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

PROJECT SUMMARY/ABSTRACT The risks of ideating, suicide attempt (SA), and dying by suicide have never been greater for Mexican teens. In the past two decades, the rates of suicidal behaviors (SB) among Mexican youth have shown a 3.4- fold increase. Today, 2.8% of Mexican teens ages 15 to 19 report SA (3.8% females, 0.3% boys). Even though

reported SA are lower in Mexican youth compared to their U.S. counterparts, this has become a critical issue given its increase in Mexico, the lack of Evidence Based Practices (EBP), and its future clinical implications. SB have sobering implications for the future well-being of Mexican youth, as they are associated with a myriad

of short- and long-term negative outcomes, including premature death. Suicidal youth in Mexico, 50% of them who are or were in contact with providers, do not have access to the quality treatments developed in and available to their counterparts in high-income nations. This access disparity is not unique to Mexico; most

suicidal youth in other middle and low-income nations (LMIC) are not treated with quality interventions available in rich nations. Moreover, youth in LMIC have high rates of SB and 75% of all suicides occur in these nations. This is a mental health care injustice that demands urgent resolution. This NIMH R34 award application proposes to conduct an adaptation, implementation, and pilot testing of

the culturally centered CBT protocol, the Socio-Cognitive Behavioral Therapy for Suicidal Behaviors (SCBT- SB), among suicidal youth in Mexico City, Mexico. SCBT-SB is a psychosocial treatment developed with the support of the NIMH specifically for suicidal Latinx youth. SCBT-SB is available in Spanish, has an established

training model, and has yielded promising results in intent to treat analyses in reducing SA and depressive symptoms in comparison to treatment as usual (TAU). Furthermore, it is the CBT protocol with the most empirical evidence for Latinx youth with SB. SCBT is attuned to the cultural needs of Latinx suicidal youth in

real-world service settings. This will be the first time that SCBT-SB, and for that matter, any suicidal ideation and behaviors evidence-based treatment, will be used in Mexico to treat suicidal youth in contact with mental health services in the public health sector. By implementing and pilot testing SCBT-SB with suicidal Mexican

youth, this project addresses profound gaps in services for this population and of training for clinicians. The research plan will (a) culturally adapt and contextualize the SCBT-SB for its implementation in the Mexican public health system, (b) pilot test the protocol through an RCT (SCBT-SB vs TAU; 60 patients and

caregivers) and (c) evaluate the implementation process of the SCBT-SB and assess qualitatively possible factors that may promote or hinder its future uptake. The short and long-term knowledge and research implications include (a) its potential to improve the lives of suicidal Mexican youth; (b) the knowledge about

transnational implementation of EBTs in the Mexican public health sector; and (c) the understanding of the implementation and treatment effect of SCBT-SB in Mexico.