Effects of Delinquency-Focused Intervention On Adolescent Girls' Long Term Depression and Suicide Risk Trajectories

Adolescent girls involved in juvenile justice are at elevated risk for suicide and depression into adulthood. Multidimensional Treatment Foster Care (MTFC) reduces not only treatment targets (delinquent acts, criminal referral rates, and days in locked settings) among such girls, but also positively impacts homework completion, teenage pregnancy, and depressive symptoms through 2-year follow-up. Given Capaldi and Patterson’s failure model and Elder’s life-course theory, intervention-related improvements in these broad domains of behavior may alter longterm depression and suicide risk pathways. Thus, we tested MTFC effects on longterm trajectories of these problems.

Method: 166 girls [mean (SD) age = 15.3 (1.2) years; 74% Caucasian] with a recent criminal referral who were mandated to out-of-home care were enrolled in one of two randomized trials of MTFC (n = 81) versus group care (GC; n = 85). We measured depressive symptoms (CESD) and suicidal ideation (Brief Symptom Inventory) repeatedly (9+ times) to adulthood [mean (SD) follow-up = 8.8 (2.9) years], and post-baseline suicide attempt history (Columbia Suicide Severity Rating Scale) in adulthood. We used hierarchical linear growth models that accounted for person-specific timelines of assessment to test intervention effects (intent-to-treat).

Results: Relative to GC, decreases in suicidal ideation rates were marginally stronger in MTFC [odds ratio (OR) (95% CI) = .92 (.84–1.01), p < .10]; a significant interaction favored MTFC in Trial 2 [OR (CI) = .88 (.80–0.97), p < .01]. MTFC effects were partially mediated [indirect effect (SE) = -1.79 (.002), p < .10] by greater reductions in rates of depressive symptoms for MTFC relative to controls [β = -.86 , p <.05]. No significant MTFC effect on suicide attempt was detected; however, MTFC effects on depressive symptom and suicidal ideation, and the associations these symptoms (coefficients = .068, p < .05 and 10.87, p < .01, respectively) had with suicide attempt are consistent with a potentially protective effect.

Conclusions: MTFC decreased depressive symptoms and suicidal thinking beyond the decreases attributable to time and another active intervention. Thus, MTFC has further impact on girls’ lives than originally anticipated. Understanding the mechanisms of these effects will inform prevention development; specifically: whether effects are wholly mediated by reductions in MTFC targets, and whether girls in need of specialized intervention are identifiable when initially referred. Additional intervention could further reduce depression and suicide risk. Doing so within the first 12 months post-intervention could avert problems in adolescence, the developmental period of greatest risk.