RecruitingNot ApplicableNCT07063914

Stratified-Care School-Based Intervention for Adolescent Suicidal Ideation

Acceptability and Feasibility of a Stratified-Care School-Based Intervention for Adolescent Suicidal Ideation in Chile: A Study Protocol

Sponsor

Universidad de los Andes, Chile

Enrollment

60 participants

Start Date

Jun 25, 2025

Study Type

INTERVENTIONAL

Conditions

Suicidal Ideation

Summary

Background. Suicidal ideation and depressive symptoms are highly prevalent among adolescents, with suicide representing a leading cause of death in this age group worldwide. School-based indicated prevention programs using cognitive behavioral therapy (CBT) have shown promise in addressing these mental health challenges. The Reframe-IT+ (Chile) and CARIBOU (Canada) programs are CBT-based, individually delivered interventions targeting adolescents at risk of suicide. This study aims to evaluate a culturally adapted stratified-care model using these two interventions, matched to depressive symptom severity. Methods. This is a quasi-experimental, single-arm study with pre-post assessments and follow-ups at 3, 6, 9, and 12 months. Six secondary schools with high socioeconomic vulnerability in Santiago, Chile, will participate. Students with suicidal ideation and mild/moderate depressive symptoms (PHQ-9 \< 20) will be offered Reframe-IT+, while those with severe symptoms (PHQ-9 ≥ 20) will be offered CARIBOU. Primary outcomes include the acceptability of CARIBOU, feasibility of the stratified-care model, and implementation fidelity. Secondary outcomes include reductions in suicidal ideation, depression, anxiety, hopelessness, and improvements in functioning, quality of life, behavioral activation, emotional regulation, and problem-solving skills. Discussion. This protocol addresses the need for scalable, culturally sensitive interventions for adolescent suicide prevention in school settings. By evaluating both the process and early outcomes of a stratified-care approach, this study will generate valuable evidence to inform future large-scale effectiveness trials and policy development in adolescent mental health.

Eligibility

Min Age: 14 YearsMax Age: 18 Years

Inclusion Criteria10

Located in Santiago, Chile.
Secondary education level (grades I-IV Medio).
Coeducational schools.
At least two classes per grade level in secondary education.
A minimum of 30 students per class.
Socioeconomic vulnerability level of ≥ 50%, as measured by the School Vulnerability Index (Índice de Vulnerabilidad Escolar - IVE-SINAE), which includes factors such as parental education and total household income.
Enrolled in grades I, II, or III Medio.
Suicidal ideation within the past month, defined as a score ≥ 3 on the Columbia-Suicide Severity Rating Scale (C-SSRS).
For the Reframe-IT+ program: mild or moderate depressive symptoms, defined as a PHQ-9 score \< 20.
For the CARIBOU program: severe depressive symptoms, defined as a PHQ-9 score ≥ 20.

Exclusion Criteria3

Participation in a structured suicide prevention program (Reframe-IT+) during 2024.
Severe psychotic symptoms, such as perceptual disturbances or delusional ideas, assessed during the eligibility interview.
Suicide attempt(s) in the past three months, assessed during the eligibility interview.

Interventions

BEHAVIORALReframe-IT and CARIBOU

Reframe-IT+ An individual intervention based on cognitive-behavioral therapy (CBT) focused on developing skills in behavioral activation, cognitive restructuring, emotion regulation, stress tolerance, and problem-solving. It is delivered in the school setting by a trained psychologist from the research team. The program consists of 13 weekly sessions of 45 minutes each: 5 face-to-face sessions and 8 combined digital/in-person sessions where students use a computer under the supervision of a psychologist facilitator. CARIBOU An individual CBT-based intervention focused on behavioral activation, cognitive restructuring, problem-solving, and communication skills. It is conducted in the school setting by a trained psychologist and consists of 16 weekly sessions of 45 minutes each.