The goal of this randomized pragmatic clinical trial is to examine the feasibility, acceptability, and mechanisms of change of a brief adaptation of Interpersonal Psychotherapy for Adolescents (BIPT-A), adapted and task-shifted to lay providers (mentors, youth trusted adults) in youth community centers (YCCs) as an upstream approach to suicide. It focuses on Hispanic adolescents ages 12-17 enrolled in these YCCs. The pragmatic clinical trial will evaluate the acceptability and feasibility of adapted IPT-A delivered by mentors in YCCs and whether adapted BIPT-A impacts mechanisms of change (depressive symptoms, belongingness, and burdensomeness or feeling like a burden to others). The main questions to answer are: * Is adapted BIPT-A, when delivered by trained lay providers (youth mentors), feasible and acceptable in youth community centers? * Does adapted BIPT-A, delivered by lay providers, change key risk factors (i.e., key mechanisms: depressive symptoms, low belongingness, and perceived burdensomeness) associated with suicide ideation? The investigators will compare adolescents randomized to adapted BIPT-A (6 sessions) delivered by a trained youth mentor with those receiving usual services at the community center (one individual session focused on active listening). Participants will: 1. Be screened for subthreshold depression using the Patient Health Questionnaire Adolescent version (PHQ-A). Adolescent participants will be included if they score between 4 and 9 (mild depression). Participants with a PHQ-A score of 10 or higher (severe depression) will not be eligible and will be referred to a licensed mental health provider for appropriate care. 2. Be randomized to adapted BIPT-A or usual care. Adolescent participants in the intervention arm will participate in 6 weekly, adapted BIPT-A sessions with a trained youth mentor. Intervention focuses on education, affect identification, and interpersonal skills.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
46
Adolescents in this intervention will receive 6 weekly sessions of an adapted brief version of Interpersonal Psychotherapy for Adolescents (BIPT-A), delivered by trained lay providers (i.e., youth mentors) in youth community centers. The adaptation used a community-participatory research approach to culturally and contextually meet the needs of immigrant-origin inner-city adolescents. The adapted intervention keeps core elements (education, affect identification, and interpersonal skills) and bolsters these skills to target belongingness and burdensomeness, which are factors associated with suicide ideation. Sessions follow a structured, manualized approach. The goal is to reduce depressive symptoms, increase sense of belongingness, and decrease perceived burdensomeness among adolescents with subthreshold depression (score between 4-9 in the PHQ-A).
Participants in this arm will continue to receive the standard youth programs and services offered by the youth community centers, including mentoring, academic support, and recreational activities. They will not receive BIPT-A.
Boston College
Chestnut Hill, Massachusetts, United States
Feasibility of the intervention
The Feasibility of Intervention Measure (FIM) is a 4-item self-report survey (Weiner et al., 2017) used to assess whether the intervention can be successfully carried out (feasible). The scores for the 4 items are averaged, yielding a total score of 1-5, where 1-2 indicates low perceived feasibility, 3 indicates moderate, and 4-5 indicates high perceived feasibility. In summary, higher scores indicate higher perceived feasibility (a better outcome).
Time frame: Up to 7 weeks.
Acceptability of the intervention
The Acceptability and Appropriateness of Intervention Measure (AIM) is an 8-item self-report survey that assesses whether the intervention is satisfactory (acceptability) and relevant (appropriateness). The measure is divided into 4-item subscales: acceptability and appropriateness. These constructs are evaluated separately, with an average score ranging from 1 (low) to 5 (high) (Weiner et al., 2017). Higher scores indicate higher satisfaction (acceptability) and relevance (appropriateness), meaning a better outcome.
Time frame: Up to 7 weeks
Change in depressive symptoms
Depressive symptoms are one of the study's mechanisms of change associated with passive suicide ideation. Depressive symptoms will be measured with the Patient Health Questionnaire-9 Adolescent version (PHQ-A), a 9-item self-report scale. PHQ-A has been validated with the adolescent and Hispanic populations. Most studies use ≥10 as the cutoff score, indicating clinically significant depressive symptoms among adolescents. The total score is the sum of all 9 items (0-27), where 0-4 is minimal or no depression, 5-9 mild depression, 10-14 moderate depression, 15-19 moderately severe depression, and 20-27 severe depression. In summary, higher scores indicate greater severity of depressive symptoms (a worse outcome).
Time frame: Up to 7 weeks.
Change in interpersonal factors associated with passive suicide ideation.
Thwarted Belongingness (TB) and Perceived Burdensomeness (PB) are two factors associated with passive suicide ideation. These two factors are mechanisms of change targeted by the intervention. The Interpersonal Needs Assessment (INQ-15) measures the extent to which individuals believe they belong (i.e., TB using 9 items) or perceive themselves as a burden to others (i.e., PB using 6 items), which are scored separately, one for TB and one for PB. Scholars use either the sum score or the average. This study will use mean scores because they preserve the 1-7 scale and provide easier, consistent interpretation. Higher scores indicate higher Thwarted Belongingness and Perceived Burdensomeness (worse outcomes).
Time frame: Up to 7 weeks.
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