Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide

McCauley, Elizabeth; Berk, Michele; Asarnow, Joan Rosenbaum; Adrian, Molly; Cohen, Judith A.; Korslund, Kathyrn; Avina, Claudia; Hughes, Jennifer L.; Harned, Melanie S.; Gallop, Robert; Linehan, Marsha M.

doi:10.1001/jamapsychiatry.2018.1109

Cited by 387 publications

(326 citation statements)

References 49 publications

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“…They were also comparable to the tightly controlled and monitored I‐GST condition used to mimic TAU in the McCauley et al. () DBT study (21.5% in I‐GST vs. 20.3% in our E‐TAU condition at 6 months, 10.3% in I‐GST vs. 6.6% in our E‐TAU condition at 12 months), although Mehlum et al. () and Asarnow et al.…”

Section: Discussionsupporting

confidence: 82%

“…Exposure to CBT and/or DBT skills is likely weaker in other studies that used an active study‐provided comparator treatment, such as I‐GST in McCauley et al. ().…”

Section: Discussionmentioning

confidence: 97%

“…The McCauley et al. () study used the Linehan Suicide Attempt Self‐Injury Interview (SASII; Linehan, Comtois, Brown, Heard, & Wagner, ), which requires that adolescents indicate that they believed that their acts ‘could have led to death’ to be coded as a SA. Many attempts in our study would not have been coded if we used the latter definition.…”

Section: Discussionmentioning

confidence: 99%

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Family‐focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co‐occurring risk factors: a randomized trial

Esposito‐Smythers¹,

Wolff

Liu

et al. 2019

Child Psychology Psychiatry

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Background Suicide is the second leading cause of death among adolescents. The purpose of this study was to test a family‐focused outpatient cognitive behavioral treatment (F‐CBT) protocol for depressed adolescents following psychiatric hospitalization for a suicide attempt or suicidal ideation, and who had a co‐occurring risk factor (suicidal behavior prior to the index admission, nonsuicidal self‐injury, and/or a substance use disorder), in a randomized Phase 2 efficacy trial. Method One hundred forty‐seven adolescents (mean age = 14.91 years; 76.2% female, 85.5% White) and their families, recruited primarily from an inpatient psychiatric hospitalization program, were randomly assigned to F‐CBT or enhanced treatment‐as‐usual (E‐TAU). A suicide attempt was the primary outcome variable. Depression, suicidal ideation, and nonsuicidal self‐injury are also reported here. Assessments were completed at pretreatment as well as 6, 12, and 18‐months postrandomization (Trial Registration ClinicalTrials.gov Identifier: NCT01732601). Results In the sample as a whole, rates of attempts decreased from 20% at 6 months to 9% at 12 months to 7% at 18 months. There was no evidence of a significant difference between treatment arms in rates of suicide attempts, major depressive disorder, suicidal ideation, or nonsuicidal self‐injury at any of the postrandomization assessment points. Conclusions Though F‐CBT was associated with reductions in suicidality, depression, and nonsuicidal self‐injury, E‐TAU showed an equally strong effect. Greater frequency of F‐CBT treatment sessions, particularly at the start of care, and alternative approaches to transitioning to care at 12 months, may be necessary when using F‐CBT with this population.

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Section: Discussionsupporting

confidence: 82%

“…Exposure to CBT and/or DBT skills is likely weaker in other studies that used an active study‐provided comparator treatment, such as I‐GST in McCauley et al. ().…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Family‐focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co‐occurring risk factors: a randomized trial

Esposito‐Smythers¹,

Wolff

Liu

et al. 2019

Child Psychology Psychiatry

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“…Dialectical behavior therapy (DBT) is the only treatment for adolescents that has replicated effects in decreasing self‐harm behaviors across two randomized controlled trials (McCauley et al., ; Mehlum et al., , ). The Collaborative Adolescent Research on Emotions and Suicide (CARES) study was a multisite clinical trial conducted in the United States that compared the short‐ and longer‐term efficacy of DBT and individual and group supportive therapy (IGST) – an active intervention used in prior studies and matched in terms of common factors – in reducing SA.…”

Section: Introductionmentioning

confidence: 99%

“…The Collaborative Adolescent Research on Emotions and Suicide (CARES) study was a multisite clinical trial conducted in the United States that compared the short‐ and longer‐term efficacy of DBT and individual and group supportive therapy (IGST) – an active intervention used in prior studies and matched in terms of common factors – in reducing SA. Two prior publications describe the study aims, rationale, and design (Berk et al., ) as well as the primary outcomes of the interventions (McCauley et al., ). In short, results indicate that DBT was more effective than IGST at decreasing suicidal ideation (SI), NSSI, SAs, and SH at the end of active treatment, but between‐group differences were no longer significant by the 12‐month follow‐up (McCauley et al., ).…”

Section: Introductionmentioning

confidence: 99%

Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions

Adrian

McCauley

Berk

et al. 2019

Child Psychology Psychiatry

Self Cite

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Background In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST. Methods Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes. Results Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals. Conclusions These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

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Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

et al. 2019

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IMPORTANCE Emergency department (ED) visits present opportunities to identify and refer suicidal youth for outpatient mental health care, although this practice is not routine.OBJECTIVE To examine whether a motivational interviewing-based intervention increases linkage of adolescents to outpatient mental health services and reduces depression symptoms and suicidal ideation in adolescents seeking emergency care for non-mental health-related concerns who screen positive for suicide risk. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, adolescents aged 12 to 17 years who screened positive on the Ask Suicide Screening Questions (ASQ) during a nonpsychiatric ED visit at 2 academic pediatric EDs in Ohio were recruited from INTERVENTIONS The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) intervention included motivational interviewing to target family engagement, problem solving, referral assistance, and limited case management. The enhanced usual care (EUC) intervention consisted of brief mental health care consultation and referral. MAIN OUTCOMES AND MEASURES Primary outcomes were mental health treatment initiation and attendance within 2 months of ED discharge and suicidal ideation (assessed by the Suicidal Ideation Questionnaire JR) and depression symptoms (assessed by the Center for Epidemiologic Studies-Depression scale) at 2 and 6 months. Exploratory outcomes included treatment initiation and attendance and suicide attempts at 6 months. RESULTS A total of 168 participants were randomized and 159 included in the intention-to-treatanalyses (mean [SD] age, 15.0 [1.5] years; 126 [79.2%] female; and 80 [50.3%] white). Seventy-nine participants were randomized to receive the STAT-ED intervention and 80 to receive EUC. At 2 months, youth in the STAT-ED group had similar rates of mental health treatment initiation compared with youth in the EUC group as assessed by parent report (29 [50.9%] vs 22 [34.9%]; adjusted odds ratio [OR], 2.08; 95% CI, 0.97-4.45) and administrative data from mental health care agencies (19 [29.7%] vs 11 [19.3%]; adjusted OR, 1.77; 95% CI, 0.76-4.15). At 2 months, youth in the STAT-ED group and the EUC group had similar rates of treatment attendance (1 appointment: 6 [9.7%] vs 2 [3.6%]; adjusted OR, 2.97; 95% CI, 0.56-15.73; Ն2 appointments: 10 [16.1%] vs 7 [12.7%]; adjusted OR, 1.43;95% CI, 0.50-4.11). There were no significant group × time differences in suicidal ideation (F = 0.28; P = .72) and depression symptoms (F = 0.49; P = .60) during the 6-month follow-up period. In (continued)

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Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide

Abstract: ClinicalTrials.gov Identifier: NCT01528020.

Cited by 387 publications

References 49 publications

Family‐focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co‐occurring risk factors: a randomized trial

Family‐focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co‐occurring risk factors: a randomized trial

Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions

Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

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