People with first episode psychosis (FEP) are at high risk for suicide but are often excluded from suicide prevention treatment research. Furthermore, existing interventions for suicide have not been adapted to address the unique experiences of people with FEP, such as mental health stigma. People with FEP experience high rates of stigma, which is associated with increased risk for suicide in this population. The families of those with FEP also experience stigma (i.e., associative stigma), which is associated with suicide risk factors for those with FEP.
Therefore, this study proposes the development of an eight-session, adjunctive suicide prevention intervention targeting stigma reduction for adolescents and young adults with FEP following hospital discharge, called RESTEPS (Reducing Stigma – A Treatment for Early Psychosis to Prevent Suicide). RESTEPS integrates two evidence-based interventions: safety planning and Narrative Enhancement/Cognitive Therapy (NECT), a stigma-reduction intervention for people with psychosis. RESTEPS also includes four joint family sessions to address associative stigma and support safety planning. The overarching aim of RESTEPS is to reduce suicidality among people with FEP through stigma reduction and improved family functioning.
In Aim 1, we will develop and refine the intervention based on qualitative interviews from individuals with FEP and their family members/significant others (i.e., SOs). In Aim 2, we will assess the feasibility and acceptability of RESTEPS, along with the preliminary effects. It is hypothesized that the intervention will be feasible and acceptable to participants, as evidenced by satisfaction, recruitment/retention rates, and qualitative participant feedback. It is also hypothesized that the intervention will demonstrate preliminary efficacy through changes over time on primary (e.g., suicidal ideation severity) and related (e.g., suicidal behaviors, depressive symptoms, hopelessness, psychotic symptoms, treatment engagement) outcome measures, along with changes in potential mechanisms (e.g., self-stigma, associative stigma, family functioning).
This study includes two phases; in both phases, adolescents and young adults (15-25 years old) diagnosed with a schizophrenia-spectrum disorder or a mood disorder with psychotic features and experiencing suicidal thoughts within the past month will be recruited from inpatient units at Butler Hospital. In phase one, 15 patients and 15 SOs will complete qualitative interviews providing feedback on RESTEPS. In phase two, 35 participants and their corresponding SOs will complete the eight-session intervention. Sessions will focus on safety planning, psychoeducation, cognitive restructuring, and narrative enhancement (half will include the participant’s SO). Participants will complete baseline, post-intervention (8 weeks), and follow-up (20 weeks post-discharge) assessments, during which key study constructs will be assessed using validated measures (e.g., Columbia-Suicide Severity Rating Scale), including satisfaction with the intervention and study.
RESTEPS is a novel intervention that uses evidence-based practices for both suicide prevention and psychosis, addressing key gaps in treatment for this population. Because this intervention centers the specific experiences and needs of people with FEP being discharged from psychiatric hospitalization, a group at particularly high risk for suicide, it is uniquely positioned to maximize impact on suicide prevention. The findings from this pilot study will be used to refine and inform a future, fully-powered randomized controlled trial of the RESTEPS intervention.
