A randomized controlled trial of a brief virtual group intervention for adolescents with mild to moderate suicidal ideation and their caregivers: preliminary caregiver outcomes

The objective was to conduct a randomized controlled trial to evaluate Building Resilience and Attachment in Vulnerable Adolescents (BRAVA), a brief group intervention for youth with mild to moderate suicidal ideation (SI) and their caregivers. We hypothesized that caregivers in the BRAVA group would show significant improvements in life stress and sense of caregiver competency postintervention compared to the control group. We conducted a single-site randomized controlled trial with 99 youth (13-17.5 years) with SI rated as a 1 on suicide item of the HEADS-ED (Home, Education, Activities and peers, Drugs and alcohol, Suicidality, Emotions and behaviors, and Discharge resources) screening tool and their caregiver(s). Families were recruited from a pediatric hospital or the community. All families completed an intake and were randomized to the 6-week BRAVA intervention (n = 50) or the control group (n = 49; weekly text messages with ability to join BRAVA after exit). The caregiver group included psychoeducation on adolescent development, conflict management, and crisis de-escalation. Caregivers completed the Perceived Stress Scale (PSS) and the Parent Sense of Competency Scale (PSOC) at intake and exit. Repeated-measures multivariable analysis of variance (MANOVA) with follow-up univariable analyses were conducted. Thirty-five caregivers (70%) in the intervention group completed an exit interview, and 36 (73.5%) in the control group. The mean number of treatment sessions attended was 4.73 (SD = 1.64). No significant differences were found between groups at intake for any demographic or clinical variables. MANOVA analyses found no significant Group (treatment, control) by Time (pre-post) interaction (F2,68 = 3.109; p = .051; effect size [ES] = 0.084) but a significant main effect for Time (F2,68 = 78.286; p < .001; ES = .697). Follow-up univariable analyses found a significant Group by Time interaction for PSS (F1,69 = 5.193; p = .026; ES = 0.07) and a main effect of Time for PSOC (F1,69 = 157.309; p < .001; ES = 0.695). Caregiver PSS decreased for the treatment group (21.6 vs 19.6) and increased slightly for the control group (20.1 vs 20.9), and PSOC improved over time for all. BRAVA can reduce caregivers’ perceived stress, helping them view their lives as less unpredictable, uncontrollable, and overloaded. The sense of competency improved for all over time, regardless of treatment condition, suggesting that noticing a problem with their teen and acting on it helped them feel more competent.