Implementation and pilot testing of a culturally centered CBT protocol for suicidal behaviors among youth in Mexico City

Emma Pendleton Bradley Hospital, East Providence RI

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT The risks of suicidal ideation, suicide attempts (SA), and death by suicide have never been greater for adolescents living in Mexico. Over the past two decades, the prevalence of suicidal behaviors (SB) among Mexican youth has increased 3.4-fold. Currently, 2.8% of adolescents aged 15 to 19 report having attempted suicide (3.8% of females and 0.3% of males). Although the reported rates of SA in Mexico are lower than those in the United States, the rising trend, the lack of evidence-based practices (EBPs), and the potential clinical consequences make this a critical public health issue. Suicidal behaviors have serious implications for the future well-being of youth in Mexico, as they are associated with a range of short- and long-term adverse outcomes, including premature death. Alarmingly, 50% of suicidal youth in Mexico—many of whom have had contact with mental health providers—do not have access to the high-quality treatments available to their counterparts in high-income countries. This disparity in access is not unique to Mexico; most suicidal youth in low- and middle-income countries (LMICs) lack access to empirically supported interventions. Moreover, LMICs account for 75% of all suicides globally and report high rates of SB among youth. This represents a profound mental health care inequity that demands urgent attention. This NIMH R34 award application proposes the adaptation, implementation, and pilot testing of a culturally centered cognitive behavioral therapy protocol—Socio-Cognitive Behavioral Therapy for Suicidal Behaviors (SCBT-SB)—among suicidal youth in Mexico City. SCBT-SB is a psychosocial treatment developed with support from the NIMH specifically for youth of Latin American descent experiencing suicidal behaviors. The protocol is available in Spanish, includes a structured training model, and has demonstrated promising results in intent-to-treat analyses, showing reductions in suicide attempts and depressive symptoms compared to treatment as usual (TAU). It is currently the CBT protocol with the strongest empirical support for youth of Latin American descent with SB and is designed to meet the cultural needs of suicidal youth in real-world service settings. This project marks the first time SCBT-SB—or any evidence-based treatment for suicidal ideation and behaviors—will be implemented in Mexico to treat youth engaged with the public mental health system. By piloting SCBT-SB with suicidal youth in Mexico, this initiative addresses critical gaps in both clinical services and clinician training. The research plan includes: (a) culturally adapting and contextualizing SCBT-SB for implementation within the Mexican public health system; (b) conducting a randomized controlled trial (SCBT-SB vs. TAU) with 60 patients and their caregivers; (c) evaluating the implementation process and qualitatively assessing factors that may facilitate or hinder future uptake. The short- and long-term implications of this work include: (a) improving outcomes for suicidal youth in Mexico; (b) generating knowledge about the transnational implementation of EBPs in the Mexican public health sector; (c) enhancing understanding of SCBT-SB’s effectiveness and implementation in Mexico; and (d) informing future efforts to implement SCBT-SB in diverse settings across the United States.