Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up

Lars Mehlum; Maria Ramberg; Anita J Tørmoen; Egil Haga; Lien M Diep; Barbara H Stanley; Alec L Miller; Anne M Sund; Berit Grøholt

doi:10.1016/j.jaac.2016.01.005

Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up

J Am Acad Child Adolesc Psychiatry. 2016 Apr;55(4):295-300. doi: 10.1016/j.jaac.2016.01.005. Epub 2016 Jan 27.

Authors

Lars Mehlum¹, Maria Ramberg², Anita J Tørmoen², Egil Haga², Lien M Diep³, Barbara H Stanley⁴, Alec L Miller⁵, Anne M Sund⁶, Berit Grøholt²

Affiliations

¹ National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: lars.mehlum@medisin.uio.no.
² National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital.
⁴ Columbia University, New York, USA, and the University of Oslo.
⁵ Montefiore Medical Center and Albert Einstein College of Medicine, New York, USA.
⁶ Norwegian University of Science and Technology and St. Olav's University Hospital, Trondheim, Norway.

PMID: 27015720
DOI: 10.1016/j.jaac.2016.01.005

Abstract

Objective: We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics.

Method: Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance.

Results: Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged.

Conclusion: A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.

Clinical trial registration information: Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129.

Keywords: attempted suicide; longitudinal; psychotherapy; randomized trial; self-harm.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Behavior Therapy / methods*
Borderline Personality Disorder / psychology
Borderline Personality Disorder / therapy*
Female
Follow-Up Studies
Humans
Male
Prospective Studies
Self-Injurious Behavior / psychology
Self-Injurious Behavior / therapy*
Suicidal Ideation
Suicide / psychology*
Suicide, Attempted / psychology
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00675129