The RUPP Center at UT Southwestern

The Child and Adolescent Psychiatry division at UT Southwestern has been awarded a 5-year Research Unit for Pediatric Psychopharmacology and Psychosocial Interventions (RUPP-PI). Eight centers across the U.S. were selected as sites for the RUPP-PI centers, and will conduct research projects aimed at investigating psychopharmacological and/or psychosocial interventions for youth with youth with psychiatric disorders. Five of these Centers (Duke University, Johns Hopkins University, New York Psychiatric Institute, University of Pittsburgh/Western Psychiatric Institute, and UT Southwestern) are collaborating on a project with major public health significance. The Principal Investigator of the UT Southwestern site is Dr. Graham Emslie, Director of Child Psychiatry.

Suicide is the 3rd leading cause of death among adolescents ages 15-19, and accounts for 2,000 deaths annually. The two most significant risk factors for completed suicide in adolescents are depression and a history of suicide attempt. Approximately 2 million U.S. adolescents attempt suicide each year, and almost 700,000 receive medical attention for their attempt. This makes suicide attempts one of the major public health problems affecting this age group. However, psychopharmacological and psychosocial studies of early-onset depression have excluded suicidal individuals from randomized clinical trials, and there have been only a few, underpowered studies that target youth suicidal behavior, most without clear positive results.

The 5 collaborating Centers plan to recruit 320 adolescents (ages 12-18) with depression and a recent suicide attempt. The primary aim of the study is to compare medication management alone versus medication management plus cognitive behavioral therapy (CBT) over a 6 month treatment study. All subjects will receive medication management, which will be based on a medication algorithm (similar to an algorithm studied in Texas mental health clinics). Psychiatrists will be given guidelines for treatment, but will make clinical decisions to determine which treatments are best for each child. Half of the adolescents will also receive CBT, which has been modified from Beck's CBT treatment of suicidal adults.

This 5 year study, which begins Spring 2003 will help determine the best treatments for adolescents with symptoms of depression and who have made a recent suicide attempt. This field of study is vital, as this population has received limited systematic study.