This study evaluated the effectiveness of multisystemic therapy (MST) in reducing attempted suicide among predominantly African-American youths referred for emergency psychiatric hospitalization.
MST is a family-centered, home-based intervention that targets the multiple systems in which the youth and family are embedded. MST adopts Bronfenbrenner's (1979) social-ecological model of human development, which suggests that problem behaviors are often maintained by problematic transactions within and across the multiple systems of the youths' social ecology. The current study involved 156 juveniles who were approved for emergency psychiatric hospitalization at the Medical University of South Carolina because of suicidal ideation/planning or attempted suicide, homicidal ideation or behavior, psychosis, or other threat of harm to self or others. Sixty-five percent of the youths were African-American. Families were randomly assigned to either the MST or hospitalization condition. The youths were assessed for attempted suicide, suicidal ideation, depressive affect, and parental control before treatment, at 4 months after recruitment, and at the 1-year post-treatment follow-up. The results show that MST was significantly more effective than emergency hospitalization in decreasing rates of attempted suicide at 1-year follow-up. Also, the rate of symptom reduction over time was greater for the youths who were treated with MST. An examination of the outcome slopes indicated that European-American youths and African-American youths followed somewhat different outcome trajectories based on treatment condition. Although the trajectory for MST was nearly identical across ethnic groups, the slope for European-Americans appeared steeper than for African-Americans in the hospitalization condition. This might suggest that African-American youths who receive standard psychiatric hospitalization improve at a slower rate than their European-American counterparts. Thus, the findings generally support MST's effectiveness in reducing attempted suicide in psychiatrically disturbed youths; whereas, the treatment effects of hospitalization varied according to informant and youths' demographic characteristics. 1 table, 1 figure, and 42 references