A randomised controlled trial of a culturally adapted didactic strategy for suicidal ideation (CADS-S) in young male students in Pakistan

Abstract Objectives: Suicidal ideation, plans and attempts, is a leading public health issues among adolescents worldwide, including in Pakistan. This study examines the effectiveness of a culturally adapted didactic strategy (CADS) in targeting suicidal ideation and associated symptomatology (ClinicalTrials.gov: NCT05324670) . Method: Adolescents ( n = 70, male) expressing suicidal ideation who recently engaged in self-harm (previous 6 months), were assigned to 6 sessions (weekly) of CADS or a control intervention (psycho-education material) and assessed pre- and post-intervention utilising the Beck Scale for Suicidal Ideation (BSS), the Depression, Anxiety and Stress Scale-21 (DASS-21) and Barratt Impulsiveness Schedule-II (BIS-II). Results: Participants in the CADS cohort demonstrated a significant reduction in suicidal ideation compared to controls at treatment end ( F = 266.7, p < 0.001, η p 2 = 0.80), and six-weeks post intervention. Individuals receiving CADS demonstrated a modest reduction in attentional ( F = 32.5, p < 0.001, η p 2 = 0.33), motoric ( F = 45.9, p < 0.001, η p 2 = 0.41) and non-planning impulsivity ( F = 21.9, p < 0.001, η p 2 = 0.25), in depressive ( F = 142.2, p < 0.001, η p 2 = 0.68), and anxiety symptoms ( F = 43.9, p < 0.001, η p 2 = 0.40) and stress levels ( F = 96.4, p < 0.001, η p 2 = 0.59). These findings were maintained at six-week follow-up. Conclusion: CADS was an effective short-term intervention in reducing suicidal ideation, impulsivity, depressive and anxiety symptoms in a high school adolescent male population. Future studies including an active comparator and greater participant diversity would further elucidate the potential efficacy of this intervention.