Safety planning and transdiagnostic CBT to prevent suicide in Mozambican teens

Safety Planning and Cognitive Behavioral Therapy for Adolescent Suicide Prevention in Mozambique: A Hybrid Effectiveness/Implementation Cluster Randomized Trial

This project tests whether safety planning and a transdiagnostic cognitive behavioral program can reduce suicidal thoughts and behaviors in secondary school students in Mozambique.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 2100 (estimated)
• Sex: All
• Sponsor: University of Washington (Academic / other)
• Locations: 7 sites (Beira and 6 other locations)
• Trial ID: NCT06465381 on ClinicalTrials.gov

What this trial studies

This implementation trial enrolls secondary school students in Sofala Province who screen positive for active suicidal ideation and compares a brief Suicide Safety Planning Intervention, a transdiagnostic cognitive behavioral therapy program for suicide prevention, and enhanced usual care. Students are identified using the Columbia Suicide Severity Rating Scale and receive interventions delivered in or linked to local health facilities. The study measures changes in suicidal ideation and behaviors, depressive symptoms, hypothesized mechanisms of effect, and implementation outcomes such as feasibility, costs, and cost-effectiveness. Results are intended to inform scalable adolescent suicide prevention approaches for low- and middle-income country settings.

Who should consider this trial

Good fit: Ideal candidates are secondary school students in grades 9–11 at participating schools in Sofala Province who live within about 30 minutes of a participating health facility, express active suicidal ideation on the C-SSRS, and have guardian consent and youth assent.

Not a fit: Students who are not enrolled in a participating school, do not report active suicidal ideation, lack required consent/assent, are wards of the state, or attend schools too remote from participating health facilities are unlikely to be eligible or benefit from this project.

Why it matters

Potential benefit: If successful, the interventions could reduce suicidal thoughts and behaviors among Mozambican adolescents and offer a scalable prevention model for similar low-resource settings.

How similar studies have performed: Safety planning has shown benefit in high-income settings and the investigators have pilot data for adolescents, but the combined, school-based transdiagnostic CBT approach is largely untested in Mozambique and similar low-resource African settings.

Eligibility criteria

Inclusion Criteria:

Inclusion criteria for suicide risk screening:

1. Youth enrolled in a secondary school in Sofala Province that is located within 30 minutes of a health facility that hosts both an urgent care and mental health department.
2. Youth enrolled in 9th and/or 10th and/or 11th grade.
3. Legal guardian has provided consent to participate if under 18 or if youth is age 18 or older and has provided consent to participate.
4. Youth has assented to participation.

Inclusion criteria for trial participation and allocation to study arm:

1\. Youth expresses active suicidal ideation on the Columbia Suicide Severity Rating Scale (C-SSRS).

Exclusion Criteria:

1. Youth and/or guardian has not provided consent to participate, or responsible party is unable to provide informed consent.
2. Youth is not enrolled in a participating secondary school.
3. Youth declines to assent.
4. Youth is a ward of the State or any other agency, institution, or entity.

Where this trial is running

Beira and 6 other locations

• 9 Secondary Schools — Beira, Mozambique (Recruiting)
• 1 Secondary School — Caia, Mozambique (Recruiting)
• 1 Secondary School — Cheringoma., Mozambique (Recruiting)
• 1 Secondary School — Chibabava, Mozambique (Recruiting)
• 4 Secondary Schools — Dondo, Mozambique (Recruiting)
• 1 Secondary School — Maringue, Mozambique (Recruiting)
• 4 Secondary Schools — Nhamatanda, Mozambique (Recruiting)

Study contacts

• Principal investigator: Bradley Wagenaar, PhD, MPH — University of Washington
• Study coordinator: Morgan Turner, LICSW

Conditions Suicide Prevention; Suicidal Behavior; Safety Planning Intervention; Transdiagnostic Cognitive Behavioral Therapy for Suicide Prevention; Suicidal Ideation; Depressive Symptoms