NCT04728815

Brief Summary

Suicide is the 2nd leading cause of death among college students and suicidal ideation and suicide-related behaviors are a frequent presenting problem at college counseling centers (CCCs), which are overburdened. Studies show that some students respond rapidly to treatment, whereas others require considerably more resources. Evidence-based adaptive treatment strategies (ATSs) are needed to address this heterogeneity in responsivity and complexity. ATSs individualize treatment via decision rules specifying how the type and intensity of an intervention can be sequenced based on risk factors, response, or compliance. The purpose of this multisite study is to investigate the effectiveness of four adaptive treatment strategies (ATSs) to treat college students who report suicidal ideation when first seeking services at their college counseling center This multisite study will enroll moderately to severely suicidal college students in the "emerging adulthood" phase (ages 18-25) seeking services at CCCs. This Sequential Multi-Assignment Randomized Trial (SMART) will have two stages of intervention. In Stage 1, 700 participants from four CCCs will be randomized to 4-8 weeks of: 1) a suicide-focused treatment - Collaborative Assessment and Management of Suicidality (CAMS) or 2) Treatment as Usual (TAU). Sufficient responders to either intervention will discontinue services/be stepped down. Non-responders will be re-randomized to one of two Stage 2 higher intensity/dosage intervention options for an additional 4-16 weeks: 1) CAMS (either continued or administered for the first time) or 2) Comprehensive Dialectical Behavior Therapy (DBT), which includes individual therapy, skills group, and phone/text coaching for the clients and peer consultation for the counselors.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
84

participants targeted

Target at P50-P75 for not_applicable

Timeline
Completed

Started Jan 2021

Typical duration for not_applicable

Geographic Reach
1 country

4 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

January 4, 2021

Completed
21 days until next milestone

First Submitted

Initial submission to the registry

January 25, 2021

Completed
3 days until next milestone

First Posted

Study publicly available on registry

January 28, 2021

Completed
1.7 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

October 15, 2022

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

October 15, 2022

Completed
1.4 years until next milestone

Results Posted

Study results publicly available

February 29, 2024

Completed
Last Updated

February 29, 2024

Status Verified

February 1, 2024

Enrollment Period

1.8 years

First QC Date

January 25, 2021

Results QC Date

October 10, 2023

Last Update Submit

February 2, 2024

Conditions

Keywords

Dialectical Behavior Therapy (DBT)Collaborative Assessment and Management of Suicide (CAMS)University Students

Outcome Measures

Primary Outcomes (10)

  • Number of Eligible Students Who Agree to Randomization

    Among students who are eligible to participate in the study and approached about the study by an intake worker, the number who agree to randomization to one of three treatments will be reported.

    To the end of initial Randomization (up to 1 week)

  • Counselor Recruitment

    Among the counselors eligible to participate in the study, the number of counselors from each site who agree to participate.

    To the end of initial counselor recruitment (up to 2 weeks)

  • Treatment Adherence as Measured by DBT (Dialectical Behavior Therapy) Adherence Rating Scale

    Existing gold-standard adherence instruments for DBT will be used to rate a selection of sessions to assess counselors' fidelity to implementing the adaptive treatment strategies. Each item is rated on a scale where 0 = not used/not necessary, 1-3 = below adherence, 4 = minimum threshold for adherence, and 5 = adherent with high sufficiency. The DBT ACS is scored by averaging all non-zero items to create a computed global score where 3.8 and higher is considered "adherent."

    To the end of treatment period (up to 16 weeks)

  • Treatment Adherence as Measured by CAMS (Collaborative Assessment and Management of Suicidality) Adherence Rating Scale

    Existing gold-standard adherence instruments for CAMS will be used to rate a selection of sessions to assess counselors' fidelity to implementing the adaptive treatment strategies. The measure consists of 14 items evaluating clinician performance, all rated on a seven-point Likert scale ranging from 0 ("Poor") to 6 ("Excellent"). A session is rated as adherent with a score of 3.5 or greater.

    To the end of treatment period (up to 16 weeks)

  • Number of Sessions Attended by Students in Each Treatment Condition

    To the end of treatment period (up to 16 weeks)

  • Number of Students Who Attrite From the Study (by Withdrawing Early From Treatment or Dropping Out of the Trial)

    To the end of treatment period (up to 16 weeks)

  • Student Treatment Satisfaction as Measured by the Client Satisfaction Questionnaire (CSQ)

    CSQ items are rated from 1-4, with higher scores reflecting greater satisfaction.

    To the end of treatment period (up to 16 weeks)

  • Counselor Training Satisfaction

    An overall mean treatment satisfaction rating and the associated 95% confidence interval will be calculated based on counselors' responses on the Continuing Education Unit (CEU) evaluation surveys for the CAMS (Collaborative Assessment and Management of Suicidality) and DBT (Dialectical Behavior Therapy) online trainings. Item scores range from 1 (Not at all valuable) to 5 (Extremely valuable).

    To end of initial training period (up to 4 weeks)

  • Counselor Assessment of Participant Study Satisfaction During Stage 1 of Treatment as Measured by the Client Satisfaction Questionnaire (CSQ)

    An overall mean treatment satisfaction rating and the associated 95% confidence interval will be calculated based on counselors' responses on the counselor version of the Client Satisfaction Questionnaire (CSQ). Items rated from 1-4, with higher scores reflecting greater satisfaction. Participants were assessed for overall mean treatment satisfaction rating based on counselors' responses on the counselor version of the Client Satisfaction Questionnaire (CSQ). The counselor version of the CSQ is completed by the counselor, based on their assessment of how the subject appreciated and benefited from treatment.

    To the end of stage 1 (up to 8 weeks)

  • Counselor Assessment of Participant Study Satisfaction During Stage 2 of Treatment as Measured by the Client Satisfaction Questionnaire (CSQ)

    An overall mean treatment satisfaction rating and the associated 95% confidence interval will be calculated based on counselors' responses on the counselor version of the Client Satisfaction Questionnaire (CSQ). Items rated from 1-4, with higher scores reflecting greater satisfaction. Participants were assessed for overall mean treatment satisfaction rating based on counselors' responses on the counselor version of the Client Satisfaction Questionnaire (CSQ). The counselor version of the CSQ is completed by the counselor, based on their assessment of how the subject appreciated and benefited from treatment.

    Beginning to end of Stage 2 (up to 8 weeks)

Study Arms (8)

CAMS to Maintenance

EXPERIMENTAL

Subject assigned to CAMS for Phase 1. Subject is a Phase 1 CAMS Responder, thus placed into ongoing Maintenance/Monitoring.

Behavioral: CAMS - Phase 1

CAMS to CAMS

EXPERIMENTAL

Subject assigned to CAMS for Phase 1. Subject is a Phase 1 CAMS Insufficient Responder, then assigned to Phase 2 CAMS.

Behavioral: CAMS - Phase 1Behavioral: CAMS - Phase 2

CAMS to DBT

EXPERIMENTAL

Subject assigned to CAMS for Phase 1. Subject is a Phase 1 CAMS Insufficient Responder, then assigned to Phase 2 DBT.

Behavioral: CAMS - Phase 1Behavioral: DBT - Phase 2

TAU to Maintenance

EXPERIMENTAL

Subject assigned to TAU for Phase 1. Subject is a Phase 1 TAU Responder, thus placed into ongoing Maintenance/Monitoring.

Behavioral: TAU - Phase 1

TAU to CAMS

EXPERIMENTAL

Subject assigned to TAU for Phase 1. Subject is a Phase 1 TAU Insufficient Responder, then assigned to Phase 2 CAMS.

Behavioral: TAU - Phase 1Behavioral: CAMS - Phase 2

TAU to DBT

EXPERIMENTAL

Subject assigned to TAU for Phase 1. Subject is a Phase 1 TAU Insufficient Responder, then assigned to Phase 2 DBT.

Behavioral: TAU - Phase 1Behavioral: DBT - Phase 2

DBT Only

EXPERIMENTAL

Subject Assigned to DBT for Phase 1, continuing up to 16 weeks.

Behavioral: DBT - Phase 1 and 2

Study Counselors

NO INTERVENTION

Consented Study Counselors from each of the 4 sites. Data collected regarding the Counselors is minimal and is maintained completely separately from the other 7 Student Participant Arms/Groups.

Interventions

TAU - Phase 1BEHAVIORAL

4-8 weeks of TAU treatment

TAU to CAMSTAU to DBTTAU to Maintenance
CAMS - Phase 1BEHAVIORAL

4-8 weeks of CAMS treatment

CAMS to CAMSCAMS to DBTCAMS to Maintenance

up to 16 weeks of DBT treatment

DBT Only
CAMS - Phase 2BEHAVIORAL

Up to 8 weeks of CAMS treatment

CAMS to CAMSTAU to CAMS
DBT - Phase 2BEHAVIORAL

Up to 8 weeks of DBT treatment

CAMS to DBTTAU to DBT

Eligibility Criteria

Age18 Years - 25 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64)

You may qualify if:

  • Enrolled at the university;
  • Eligible to receive counseling services either in person or remotely at the campus CCC (e.g., some students who are living in specific states may not be eligible for therapeutic services).
  • to 25 years of age;
  • Moderate to severe SI over the last two weeks indicated by a score of greater than or equal to 2 on the Counseling Center Assessment of Psychological Symptoms (CCAPS-34) question, "I have thoughts of ending my life" (range is 0 "not at all like me" to 4 "extremely like me"); and
  • Agree to video recording of all therapy and assessment sessions.

You may not qualify if:

  • Students who are deemed clinically inappropriate to receive services at the CCC by an intake counselor because of imminent risk, severe psychosis, or inability to remain enrolled in school (e.g., academic failure);
  • Students being unable to remain enrolled in their university long enough to go through the minimum number of sessions for Stage 1 (4 sessions);
  • Students who have received services at the CCC within the last three months (i.e., ATSs must be based on a new treatment episode).

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (4)

University of Nevada - Reno

Reno, Nevada, 89557, United States

Location

Rutgers University

New Brunswick, New Jersey, 08901, United States

Location

Duke University

Durham, North Carolina, 27705, United States

Location

University of Oregon

Eugene, Oregon, 97403, United States

Location

Related Publications (1)

  • Kassing F, Seeley JR, Rizvi SL, Compton SN, Sinclair J, Oshin LA, Blalock K, Jobes DA, Crumlish J, Stadelman S, Gozenman-Sapin F, Snyderman T, Ruork AK, Fry CM, Gallop RJ, Goodrich J, Pistorello J. Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting. Psychother Res. 2025 Sep;35(7):1198-1212. doi: 10.1080/10503307.2024.2415104. Epub 2024 Oct 22.

MeSH Terms

Conditions

Suicide

Condition Hierarchy (Ancestors)

Self-Injurious BehaviorBehavioral SymptomsBehavior

Results Point of Contact

Title
Scott Compton, Ph.D.
Organization
Duke University

Study Officials

  • Scott Compton, PhD

    Duke University

    PRINCIPAL INVESTIGATOR
  • Jacqueline Pistorello, PhD

    University of Nevada at Reno (UNR)

    PRINCIPAL INVESTIGATOR
  • Shireen Rizvi, PhD

    Rutgers University

    PRINCIPAL INVESTIGATOR
  • John Seeley, PhD

    University of Oregon

    PRINCIPAL INVESTIGATOR

Publication Agreements

PI is Sponsor Employee
Yes

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
SINGLE
Who Masked
OUTCOMES ASSESSOR
Purpose
PREVENTION
Intervention Model
SEQUENTIAL
Model Details: Participants will be randomized to one of three treatments delivered via a hybrid model: (1) a suicide-focused treatment - Collaborative Assessment and Management of Suicidality (CAMS) for 4-8 weeks (n=35); (2) Treatment as Usual (TAU) for 4-8 weeks (n=15); or (3) Comprehensive Dialectical Behavior Therapy (DBT) for 16 weeks (n=35), which includes individual therapy, skills training, phone/text coaching for the clients, and peer consultation for the counselors. Sufficient responders to CAMS or TAU will discontinue services/be stepped down after 4-8 weeks. Non-responders to CAMS or TAU will be re-randomized to one of two higher intensity/dosage intervention options for an additional 8 weeks of treatment: (1) CAMS (either continued or administered for the first time) or (2) Comprehensive DBT. There is an 8th Arm/Group of Consented Study Counselors from each of the 4 sites.
Sponsor Type
OTHER
Responsible Party
SPONSOR

Study Record Dates

First Submitted

January 25, 2021

First Posted

January 28, 2021

Study Start

January 4, 2021

Primary Completion

October 15, 2022

Study Completion

October 15, 2022

Last Updated

February 29, 2024

Results First Posted

February 29, 2024

Record last verified: 2024-02

Data Sharing

IPD Sharing
Will share

We will participant de-identified data (linked only by GUID) with the National Institute of Mental Health Data Archive (NDA). The NDA is an informatics system and research data repository developed by the National Institutes of Health (NIH) to share research data. The NDA provides the infrastructure to store, search across, and analyze various types of data. In addition, The NDA provides longitudinal storage of a research participant's information generated by one or more research studies. In other words, the NDA is able to associate a single research participant's genomic, imaging, clinical assessment and other information even if the data were collected at different locations or through different studies. By doing so, the NDA gives researchers access to more data than they can collect on their own, making it easier and faster for researchers to gather, evaluate, and share research information from a variety of sources.

Shared Documents
STUDY PROTOCOL, SAP
Time Frame
All subject data will be submitted for inclusion in the NDA, through the conclusion of data collection activities. Data is to be submitted cumulatively, every 6 months.
Access Criteria
The NIH will provide access to scientific investigators for research purposes. Qualified researchers who have completed a Data Use Certification and received approval from the NDA Data Access Committee (DAC) may be approved to access broadly shared data. A separate request process exists for access to data in federated sources. Additionally, the DAC and support staff at NIH have access to NDA shared data.
More information

Locations