Stratified-care school program for teens with suicidal thoughts

Acceptability and Feasibility of a Stratified-Care School-Based Intervention for Adolescent Suicidal Ideation in Chile: A Study Protocol

This program will try a stepped CBT approach using Reframe-IT+ for teens with mild/moderate depression and CARIBOU for those with severe depression to reduce suicidal thoughts in high-school students in vulnerable Santiago schools.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 14 Years to 18 Years
• Sex: All
• Sponsor: Universidad de los Andes, Chile (Academic / other)
• Locations: 1 site (Santiago, Las Condes)
• Trial ID: NCT07063914 on ClinicalTrials.gov

What this trial studies

This is a single-arm, quasi-experimental project delivering a culturally adapted stratified-care model in six secondary schools in Santiago, Chile, with pre-post measurements and follow-ups at 3, 6, 9, and 12 months. Students with recent suicidal ideation are screened with the C-SSRS and PHQ-9 and are routed to Reframe-IT+ if their PHQ-9 is below 20 or to CARIBOU if their PHQ-9 is 20 or higher. Both interventions are individually delivered, CBT-based programs adapted for the local context and aimed at reducing depressive symptoms and suicidal ideation. The study focuses on schools with high socioeconomic vulnerability and collects outcome data over one year to measure change.

Who should consider this trial

Good fit: Ideal candidates are students enrolled in grades I–III Medio at participating Santiago schools who report suicidal ideation in the past month (C-SSRS ≥ 3) and meet the PHQ-9 cutoffs for either the Reframe-IT+ (PHQ-9 < 20) or CARIBOU (PHQ-9 ≥ 20) program.

Not a fit: Students not enrolled in the participating schools or grades, those without recent suicidal ideation, or those already engaged in a structured suicide-prevention program may not receive benefit from this intervention.

Why it matters

Potential benefit: If successful, the program could reduce suicidal thoughts and depressive symptoms by providing timely, severity-matched CBT interventions delivered in schools.

How similar studies have performed: Previous school-based CBT programs including earlier Reframe-IT and CARIBOU work have shown promising reductions in depressive symptoms and suicidal ideation, though using a stratified-care matching by severity in this setting is less commonly tested.

Eligibility criteria

Inclusion Criteria:

* Inclusion Criteria for Educational Institutions

  * Located in Santiago, Chile.
  * Secondary education level (grades I-IV Medio).
  * Coeducational schools.
  * At least two classes per grade level in secondary education.
  * A minimum of 30 students per class.
  * Socioeconomic vulnerability level of ≥ 50%, as measured by the School Vulnerability Index (Índice de Vulnerabilidad Escolar - IVE-SINAE), which includes factors such as parental education and total household income.

Inclusion Criteria for Students

* Enrolled in grades I, II, or III Medio.
* Suicidal ideation within the past month, defined as a score ≥ 3 on the Columbia-Suicide Severity Rating Scale (C-SSRS).
* For the Reframe-IT+ program: mild or moderate depressive symptoms, defined as a PHQ-9 score \< 20.
* For the CARIBOU program: severe depressive symptoms, defined as a PHQ-9 score ≥ 20.

Exclusion Criteria:

* Exclusion Criteria for Students

  * Participation in a structured suicide prevention program (Reframe-IT+) during 2024.
  * Severe psychotic symptoms, such as perceptual disturbances or delusional ideas, assessed during the eligibility interview.
  * Suicide attempt(s) in the past three months, assessed during the eligibility interview.

Where this trial is running

Santiago, Las Condes

• Universidad de los Andes — Santiago, Las Condes, Chile (Recruiting)

Study contacts

• Study coordinator: Jorge E Gaete, MD, PhD

Conditions Suicidal Ideation; suicide; adolescents; depression; schools; prevention