Of course, King’s results would need to be repeated in future studies to be fully corroborated, and there’s no call to adopt this type of intervention more widely—even by King and her colleagues. (The new paper is a secondary analysis of results measured 10 years after the study. That’s one reason King is cautious about her results.) But given the early signs and taken alongside other social-centric therapeutic approaches being used by researchers at Stanford and elsewhere, some experts say a potent tool in combatting teen suicide might have been hiding in plain sight.
“It’s kind of recognizing we’ve missed a trick,” says Martin Webber, a professor of social work at the University of York, “in terms of utilizing the assets that are available within people’s communities.”
Historically, it has been extremely difficult to show a change in suicide rates with enough statistical clarity to conclude a true change over chance or coincidence. That’s because actual rates of suicide are low—even in high-risk groups, such as teens with a history of self-harm and hospitalization. This means that researchers need huge sample sizes to detect a true change.
King and her University of Michigan team enrolled 448 people. About half—223—were prescribed coordinated support from friends and family on top of standard care, while 225 received only standard care. (Standard care consisted of psychotherapy and medication.) The combined cohort was large enough to detect a difference in overall death rates, though still insufficient to find a statistically significant difference in deaths attributable specifically to suicide: There was one known suicide among the intervention group, versus three in the control group.
But when King analyzed not just confirmed suicide deaths but also drug-overdose deaths that were not labeled “accidental,” a pattern emerged. There was just one of these in the intervention group, versus eight in the control group—a statistically significant difference. All deaths occurred in adulthood, when the subject was at least 18.
The study made a splash on Twitter with prominent experts in the field. Peter Kramer, who wrote the best-selling book Listening to Prozac, called the study a must-read. Allen Frances, who chaired the task force that authored the latest diagnostic manual for psychiatric disorders, wrote: “We’ve learned so very much, but still fail miserably in doing the simple things well.”
King started as a faculty psychologist in the adolescent psychiatric inpatient unit at the University of Michigan hospital system in 1989. “More than half of the adolescents hospitalized were there because of suicide risk,” she says. That clinical experience led her to develop the new intervention.
In King’s approach, teens nominate trusted adults—for example, parents, grandparents, aunts, uncles, family friends, teachers, or clergy—to serve as a support team. (Parents have veto power.) The adults then get an hour-long training session and weekly phone calls from King’s intervention specialists to talk about how things are going. They are cautioned to not feel responsible for the teen’s behavior—“We’re not asking them to be mental-health professionals,” King says—but they agree to check in with their teen once a week by phone, a face-to-face meeting, or an outing.