Is DBT a Viable Option for Teens With High Suicide Risk?
Dialectical behavior therapy (DBT) is an effective treatment method for reducing self-harm and suicide attempts in adolescents with a high risk for suicide, according to new findings.
Researchers made this determination based on the results of a study of 173 adolescents aged 12 to 18 years. All participants included in the study had attempted suicide at least once before, had at least 3 prior self-harm episodes, and had suicidal ideation or emotional dysregulation.
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The study took place from January 1, 2012, to August 31, 2014, at 4 academic medical centers. Follow-up lasted up to 1 year.
Each participant was randomly assigned to treatment with DBT or individual and group supportive therapy (IGST) for 6 months. Individual and group psychotherapy sessions, therapist consultation meetings, and parent contact occurred in each group as needed.
Primary outcomes included suicide attempts, non-suicidal self-injury, and total self-harm based on the Suicide Attempt Self-Injury Interview instrument.
Upon completion of the trial, DBT was found to be significantly beneficial for all primary outcomes. The following improvements were observed in each group:
- No suicide attempts: 65 (90.3%) of 72 patients receiving DBT vs 51 (78.9%) of 65 patients receiving IGST, with an odds ratio (OR) of 0.30.
- No non-suicidal self-injury: 41 (56.9%) of 72 patients receiving DBT vs 26 (40.0%) of 65 patients receiving IGST (OR 0.32).
- No self-harm: 39 (54.2%) of 72 patients receiving DBT vs 24 (36.9%) of 65 patients receiving IGST (OR 0.33).
In addition, self-harm rates declined over the course of 1-year follow-up.
A higher proportion of patients receiving DBT completed treatment compared with those receiving IGST (75.6% vs 55.2%). However, according to pattern-mixture models, this did not significantly affect outcomes.
The researchers noted that the advantage of DBT over IGST declined over time. No statistically significant differences were observed between groups from 6 to 12 months (OR 0.65).
“The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents,” the researchers wrote. “On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.”
—Christina Vogt
Reference:
McCauley E, Berk MS, Asarnow JR, et al. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial [Published online June 20, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.1109