McCauley E, et al. - This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers, to assess the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for decreasing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths. In highly suicidal self-harming adolescents, the efficacy of DBT for decreasing self-harm and suicide attempts was supported. Outcomes suggested DBT as the first well-established, empirically supported treatment for reducing repeated suicide attempts and self-harm in youths.

Methods

• For the purpose of this investigation, 173 members (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were analyzed.
• They evaluated adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use.
• Participants were followed up for 1 year in this analysis.
• Participants in the study were randomly assigned to DBT or IGST.
• Duration of treatment was 6 months.
• Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed.
• Suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview were a priori planned outcomes.

Results

• An aggregate of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied.
• It was observed that significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78).
• It was noted that rates of self-harm reduced through 1-year follow-up.
• Findings revealed that the advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P=.61).
• According to the findings obtained, treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models showed that this difference did not informatively affect outcomes.