suicide prevention program targeting reductions in cognitions of perceived burdensomeness. An open trial of the program was conducted to examine the feasibility of the study protocol, generate feedback regarding the LEAP program modules, and refine the program modules. A pilot randomized controlled trial of the program was also conducted to examine participant satisfaction with the intervention and adherence to the intervention protocol, to test the research protocol, and to provide initial evidence for its efficacy. The open trial consisted of eight adolescents who completed a baseline assessment, received the LEAP intervention, and completed a post-intervention assessment. Results indicated sufficient feasibility of the study protocol and acceptability of the LEAP intervention. The pilot randomized controlled trial consisted of 80 adolescents who were randomly assigned to either the LEAP intervention or a treatment-vi as-usual control condition. Results indicated that those who completed the LEAP intervention showed significantly reduced perceived burdensomeness scores at post-intervention, as compared to those in the control condition. In addition, those who completed the intervention reported significantly reduced perceived burdensomeness, thwarted belongingness, and depressive symptom scores at follow-up, as compared to those in the control condition. No significant reductions in suicidal ideation were noted for those who completed the intervention, as compared to those in the control condition. Strengths and weaknesses of the present studies are discussed, and considerations for future research directions are noted.